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Thread: Medicare for all

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    cyphersmith's Avatar
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    Medicare for all

    Surprised nobody has posted this yet. Sanders today announced his Medicare for All plan.

    17 Senators Introduce Medicare for All Act
    Wednesday, September 13, 2017
    WASHINGTON, Sept. 13 – Sen. Bernie Sanders (I-Vt.) and 16 of his Democratic colleagues introduced legislation Wednesday to guarantee health care to every American by expanding and improving Medicare.

    “Today, we begin the long and difficult struggle to end the international embarrassment of the United States being the only major country on earth not to guarantee health care to all its people,” Sanders said. “At a time when millions of Americans do not have access to affordable health care, the Republicans, funded by the Koch brothers, are trying to take away health care from up to 32 million more. We have a better idea: guarantee health care to all people as a right, not a privilege, through a Medicare for All, single-payer health care program.”

    Sixty percent of the American people want to “expand Medicare to provide health insurance to every American,” including 75 percent of Democrats, 58 percent of Independents, and 46 percent of Republicans, according to an April 2017 poll by The Economist/YouGov.

    The Medicare for All Act of 2017 establishes a national health insurance program called the Universal Medicare Program. Under this legislation, every resident of the United States will receive health insurance through an expanded Medicare program with improved and comprehensive benefits.

    It has been the goal of Democrats since Franklin D. Roosevelt to create a universal health care system guaranteeing health care to all people.

    Sanders introduced the bill in the Senate along with Sens. Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Al Franken (D-Minn.), Kirsten Gillibrand (D-N.Y.), Kamala Harris (D-Calif.), Martin Heinrich (D-N.M.), Mazie Hirono (Hawaii), Patrick Leahy (D-Vt.), Edward Markey (D-Mass.), Jeff Merkley (D-Ore.), Brian Schatz (D-Hawaii), Jeanne Shaheen (D-N.H.), Tom Udall (D-N.M.), Elizabeth Warren (D-Mass.) and Sheldon Whitehouse (D-R.I.).

    The Affordable Care Act, which Sanders supported when it was passed in 2010, was an important step forward. It provided access to health insurance for millions of people, but 28 million people remain uninsured.

    Under today’s health care system in the United States, tens of millions are underinsured, meaning they have insurance but cannot afford to use it because of high deductibles and co-payments. One out of five American adults cannot afford their prescriptions. And thousands of people die each year because they cannot afford medical care.

    Despite so many uninsured and under-insured, the United States spends far more per capita on health care than any other nation. According to the OECD, in 2015, the U.S. spent almost $10,000 per person for health care, while the Canadians spent $4,644, the Germans $5,551, the French $4,600, and the British $4,192 even though all of these other countries guarantee health care to all of their people. Despite this huge expenditure, life expectancy in America is lower than most other industrialized countries and our infant mortality rates are much higher.

    The Medicare for All Act of 2017 would ensure that Americans will no longer have to delay or avoid going to the doctor because they can't afford it; that a hospital stay will not bankrupt you or leave you deeply in debt; that you will be able to get the prescription drugs you need at a price you can afford; that middle class families will never have to spend 20 or 30 percent of their incomes on health care; and, that Americans will save billions of dollars a year in medical administrative costs.

    Under this bill, Americans will benefit from the freedom and security that comes with finally separating health insurance from employment. As is the case in every other major country, employers would be free to focus on running their businesses rather than spending an enormous amount of time, energy and money trying to provide health insurance to their employees.

    The bill has been endorsed by 30 national organizations and unions including: Labor Campaign for Single Payer, Our Revolution, Social Security Works, Progressive Campaign Change Committee, Democracy for America, Working Families Party, MoveOn, All of Us, Demand Progress, Health Care Now, Progressive Democrats of America, CREDO, Public Citizen, Latinos for Healthcare Equality, Americans for Democratic Action, AIDS Healthcare Foundation, DailyKos, Food & Water Watch, Friends of the Earth, 350.org, American Sustainable Business Council, LULAC (League of United Latin American Citizens), National Nurses United, International Association of Machinists and Aerospace Workers, New York Nurses Association, Utility Workers Union of America, International Federation of Professional and Technical Engineers, United Mine Workers of America, Amalgamated Transit Union and Brotherhood of Maintenance of Way Employes Division of the International Brotherhood of Teamsters.

    In addition to the legislation, Sanders published a paper outlining several options for funding the Universal Medicare Program. As the wealthiest country in the world, we have a variety of options available to support a universal, single-payer health care system.

    Sanders and his colleagues will introduce the bill at a press conference in Hart 216 today at 2 PM. The event will be live streamed here. His prepared remarks can be found here.

    For a copy of the Medicare for All Act, click here.

    For a copy of the executive summary of the Medicare for All Act, click here.

    For the summary by title of the Medicare for All Act, click here.

    For a copy of the “Options to Finance Medicare for All," click here.
    Except for the link for the livestream, I put in all the links at the end.

    I like the ideas for paying for it, and originally thought that he should have attached one of them to his bill, then realized that as a Senator he could not. The Senate doesn't have the power to initiate tax bills. So many people are criticizing him for not putting in anything to pay for it, but because it's a Senate bill he literally cannot put in anything to pay for it.

 

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    Pony Up! Ovinomancer's Avatar
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    Those payment options are incoherent. By the paper, costs over 10 years for medical will be $49 trillion. Accepting the best cast savings per year as outlined shaves a whopping $6 trillion over 10 years. So we need to finance $43 trillion.

    Option 1: 7.5% payroll tax
    Problem -- eliminates the vast majority of payroll in the US with the $2 million in payroll starting line. After that, assumes that the money spent on healthcare will suddenly become income for the family and not just disappear.
    Taken at face value (laughably): saves $3.9 T/10 years

    Running debt total: $44.1 T/10 years


    Option 2: 4% income tax.
    Problems: this one's straight forward, although the math to get to the amount saved and the assumptions therein are hidden, so I can't check for crazy (like assuming the difference from option 1 is added to income).
    Taken at face value: $4.2 T/10 years
    Running total : $38.9 T/10 years

    Option 3: Savings from Health Tax Expenditures
    Problems: okay, if you do option 1, these are already gone, so this cannot work with option 1. We'll use the higher of the two.
    Taken at face value: $4.2 T/10 years

    Running debt total: removing option 1 is a net down of $0.3T, so $28.6T/10 years

    Option 4: Higher tax brackets
    Problems: goes right in and screws those same small businesses that were excluded in option 1. Jacks up income tax on most small businesses by 10%. Lots more unemployment. Also taxes capital gains as income for high earners. That's gonna hit the market hard.
    Taken at face value: $1.8T/10 years

    Running debt total: $37.1 T/10 years

    Option 5: Estate tax
    Problem: this is a punishment tax, straight up. It barely earns, so it's just here as a hat tip to occupiers.
    Take at face value: $0.3T (I rounded up)/10 years

    Running debt total: $34.1 T/10 years

    Somewhere in here, there needs to be some serious savings, because this is barely moving the needle while using the best case predictions (and the government is famous for overselling shit like this).

    Option 6: Okay, I'm going to wrap up the remaining options as one because they're all pretty much negligible individually and only exist to selling to the occupy crowd, not earn meaningful revenue.
    Taken at face value: $2.6T (rounded up)/10 years

    Running debt total: $31.5 T/10 years

    So, taking ALL of the options, at their face value best case, we have payroll tax increased 7.5% on some people (with a weird line on who those people are, some higher earners, most not), everyone's income tax up 4%, and a bunch of 'punish the rich' schemes that barely earn revenue and certainly do little to offset the massive cost. A massive cost that triples current debt over 10 years without considering any other spending -- just medicare for all. They put together a list of things that don't pay for the service (not even close) but sell well to those concerned about monetary "justice". It's a sham, using their numbers. A more realistic take on the impact of these schemes will see rapidly diminishing returns from most of those targeted at the rich and higher taxes for the common person. The 7.5% payroll tax is far too little and exempts a huge number of workers, meaning it can't possibly make up the numbers. A realistic take on how to pay for this would be obviously costly and require a huge buy in from a US that's already exhausted from poor economic performance and has little appetite for more austerity. We're going to have to take the austerity, but it's hard to sell a new thing that adds more, hence why Sanders, who's pie the money sky already, put out this crapfest that sells well but can't perform, even to it's own best estimates.

    I just can't even.
    Quote Originally Posted by PWD View Post
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    I think ovi's right.

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    Cha is my dump stat imperialus's Avatar
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    I always struggle to understand how America can't figure out something to provide universal health care. I guess the point has really been driven home for me in the past month and a half.

    You see, Imperialus Jr. is due to be born this January. Mrs. Imperialus has had very difficult pregnancy so far. So far the running tally is a trip to the urgent care clinic, two trips to the ER, a weeks hospitalization, probably about 2 dozen blood tests, 4 ultrasounds, and an MRI. We've got another more detailed ultrasound next week and a fetal MRI next week as well. Know what we've paid for out of pocket? About 70 dollars in parking at the Hospital, and about 400 dollars upgrading her from a semi private room to a private room in the Hospital.

    It would boggle my mind to even think about how much we'd pay for that if we lived a couple hours south of here.

    *edit* some quick google fu puts the price tag for the MRI at around 2500 a pop and the ultrasounds at around 300. Hospital avarage seems to be 1800/day. That means that we'd already be in for FIFTEEN thousand motherfucking dollars! I mean to be fair, up here if we didn't have insurance the hospital room upgrade would have been closer to a thousand dollars but seriously, what the actual fuck?
    Last edited by imperialus; September 14th, 2017 at 12:16 AM.

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    hammerHead32's Avatar
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    ..
    Last edited by hammerHead32; September 14th, 2017 at 01:12 AM.
    ... a queer feeling, which elicits a call for more depth regards the campaign.

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    Friendly Coffee Kzach's Avatar
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    Quote Originally Posted by imperialus View Post
    This quote is hidden because you are ignoring this member.
    I always struggle to understand how America can't figure out something to provide universal health care. I guess the point has really been driven home for me in the past month and a half.
    It's pretty easy to understand. America is run by oligarchs, not democracy.
    "Cunt. A word that sounds like a tennis ball hitting a racket in the sweet spot." ~ shiningbrow

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    Pony Up! Ovinomancer's Avatar
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    Quote Originally Posted by imperialus View Post
    This quote is hidden because you are ignoring this member.
    I always struggle to understand how America can't figure out something to provide universal health care. I guess the point has really been driven home for me in the past month and a half.

    You see, Imperialus Jr. is due to be born this January. Mrs. Imperialus has had very difficult pregnancy so far. So far the running tally is a trip to the urgent care clinic, two trips to the ER, a weeks hospitalization, probably about 2 dozen blood tests, 4 ultrasounds, and an MRI. We've got another more detailed ultrasound next week and a fetal MRI next week as well. Know what we've paid for out of pocket? About 70 dollars in parking at the Hospital, and about 400 dollars upgrading her from a semi private room to a private room in the Hospital.

    It would boggle my mind to even think about how much we'd pay for that if we lived a couple hours south of here.

    *edit* some quick google fu puts the price tag for the MRI at around 2500 a pop and the ultrasounds at around 300. Hospital avarage seems to be 1800/day. That means that we'd already be in for FIFTEEN thousand motherfucking dollars! I mean to be fair, up here if we didn't have insurance the hospital room upgrade would have been closer to a thousand dollars but seriously, what the actual fuck?
    Those prices are made up: as is no one pays that not that you fabricated them. Both of my kids put me out of pocket about $500 together. Sure, I pay for insurance, but, from what I've seen, that amount is about what someone with my salary would pay into the tax system for medical care up north.

    The biggest difference between the systems is cost of drugs. And that's largely because, rightly or wrongly, the US market subsidizes drug costs for much of the world.
    Quote Originally Posted by PWD View Post
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    I think ovi's right.

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    hammerHead32's Avatar
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    one page dungeon module R1:Rationing

    Entitlement = prestige class
    Prestige class has levels; baseline = 0 level = minimum service provided to every citizen, if any; e.g.: Healthcare; baseline, one free dental cleaning per year
    Levels are earned through experience points
    Experience points = work credit(s), earned through employment or purchased levels are ever widening concentric circles of coverage
    Experience points earned by work or purchased (today’s social security credit)
    Rationing Action Point Total (RAPT) determines whether a given service shall be provided to an individual, if that service is not normally covered by the current level
    Services are feats, skills, and powers
    v Feats = full coverage
    v Skills = partial or copay coverage
    v Powers = current Ration Action Point total locates individual in rationing queue, if economic reality reduces the ability of the government to a given level of service; people who don’t work and can’t pay have the lowest score and are the first to be rationed.

    Healthcare System rationing for retiree who didn’t work very much; regardless of what workers are offered, most healthcare cost are incurred by the elderly, so there are seven levels of coverage after retirement age, six representing a bell curve of 3 standard deviations plus a baseline 0-level. Grandfather current elderly; they keep what they have. Put in place for baby boomers. Two ways of looking at the curve:
    From the user’s standpoint:
    Like getting a social security card, everyone starts at level 0
    ü level 0 = baseline coverage; extreme left 3rd deviation out; it gets baseline coverage; example: medical coverage baseline = 1 free annual teeth cleaning
    ü level 1 = copper coverage; extreme left 2rd deviation out;= baseline + another group of coverages
    ü level 2 = silver (level 2-4 same coverage: differing copay);
    ü level 3 = electrum
    ü level 4 = gold
    ü level 5 = platinum fantastic coverage; no service left out, copay
    ü level 6 = mithril unlimited coverage; no service left out, min copay

    Standard Healthcare for working people. Workers start out with Gold, Electrum, Silver coverage, depending on what the nation can afford. They keep it as long as the work credits are being earned at a strong enough rate. Otherwise, the drop down in coverage to Electrum, Silver, or Copper coverage. Conversely, with effort and work credits they can move up in coverage.

    From the administrator's standpoint:
    Management of the system is designed to service the typical American worker (i.e., someone who works 50 - 60 years of their life) with most falling in the silver electrum and gold coverages
    § techniques for management include
    § changing the experience points required per level
    § adjusting the feats and skills at a given level

    Point of System Management is to privilege industry, both the employers and the effort of the individuals at work. Rationing Policy follows point of system management - If the typical American worker is being denied access to the better coverages, whether by economic downturn (scale Ration Action Points by unemployment rate?), demographic blip, natural disasters, absurd shortages of rare earth, end of time doomsday scenario, etc. - Then rationing must increase until a better threshold is achieved.

    Level is determined by current experience points. Everyone starts at 0-level experience points are earned in work or by purchase. All experience points have equal value; e.g., the quarter of work performed by the doctor, soldier, or laborer counts no more or less than the one put in by cashierist or dock worker.

    Strictures:
    ü Each Prestige Class must have a baseline, or 0-level, even if this is an empty service
    ü No person shall be prevented from opting out (they still get baseline) or opting up (more experience points can always be purchased by those who can afford to do so)

    NET SOCIAL STATEMENT: Privileged American Citizen, you were told the rules and you wound up given your own initiative and without equivocation with the best healthcare America could afford to give you.
    Last edited by hammerHead32; September 14th, 2017 at 08:26 AM.
    ... a queer feeling, which elicits a call for more depth regards the campaign.

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    cyphersmith's Avatar
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    Quote Originally Posted by Ovinomancer View Post
    This quote is hidden because you are ignoring this member.
    Those payment options are incoherent. By the paper, costs over 10 years for medical will be $49 trillion. Accepting the best cast savings per year as outlined shaves a whopping $6 trillion over 10 years. So we need to finance $43 trillion.

    I just can't even.
    Your numbers are wrong. The number you're using as the starting point is the estimate of the total amount we (meaning all Americans, overall) will spend over the next then years if nothing is done. It's not the estimate of the cost of the plan. The estimates for the cost of this plan vary. I've seen estimates between $1.5T/year and $31T/10 years. Neither of which is even close to your starting point. Then you ignore the cost savings in your math. And screwed up the math, to boot. Your first set of numbers, a savings of $3.9T/10 years then a total of $44.1T/10 years adds up to $48T, which is neither the $49T you start with nor the $43T you say we need to finance. Then on option 5 you say the savings is $0.3T but you actually subtract $3T, somewhat offsetting your original error.

    Option 3: Savings from Health Tax Expenditures
    Problems: okay, if you do option 1, these are already gone, so this cannot work with option 1. We'll use the higher of the two.
    Taken at face value: $4.2 T/10 years

    Running debt total: removing option 1 is a net down of $0.3T, so $28.6T/10 years
    Option 1 and option 3 are not mutually exclusive. Option 1 is an increase in the payroll tax. This has nothing to do with all of the tax write-offs that people and corporations get for the insurance they currently pay for.

    Doing your math properly, starting at $43T, your number ends at $26T, a $5.5T difference. But that number is the amount it would cost everyone over the next ten years if there is no change. You're not taking the change into account. How much of the remaining is overhead and other expenses that are no longer going to be there?

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    Religipster Enkhidu's Avatar
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    Quote Originally Posted by imperialus View Post
    This quote is hidden because you are ignoring this member.
    I always struggle to understand how America can't figure out something to provide universal health care. I guess the point has really been driven home for me in the past month and a half.

    You see, Imperialus Jr. is due to be born this January. Mrs. Imperialus has had very difficult pregnancy so far. So far the running tally is a trip to the urgent care clinic, two trips to the ER, a weeks hospitalization, probably about 2 dozen blood tests, 4 ultrasounds, and an MRI. We've got another more detailed ultrasound next week and a fetal MRI next week as well. Know what we've paid for out of pocket? About 70 dollars in parking at the Hospital, and about 400 dollars upgrading her from a semi private room to a private room in the Hospital.
    One, I hope everything is OK for Mrs. Imperialus and Jr.

    Two, it's not very useful at a macro level to track out of pocket expenses. Its far more useful to track actual costs all the way down the supply chain. Unfortunately, the US system isn't designed to be able to track those costs (and, as far as I know, neither is the Canadian system - only the point of service is not-for-profit, IIRC).

    If we were truly serious about providing better care for everyone, we'd force the point of service to be non-profit across the board, and then "encourage" medical suppliers to also be non-profit. Answering "who pays" doesn't actually address the root problem, which is that the point of service costs are completely out of control even if the health care fairy paid for everything.

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    Pony Up! Ovinomancer's Avatar
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    Quote Originally Posted by cyphersmith View Post
    This quote is hidden because you are ignoring this member.
    Your numbers are wrong. The number you're using as the starting point is the estimate of the total amount we (meaning all Americans, overall) will spend over the next then years if nothing is done. It's not the estimate of the cost of the plan. The estimates for the cost of this plan vary. I've seen estimates between $1.5T/year and $31T/10 years. Neither of which is even close to your starting point. Then you ignore the cost savings in your math. And screwed up the math, to boot. Your first set of numbers, a savings of $3.9T/10 years then a total of $44.1T/10 years adds up to $48T, which is neither the $49T you start with nor the $43T you say we need to finance. Then on option 5 you say the savings is $0.3T but you actually subtract $3T, somewhat offsetting your original error.


    Option 1 and option 3 are not mutually exclusive. Option 1 is an increase in the payroll tax. This has nothing to do with all of the tax write-offs that people and corporations get for the insurance they currently pay for.

    Doing your math properly, starting at $43T, your number ends at $26T, a $5.5T difference. But that number is the amount it would cost everyone over the next ten years if there is no change. You're not taking the change into account. How much of the remaining is overhead and other expenses that are no longer going to be there?
    Both errors count in favor, though, so hard to complain they cut wrong. Second, I took the savings for consolidation and reduced overhead into account initially, as they're laid out in the document itself. If they have even more wildly optimistic assumptions, I'd be glad to see them.

    And, all of that said, your version still ends up adding half the current debt over ten years, using the best case scenario numbers presented by those pushing the plan. If you can't pay for it with wildly optimistic assumptions, how the fuck does that survive contact worth the real world?
    Quote Originally Posted by PWD View Post
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    I think ovi's right.

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    cyphersmith's Avatar
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    Quote Originally Posted by Ovinomancer View Post
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    Both errors count in favor, though, so hard to complain they cut wrong. Second, I took the savings for consolidation and reduced overhead into account initially, as they're laid out in the document itself. If they have even more wildly optimistic assumptions, I'd be glad to see them.

    And, all of that said, your version still ends up adding half the current debt over ten years, using the best case scenario numbers presented by those pushing the plan. If you can't pay for it with wildly optimistic assumptions, how the fuck does that survive contact worth the real world?
    And you're still not understanding exactly what that $49T number means. That's NOT the cost of the plan, that's the amount Americans would be spending over the next 10 years if nothing is done.

    The most optimistic number I have seen for how much the plan will cost is $1.5T/year. The above pays for that. The least optimistic I have seen is about double that. The above only pays for about 2/3 of that.

    And, to be absolutely honest, nobody expects it to pass, not even Sanders. It's intention is to start the discussion.

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    Pony Up! Ovinomancer's Avatar
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    Quote Originally Posted by cyphersmith View Post
    This quote is hidden because you are ignoring this member.
    And you're still not understanding exactly what that $49T number means. That's NOT the cost of the plan, that's the amount Americans would be spending over the next 10 years if nothing is done.

    The most optimistic number I have seen for how much the plan will cost is $1.5T/year. The above pays for that. The least optimistic I have seen is about double that. The above only pays for about 2/3 of that.

    And, to be absolutely honest, nobody expects it to pass, not even Sanders. It's intention is to start the discussion.
    The document saying that consolation and overhead reduction and prescription changes will save $600 billion a year. Save from what? The only number presented before that is how much the current system will cost, not either of your numbers. So, what are those savings representing?

    Also, if you want discussion, maybe you can provide links to the sources on what the new plan will cost (since Sanders couldn't be bothered in his plan), and what assumptions are being made?

    Finally, to touch back on an earlier point, the description of option 3 says that most of the deductions that will be removed are deductions on the expense of pretax insurance premiums paid by the employer. The selfsame premiums that are no longer being paid under option 1, having been replaced by the 7.5% payroll tax. You cannot tax something that doesn't exist anymore.

    The only discussion here is just how ludicrous the costs and revenue plans really are. If you're remotely thinking these are functional, I have some bottom land at a steal. We can do single payer, but funding it will be painful, and mostly to the middle class. Enough money doesn't exist anywhere else.
    Quote Originally Posted by PWD View Post
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    I think ovi's right.

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    hammerHead32's Avatar
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    Quote Originally Posted by Ovinomancer View Post
    This quote is hidden because you are ignoring this member.

    The only discussion here is just how ludicrous the costs and revenue plans really are. If you're remotely thinking these are functional, I have some bottom land at a steal. We can do single payer, but funding it will be painful, and mostly to the middle class. Enough money doesn't exist anywhere else.
    What middle class? Or, rather which middle class are you referring to?
    https://inequality.org/facts/income-inequality/
    Last edited by hammerHead32; September 15th, 2017 at 10:57 AM.
    ... a queer feeling, which elicits a call for more depth regards the campaign.

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    That's Wacist! Mistwell's Avatar
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    Quote Originally Posted by Ovinomancer View Post
    This quote is hidden because you are ignoring this member.
    Those prices are made up: as is no one pays that not that you fabricated them. Both of my kids put me out of pocket about $500 together. Sure, I pay for insurance, but, from what I've seen, that amount is about what someone with my salary would pay into the tax system for medical care up north.

    The biggest difference between the systems is cost of drugs. And that's largely because, rightly or wrongly, the US market subsidizes drug costs for much of the world.
    Dude, we honestly and sincerely paid close to $20,000 over my wife's pregnancy, between pre-birth issues, birth issues, and post-birth issues. And we HAVE insurance! We maxed out our deductibles. And it was not in pharma bills - that was a negligible part of it.
    I like hats.

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    Pony Up! Ovinomancer's Avatar
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    Quote Originally Posted by Mistwell View Post
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    Dude, we honestly and sincerely paid close to $20,000 over my wife's pregnancy, between pre-birth issues, birth issues, and post-birth issues. And we HAVE insurance! We maxed out our deductibles. And it was not in pharma bills - that was a negligible part of it.
    So... you're saying anecdote isn't data?

    Also, iirc, your kid, who seems awesome, had a lot of really serious issues, yeah?
    Quote Originally Posted by PWD View Post
    This quote is hidden because you are ignoring this member.
    I think ovi's right.

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