2033

I’m Sharpe (Daniel) not Robert Sharp. There are/were two Sharps.

2034

AKA The Mad Hungarian.

2035

You have to be willing to compromise with them on some things. Stuff that you don’t like, in order to get them on board with stuff you do.

You can’t hope to just defeat then utterly and have them cease to exist. It won’t happen.

Now, I say this realizing that the current incarnation of the GOP needs to change for this to really be feasible. I don’t exist you to compromise on stuff like repealing the ACA and replacing it with nothing. The position of the GOP regarding the ACA was nonsensical . It wasn’t consistent with any real ideology.

But, of the GOP comes back to a more reasonable position of simply wanting less government intervention in the lives of individuals, then it makes sense to compromise on that front.

Because then you can get some of what you want, and they will have some vested ownership of it.

2036

Wouldn’t a potential republican option be to pursue a complete privatization of medicare and have the exchanges take over - with a potential federally funded provider being one of the exchange options?

There’s lot of reasons why this will likely not work in practice but logically this seems inline with the party’s stated values. I also feel like that, if packaged correctly to ease the transition and ensure
proper funding levels, such a plan can get bipartisan support.

2037

At a certain point, I think justice must be wrought. The Republicans lied, cheated, and stole their way to where we are now without the slightest hint of repercussions. It might be nonsensical or even “bad,” but wanting to see them rightly punished for it instead of being rewarded with concessions to their still-loony-as-fuck positions if they come back off the ledge 5% is a pretty unexceptional response.

2038

Justice will be when the Dems can safely split into two parties because the Republicans are as viable as the Libertarians are today.

The Republican party as it is now- to save America it must be destroyed, period. It’s too far gone.

2039

There is actually a recent precedent for the GOP to voluntarily come to its senses. After years of fiscal mismanagement in Kansas by a Republican governor and legislature, the legislature blinked and voted to raise taxes. Shortly thereafter, the governor decided not to finish his term. Perhaps this is a case study for how moderate Republicans can retake control.

2040

Similar sort of thing happened in Louisiana. Bobby Jindal left office and John Bel Edwards, a democrat, was voted in as governor. Mind you, a Louisiana democrat is pretty much a republican anywhere but a gulf state, but he’s way better than exorcist-in-chief Jindal.

2041

Well, crap. . . how did I manage that? Well, regardless, my apologies.

2042

Fair question and you 've asked it before but the discussion went so quickly, I never really had time to answer.

First of all, let’s start with the areas of agreement. I don’t necessarily 100% agree with these, but at this point fate, the public, and events have happened that it is pointless to relitigate them. AKA the tribe has spoken.

  1. The government has the obligation to provide citizens with some level of health care.
  2. The federal government has a significant role in funding health care.
  3. An increase in taxes is necessary to pay for 1 and 2.
  4. The taxes need to be progressive.
  5. I particularly agree that we need drastically reduce cost in our health care system (This is my 1st, and 2nd biggest issue with ACA)

Republican/conservative principals that I think can help control cost.

  1. Administered at the state level
    Much of the federal government funding should be in the form of block grants to states.
    We don’t know how to provide good health care at reasonable cost at any level, Single Provider VA, Single Payer Medicare or Medicare, Private sector employer provided insurance. There are individual health care systems that do a better job. Let the state experiment before federalizing this.
  2. Focus on providing health care for all not health insurance for all.
    There is weak correlation from somebody having good insurance and getting good health care. Spend money currently spent on subsidizing insurance companies, on subsidizing health clinic, mobile health trucks serving poor and underserved areas.
  3. Use financial incentives to control costs.
    In some cases this will encourage consumers to be more price conscious (e.g. maternity options) in other cases this will encourage health care providers to be more cost conscious (reducing surgeries, expensive drug treatments etc.)
  4. Provide financial incentive for consumers to adopt healthy lifestyles
    Allow insurance companies to charge more for people who smoke, don’t exercise, take excessive drugs or alcohol, eat too much, skip meds etc.
  5. Separate the insurance aspect of health insurance from the health care benefits.
    Insurance should cover things that are rare and prohibitively expensive. Not common and inexpensive. Enroll everyone automatically in a catastrophic health care insurance program (e.g. Cassidy/Collin amendment.). This will provide everyone with 100% coverage for all health care related expense above about ~$10,000, but no benefit below that amount. People that opt out of the catastrophic coverage, will be 100% responsible for their health care costs. If they get seriously sick they will mostly be bankrupt and if they make a lot of money they are still responsible to pay back much of it after bankruptcy. The good news is premiums should well under $100/month for a 20 something in good health. Provide subsidize similar to ACA for people below the median income to purchase catastrophic coverage.
  6. Provide other mechanisms (like clinics) to help poor people with chronic conditions, receive the health care they need.
  7. Allow states to approve different type of health care benefit package
  8. Accept that life isn’t fair and sick poor people will not always get the absolutely best/most expensive health care.
    That means life time caps (but still high >$1 million dollars) and limited access to experimental treatments.

Other ideas that I aren’t easy to label as R or D.

1.Pricing should be transparent and more equitable.
Prohibit a greater than 100% markup of wholesale cost for health care service. So if a hospital charges Medicare or United Healthcare $100 for a given service than the hospital can charge Joe Blow with no insurance no more than $200. Allow state insurance regulators to further reduce this gap
2. Quickly phase out all insurance company subsidies (Risk corridors/subsidies for co-pays etc.)
3. Slowly phase in treating employer provided medical insurance as taxable benefit.
4. Require a rigorous cost/benefit analysis of all treatments and drugs. Cap treatments at something along the lines of $200K/year added life expectancy
.

2043

I think the point he was making is that none of that will happen until the GOP changes, which would require the party to implode.

You can’t compromise with the modern GOP. Their idea of compromise is you give them everything or close to it and they give you literally nothing at all.

Until that changes talking about bipartisanship and compromise is almost pointless, you can peck around the fringes with like… 5 of them and maybe make some progress, but that’s about it. They simply wont do it and trying to appease them doesn’t work because they’re not willing to even sit at the table. Their idea of working together is they get somewhat less of what they want and you get absolutely none of what you want.

2044

How would this work exactly? The current law has a penalty for smokers in some states, but at least that’s yes/no and fairly obvious. And people still lie all the time.

Now you seriously expect patients to provide an accurate estimate of kcal per day or minutes of physical activity per week? Good luck with that. If there is a financial penalty to reporting you are noncompliant with meds, eat more than 2000 kcal/day, drink more than 5x/week, or exercise less than 3x/week, then it will almost certainly affect how you measure those personal activities. As for illicit drug use… care to guess how many job applications have that particular box checked?

Doctors aren’t private investigators. They rely on patients to be honest when discussing their lifestyle, and we already know that patients will exaggerate how healthy it is - even when honesty has no negative consequences. This will just make the doctor’s job much harder.

2045

I love how everyone here is having a genuine policy discussion as if we’re ever going to get anything like thoughtful law passed, meanwhile we have Senators voting for bills while publicly calling them terrible pieces of trash that make no sense. And the President threatening to crash the exchanges.

2046

Ya I get blue and red mixed up all the time. In my mind Red = commie <> Republican. Of course, now that Russia stuff is hunky dory with the Trump Republican party it should be easy to remember :-(.

2047

To be fair, it never used to mean anything. When they showed electoral maps they alternated every election.

Then Reagan came and made the whole map red and the colors stuck with the respective parties.

2048

The current GOP would also include punishing women for having sex. Should have them register the number of encounters per month so their rates can be adjusted accordingly.

2049

When I got life insurance a nurse came and gave me a physical. She drew blood, took my resting heart rate, and measured my body composition. Then after the lab work came back I got a quote, which was quite affordable because I try to take care of myself.

Maybe health insurance companies can do the same thing. Go get a physical, if you’re obese or smoking or on drugs or something, the Doctor will know, and your rate is adjusted accordingly.

It’s probably not fair to everyone, but the system we have now isn’t fair either. But if your life consists of slamming Dew and Doritos while playing PC games all day, you are probably higher risk to insure than someone who exercises and eats vegetables. And that lifestyle is a conscious choice, it’s not a pre-existing condition, so I think its fair to charge that person more for insurance.

2050

Bah, just go one better and make everyone get their genome sequenced and assign values to gene markers.

I generally can’t stand slippery slope arguments, but this is one instance where I feel pretty strongly. There is a hell of a lot more that goes into health outcomes than BMI or blood pressure, for goodness’ sake.

2051

Maybe, but that’s why we let doctors decide, the ones who are trained in health and medicine. Plus, I think the insurance company wants as many low-risk customers as possible, so they are probably going to do their best to make accurate measures that suit most of the population so they can maximize their profits.

If we’re talking conservative solutions, I don’t think this is a terrible thing to add to the system. It incentivizes people to take steps to improve their health, and accurately prices care for people that can’t be bothered to. I’m not saying we charge people more who have a history of cancer, that’s an accident of birth. But people can take care of themselves, I don’t think that’s too much to ask. Maybe the Dunkin Donuts and Coca Cola lobbies will be against it, they might take a hit.

2052

Oh interesting, you’ve found a study that says that BMI, blood pressure, and resting heartrate are entirely due to lifestyle decisions with no genetic components? This will change everything!

I’m not opposed to obvious stuff that adds additional cost to actual lifestyle decisions, like a premium penalty for tobacco users or heavy drinkers or whatever. But without real goddamned clear definitions of what a “tobacco user” or “heavy drinker” or whatever is, you’re just opening the door to more insurance company fuckery.