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Trump Promises Megathread: Kept or Broken


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Where I have a hard time is BRB seems to be arguing to let the conservatives have their crack at fixing things because we need to do SOMETHING. But the ACA got conservative'd down to the ACA in the first place! An excellent cost control would've been a public option for healthcare, both driving down costs by forcing more competition on the private insurers and offering a much bigger stick to bargain over drugs with Big Pharma. But that's a progressive policy because it requires more government administration, so conservatives can't go for that. Nevermind the public sector job growth that would be created.

 

 

Hmmmmm....well.....you probably only have that feeling because I've come to the realization that this is the situation we are in. The GOP controls everything and they have the ACA in their crosshairs. I am not comfortable with that due to their past history on this subject along with the crap they have been spewing ever since the Trumpster was elected.

 

However, I am also uncomfortable with just a liberal led government doing it because it seems like their minds are always on the idea of providing everything to everyone and if we need money...tax the rich. It baffles me when I see more liberal leaning people not be concerned about the costs associated with a program. After all, the more efficient and less expensive we can provide something, the more money we have to do other things.

 

So, in summary, I've actually grown very uncomfortable with either side having total control over fixing health care (or anything).

 

 

I agree that that is the reality we're in. Republicans are in charge due to a large enough backlash to Obama/Clinton and they'll call the shots. I'm simply arguing what I think would be best for healthcare. Since I'm going to be a healthcare professional, my first priority is trying to build a system that provides the best care possible to the most people for the least amount of money. To that end, I understand that there's always going to be winners and losers. I want to maximize winners and minimize losers with whatever plan we take, and I really couldn't care less if insurance industry profits tank. I know that's not good for business, but that's not where my priorities lie. They're at the very least complicit in the inflation we've seen.

 

I support liberal insurance policies like the public option or single-payer because they're efficiently used in many other countries worldwide to good effect, most often universal healthcare. I'm not averse to some market-based competition, and that's what I view those as, even if they get administered by the government.

 

Make no mistake, I support them not because I'm some coddled millennial that wants things handed to me, but because from everything I've read and researched on our situation, I think they're the best and likely only solution to our predicament that doesn't involve just telling large swaths of the sickest among us they're out of luck. That's one cost saving measure I'm not at all comfortable with. Unfortunately, that's one that's present in most all of the GOP plans floating around right now.

 

We're taught in school that healthcare and insurance are markets that are not subject to regular free market forces. The market just doesn't respond the way markets for most other resources and services do. Therefore, I can't support a full-blown conservative ideology that states the free market will come in and fix everything. Unless of course what I'm being taught is incorrect, in which case I'm paying thousands for bad information.

 

This isn't an ideological thing for me. I just think single-payer/public option make the most sense.

 

I share premise that one side having too much power is usually a bad thing, though. Damn shame compromise became a dirty word.

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Okay, wow. That was a very informative article, dude. Thanks for posting it! I was certainly not that read up on the history of its passage, or on the specific criticisms of this interpretation:

 

A raft of reporters, commentators, and politicians argue that the president made a huge mistake in taking up healthcare at the beginning of his term, before building relationships of trust with Republicans, and then compounded that error by jamming it through quickly without any Republican input or efforts to find common ground.

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Where I have a hard time is BRB seems to be arguing to let the conservatives have their crack at fixing things because we need to do SOMETHING. But the ACA got conservative'd down to the ACA in the first place! An excellent cost control would've been a public option for healthcare, both driving down costs by forcing more competition on the private insurers and offering a much bigger stick to bargain over drugs with Big Pharma. But that's a progressive policy because it requires more government administration, so conservatives can't go for that. Nevermind the public sector job growth that would be created.

 

 

Hmmmmm....well.....you probably only have that feeling because I've come to the realization that this is the situation we are in. The GOP controls everything and they have the ACA in their crosshairs. I am not comfortable with that due to their past history on this subject along with the crap they have been spewing ever since the Trumpster was elected.

 

However, I am also uncomfortable with just a liberal led government doing it because it seems like their minds are always on the idea of providing everything to everyone and if we need money...tax the rich. It baffles me when I see more liberal leaning people not be concerned about the costs associated with a program. After all, the more efficient and less expensive we can provide something, the more money we have to do other things.

 

So, in summary, I've actually grown very uncomfortable with either side having total control over fixing health care (or anything).

 

 

I agree that that is the reality we're in. Republicans are in charge due to a large enough backlash to Obama/Clinton and they'll call the shots. I'm simply arguing what I think would be best for healthcare. Since I'm going to be a healthcare professional, my first priority is trying to build a system that provides the best care possible to the most people for the least amount of money. To that end, I understand that there's always going to be winners and losers. I want to maximize winners and minimize losers with whatever plan we take, and I really couldn't care less if insurance industry profits tank. I know that's not good for business, but that's not where my priorities lie. They're at the very least complicit in the inflation we've seen.

 

I support liberal insurance policies like the public option or single-payer because they're efficiently used in many other countries worldwide to good effect, most often universal healthcare. I'm not averse to some market-based competition, and that's what I view those as, even if they get administered by the government.

 

Make no mistake, I support them not because I'm some coddled millennial that wants things handed to me, but because from everything I've read and researched on our situation, I think they're the best and likely only solution to our predicament that doesn't involve just telling large swaths of the sickest among us they're out of luck. That's one cost saving measure I'm not at all comfortable with. Unfortunately, that's one that's present in most all of the GOP plans floating around right now.

 

We're taught in school that healthcare and insurance are markets that are not subject to regular free market forces. The market just doesn't respond the way markets for most other resources and services do. Therefore, I can't support a full-blown conservative ideology that states the free market will come in and fix everything. Unless of course what I'm being taught is incorrect, in which case I'm paying thousands for bad information.

 

This isn't an ideological thing for me. I just think single-payer/public option make the most sense.

 

I share premise that one side having too much power is usually a bad thing, though. Damn shame compromise became a dirty word.

 

I can't disagree with much here. I think we start from the same point. We both believe everyone should have access to health care that doesn't bankrupt them because they got sick. I am not willing to buy all the way into single payer plans....but, I'm starting to warm to the idea. Let's just say I'm not willing to rule them out....which is a big step from where I would have been 10 years ago. However, they have their downside too. Service tends to suffer. Instead of being able to get into have that heart surgery next week, you now have to wait 3 months. That can be a very very bad thing.

 

I also have absolutely no sympathy for insurance companies. If they need to go by the way side, then so be it. The problem with them, is that we need them to be able to pay for services....but, they shield us away from the real cost of health care. And, like I said earlier, they have no motivation to fight to lower costs and the ACA has made that worse.

 

Another factor in all of this is, if we go to a single payer plan, who chooses what a doctor (for example) makes? A doctor right now, comes out of college with hundreds of thousands of dollars in debt. My daughter is going to be a dentist and she is already told that she will have over $300,000 of debt the day she steps out of school. I'm sure a medical doctor is even worse. So, if now we are going to have the government say....Hey, doctors now make $75,000 per year, well.......one hell of a lot of kids aren't going to go into that profession. That's an example of why service suffers.

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Okay, wow. That was a very informative article, dude. Thanks for posting it! I was certainly not that read up on the history of its passage, or on the specific criticisms of this interpretation:

 

A raft of reporters, commentators, and politicians argue that the president made a huge mistake in taking up healthcare at the beginning of his term, before building relationships of trust with Republicans, and then compounded that error by jamming it through quickly without any Republican input or efforts to find common ground.

 

 

 

No problem. I thought the odd thing about that was they contradicted that sentiment immediately afterwards in the article, saying how much more unlikely major social policy changes become the longer you wait. I think either are decent arguments. Would've been interesting to see how Obama's presidential arc developed had he not pushed for ACA immediately after addressing the economy.

 

My apologies for the density of my posts. I just have a hard time condensing my thoughts sometimes.

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Where I have a hard time is BRB seems to be arguing to let the conservatives have their crack at fixing things because we need to do SOMETHING. But the ACA got conservative'd down to the ACA in the first place! An excellent cost control would've been a public option for healthcare, both driving down costs by forcing more competition on the private insurers and offering a much bigger stick to bargain over drugs with Big Pharma. But that's a progressive policy because it requires more government administration, so conservatives can't go for that. Nevermind the public sector job growth that would be created.

 

 

Hmmmmm....well.....you probably only have that feeling because I've come to the realization that this is the situation we are in. The GOP controls everything and they have the ACA in their crosshairs. I am not comfortable with that due to their past history on this subject along with the crap they have been spewing ever since the Trumpster was elected.

 

However, I am also uncomfortable with just a liberal led government doing it because it seems like their minds are always on the idea of providing everything to everyone and if we need money...tax the rich. It baffles me when I see more liberal leaning people not be concerned about the costs associated with a program. After all, the more efficient and less expensive we can provide something, the more money we have to do other things.

 

So, in summary, I've actually grown very uncomfortable with either side having total control over fixing health care (or anything).

 

 

I agree that that is the reality we're in. Republicans are in charge due to a large enough backlash to Obama/Clinton and they'll call the shots. I'm simply arguing what I think would be best for healthcare. Since I'm going to be a healthcare professional, my first priority is trying to build a system that provides the best care possible to the most people for the least amount of money. To that end, I understand that there's always going to be winners and losers. I want to maximize winners and minimize losers with whatever plan we take, and I really couldn't care less if insurance industry profits tank. I know that's not good for business, but that's not where my priorities lie. They're at the very least complicit in the inflation we've seen.

 

I support liberal insurance policies like the public option or single-payer because they're efficiently used in many other countries worldwide to good effect, most often universal healthcare. I'm not averse to some market-based competition, and that's what I view those as, even if they get administered by the government.

 

Make no mistake, I support them not because I'm some coddled millennial that wants things handed to me, but because from everything I've read and researched on our situation, I think they're the best and likely only solution to our predicament that doesn't involve just telling large swaths of the sickest among us they're out of luck. That's one cost saving measure I'm not at all comfortable with. Unfortunately, that's one that's present in most all of the GOP plans floating around right now.

 

We're taught in school that healthcare and insurance are markets that are not subject to regular free market forces. The market just doesn't respond the way markets for most other resources and services do. Therefore, I can't support a full-blown conservative ideology that states the free market will come in and fix everything. Unless of course what I'm being taught is incorrect, in which case I'm paying thousands for bad information.

 

This isn't an ideological thing for me. I just think single-payer/public option make the most sense.

 

I share premise that one side having too much power is usually a bad thing, though. Damn shame compromise became a dirty word.

 

I can't disagree with much here. I think we start from the same point. We both believe everyone should have access to health care that doesn't bankrupt them because they got sick. I am not willing to buy all the way into single payer plans....but, I'm starting to warm to the idea. Let's just say I'm not willing to rule them out....which is a big step from where I would have been 10 years ago. However, they have their downside too. Service tends to suffer. Instead of being able to get into have that heart surgery next week, you now have to wait 3 months. That can be a very very bad thing.

 

I also have absolutely no sympathy for insurance companies. If they need to go by the way side, then so be it. The problem with them, is that we need them to be able to pay for services....but, they shield us away from the real cost of health care. And, like I said earlier, they have no motivation to fight to lower costs and the ACA has made that worse.

 

Another factor in all of this is, if we go to a single payer plan, who chooses what a doctor (for example) makes? A doctor right now, comes out of college with hundreds of thousands of dollars in debt. My daughter is going to be a dentist and she is already told that she will have over $300,000 of debt the day she steps out of school. I'm sure a medical doctor is even worse. So, if now we are going to have the government say....Hey, doctors now make $75,000 per year, well.......one hell of a lot of kids aren't going to go into that profession. That's an example of why service suffers.

 

 

You're right that our access to healthcare may suffer. That's been the case anywhere else that's implemented universal care. Need to see a orthopedist for a knee you dinged up? You may have to get on a list and wait 4-6 weeks. That's really just a numbers thing if we're servicing 300M+ people. And you may only have access to certain treatments approved by some medical group - death panels, as the critics call them. These are just unfortunate drawbacks to universal healthcare that help offer cost control.

 

Even with the drawbacks, I view this as better than the alternative. We'll see what that alternative is, whenever the GOP manages to find it.

 

We agree 100% about insurance companies. I think it's morally bankrupt to try to profiteer off of people's illness.

 

With that last bit, you stumbled on one of the underlying problems that got our healthcare industry in the predicament it's in today. The insurance industry charges what it does because hospitals have wide latitude to charge whatever the hell they want for procedures, appointments, etc. The fee for service style our medical system used for a long time incentivized wasteful procedures being done to line doctor's pockets. We're still trying to transition away from that towards a system where medical professionals are paid based on quality of outcomes for the patient. Even still, there are still a lot of medical professionals (doctors in particular) with very bloated salaries. In order to really suck some of the massive cost out of our medical system, you'd have to convince those doctors (and a lot of other med professions) to take a pay cut. That's a very, very tough fight to pick. They're going to fight tooth and nail against it.

 

And even then, as you said, unchecked rise in the cost of a college degree needs to be addressed before it seems just to ask them to take a pay cut. It's not their fault they had to pay an arm and a leg before they could go to work. I know this all too well. I'll be well over $100K myself in debt before I go to work. College cost needs fixed in this country.

 

Tell your daughter best of luck, man. Dentistry is a great, stable career. Used to date a girl whose grandpa went to Creighton for dentistry. He raved about it.

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Trump is playing with fire here. Even within the context of a regular president this would be a risky promise. But to tell people that everyone is going to have much cheaper, simpler, better healthcare suggests he's not above lying to people. I mean, we've got wait and see, but people far smarter than Trump, or myself for that matter, have spent their lives trying to figure out how to implement universal coverage in the US and failed.

 

Just another promises made that's going to be very tough to deliver on. Will update the OP.

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The best part?

 

Moving ahead, Trump said lowering drug prices is central to lowering health costs nationally — and will make it a priority for him as he uses his bully pulpit to shape policy.

When asked how exactly he would force drug manufacturers to comply, Trump said part of his approach would be public pressure “just like on the airplane,” a nod to his tweets about Lockheed Martin’s F-35 fighter jet, which Trump said was too costly.


Trump waved away the suggestion that such activity could lead to market volatility. “Stock drops and America goes up,” he said. “I don’t care. I want to do it right or not at all.”He added that drug companies “should produce” more products in the United States.

 

He's going to get the pharmaceutical industry to lower drug prices by tweeting at them.

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Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details — “lower numbers, much lower deductibles”

 

Last I checked, the key to getting lower deductibles is higher premiums, so I am curious how that is going to work.

 

And I don't think that targeting drug companies alone will fix this (for your average ACA individual exchange plan, drug spend is around 20% of the total). Or the R's great plan of "selling across state lines".

 

I have a feeling this quotes are going to be like Obama's "if you like your plan you can keep it"

 

 

 

https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?utm_term=.1be24fc04d2c

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Could be, Red. Lord knows that's still a talking point and it's been 6 years.

The government negotiating with Big Pharma to bring drug prices down is one of the most important things we could do to bring the cost of insurance and the overall healthcare spending down. However, that's a decidedly progressive policy and spits in the face of conservative orthodoxy because then you're tampering with the free market, increasing Big Government, etc. etc. Hence, NONE of the GOP plans floating out there include anything like that, and most actually seek out to scale back Medicare/Medicaid ("entitlement reform").

So, none of the plans they're drawing from include this tactic, and I ASSURE you, tweeting at Big Pharma isn't going to bring those prices down. If something like this winds up in their final healthcare plan, Trump is going to have to inject it himself.

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Could be, Red. Lord knows that's still a talking point and it's been 6 years.

 

The government negotiating with Big Pharma to bring drug prices down is one of the most important things we could do to bring the cost of insurance and the overall healthcare spending down. However, that's a decidedly progressive policy and spits in the face of conservative orthodoxy because then you're tampering with the free market, increasing Big Government, etc. etc. Hence, NONE of the GOP plans floating out there include anything like that, and most actually seek out to scale back Medicare/Medicaid ("entitlement reform").

 

So, none of the plans they're drawing from include this tactic, and I ASSURE you, tweeting at Big Pharma isn't going to bring those prices down. If something like this winds up in their final healthcare plan, Trump is going to have to inject it himself.

 

I think the issues with Pharma are misunderstood. The issue with Big Pharma is the cost structure to bring a drug to market and then the process get insurance to cover it. For every successful drug, there are hundreds that don't go anywhere. The successful drugs have to cover the costs of the failures ***. The rules around capitalizing research dollars in biotech make partnering with research universities less attractive in many situations. Insurance companies have more influence over drug pricing than is healthy. And then, as you mention, the pricing based on each country's wealth index exacerbates the issue. Making changes to this structure will bring costs down faster than almost anything else.

 

Fundamentally, there is already a monopoly on individual drugs (even accounting for generics). Acknowledge it and act accordingly instead of ignoring it and letting it get out of hand...

 

*** Viagara is a wonderful example. It was originally developed as a heart or blood pressure med in the early 90s. It wasn't viable due to a persistent side-effect. It took someone with some foresight to fight internally to look at the drug for E.D. Not only has it been a success, it launched a new drug sector and is now being used to treat other non-E.D. conditions. None of the secondary research could be accomplished without the drug approved for a primary condition. It is too cost-prohibitive to conduct secondary on their own...

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