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How Angry Will You Be If The Republicans In Congress Do Not Repeal Obamacare?

Discussion in 'Politics Forum (Local/National/World)' started by Scorpio, Feb 28, 2017.



  1. searcher

    searcher Mother Lode Found Site Supporter ++ Mother Lode

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    Never looked at Obamacare as a right. Saw it as a way for the insurance companies to reap big bucks and the gov to tax you. It was basically buy health insurance that came with astronomical deductibles and ever increasing premiums or pay big gov a tax. Wonder who actually thought that up? It sure wasn't anyone with the interests of the American people in mind.

    And from what I've seen so far Trump care may be more of the same but with out a tax.

    Even if Trump care actually passes I really don't see the American people coming out ahead.

    Just my opinion (fwiw) but the only way for the American people to gain is to go to a one payer system where every single person has the same exact health care - bar none. No exceptions - no exemptions. If it's good enough for one..............it's good enough for all. Unfortunately I don't see this happening any time soon. I think both sides have the same owners.
     
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  2. Irons

    Irons Deep Sixed Site Supporter Mother Lode

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    Well he is 100% never Trump so anything Trump is for he is instantly against no matter what it is, and his district voted solidly Trump. His anti Trump rants are not flying well here.
    What pissed off many here though was his flip out over the temporary immigration ban. But hell, the guy is 1/2 syrian.

    .
     
  3. bemac

    bemac Midas Member Midas Member

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    Was Ron Paul a trump supporter? No. Was I? No. Amash didn't change his stance on anything, he is the real deal, libertarian, small gov't, and unfortunately one of very few in DC. I don't care if he's half-Jamaican, half-French, he's a full American.
     
  4. bemac

    bemac Midas Member Midas Member

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    And keep calling this an "Obamacre repeal" if you like, it doesn't make it true. This is same old GOP crap.

    I told you all, time and again, Trump was never out to take out the big boy's club, he was out to join it.
     
  5. Joe King

    Joe King Gold Member Gold Chaser

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    If outright repeal is currently impossible due to lack of votes in the Senate, the next best thing would be to just get rid of the employee and employer mandates.
    ...and couldn't Trump do that by issuing an EO telling the IRS to not enforce it? If it was ok for the big Obozo to do shit like that to have his way, F' it. Trump can play that game too. Let the SJW's cry their eyes out.
     
  6. Irons

    Irons Deep Sixed Site Supporter Mother Lode

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    Amash will not survive the next primary. Good riddance to koch brothers owned trash.
    Another thing I notice is Trump supporters are pretty happy people, while the never Trumpers of every stripe are growing more and more unhinged as time goes on. You can't tell a dyed in the wool CNN communist from a butt hurt RINO anymore.
    That makes me very happy indeed.

    .
     
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  7. Joe King

    Joe King Gold Member Gold Chaser

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    ...and neither one of 'em has clue one as to what to do about it! Strange bed fellows, indeed. lol
     
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  8. latemetal

    latemetal Platinum Bling Platinum Bling

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    Does Trump get a 2.1 million dollar tax break out of this? If Trump really wanted Romney/Obamacare dead, why didn't he do a "cleaner" bill?
     
  9. Garyw

    Garyw The Military gave me Defoliant Exposure Silver Miner

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    Looks like Ron Paul Republicans are winning How much do want to bet Rand Paul(RON PAUL'S) health plan will go thru soon. Yay
     
  10. the_shootist

    the_shootist The war is here on our doorstep! Midas Member Site Supporter ++

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    The Uniparty is alive and well in Washington!
     
  11. searcher

    searcher Mother Lode Found Site Supporter ++ Mother Lode

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    It's time to vote White House tells Republicans - even though Trumpcare is on the verge of defeat
    • White House press secretary Sean Spicer said Friday that the House would go ahead and vote on a bill to repeal and replace Obamacare this afternoon
    • He said President Trump had left 'everything on the field' in an effort to line up support
    • Lawmakers indicated Friday morning the bill was still short of the votes needed to pass
    • Trump on Thursday said the House should go ahead and vote after conservative Freedom Caucus members said they could not back package
    • A defeat would be an embarrassment for Trump, whom Sean Spicer had boasted he was changing skeptical minds just before the postponement
    • Trump slapped back with a Friday morning tweet saying right-wingers were passing up a chance to defund the nation's largest abortion provider
    • Republicans can afford to lose only 21 Republican votes
    • White House's Reince Priebus, Steve Bannon and Kellyanne Conway went to Capitol Hill to twist more Republican arms Thursday evening
    • They carried an ultimatum from the president: Vote on the package tomorrow or you can keep Obamacare
    • Latest whip count by The Hill shows 34 'No' votes – enough to sink the bill


    Read more: http://www.dailymail.co.uk/news/article-4345918/Trump-blasts-GOP-s-health-care-gridlocking-right-wingers.html#ixzz4cGuuSVoi
    Follow us: @MailOnline on Twitter | DailyMail on Facebook
     
  12. D-FENZ

    D-FENZ Gold Member Gold Chaser Site Supporter ++

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    This is insane!

    For now, the blame for this turd is on zero and the dems. Repubs should just get the hell out of the way and let it blow up- or get the whole shebang gone. Why are the repubs scrambling to get their fingerprints all over it? And you would think the dems would be all for getting the name changed to Trumpcare. WTF?

    This is bizzarro world!
     
  13. andial

    andial Sir Midas Member Site Supporter ++

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    Republicans are chumps, let it sink in.
     
  14. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    tramp just asked the house to pull the bill,

    bill is dead, no vote
     
  15. edsl48

    edsl48 Silver Member Silver Miner

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    Now everyone will blame their insurance woes on Obamacare and the Democrats as well as the Congressional RINOS...Good political move
     
  16. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    I don't think that is the way it will play,

    people are too stupid for that
     
  17. nickndfl

    nickndfl Midas Member Midas Member Site Supporter ++

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    Attach a repeal Obamacare bill to the tax plan. Then work on health care. You can't please everybody, but better to please the taxpayers than the leeches.
     
  18. solarion

    solarion Gold Member Gold Chaser Site Supporter

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    I believe the repukes are taking a calculated risk here. 33 Senate seats are up for grabs in the midterms and I believe only 8 or 9 of those are team red seats. Combine this maths with the fact that CONgress rightly believes that the average Amerikan sheeple is so overwhelmed and/or apathetic that they won't notice (or care) which scumbags are betraying them in the Senate and you have, what seems to me, a reasonable course of action for the repukes.
     
  19. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    let's be real here though,

    tramp has 2 significant defeats to his credit already,

    immigration and this,

    he wasn't elected to make a 'valiant attempt' and to get participation trophy,

    not off to a rousing start
     
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  20. Krag

    Krag Planet earth Platinum Bling

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    The guy is not very competent, a poker card player, he doesn't get the best and brightest and let them collaborate with one another but is following the same crony politics of the last guy.

    I'm hostile to compulsory "health" care plans; a Canadian or European style system would be a lot better. Vermont has a lot of community clinics which offer low cost options. The emotional relatively small percentage of the public who are disrupting meetings is unacceptable, no rational discourse can occur with such hostile biased citizen involvement whether it is due to a "health" care demand for medications and treatment or family members of people from countries suffering under a dictator demanding military actions by the USA. Irresponsible citizens who have life-threatening diseases due to their bad choices should suffer economically along with taxpayers. Citizen accountability also needs to be worked into the system whether it is higher taxes on the wealthy or larger co-pays on those receiving medical treatment due to bad choices. Also natural and preventative alternatives which are prolific in India, Germany and other more advanced countries should be much bigger options. But I doubt we will see such advances for quite a while.
     
  21. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    Others,

    The stock markets have exploded with the SP up 12% since,

    while conversely, huge move in treasury yields of 37% up, which will eventually come home to roost in a big way
     
  22. Irons

    Irons Deep Sixed Site Supporter Mother Lode

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    Health Care Bill’s Failure: Just Part of the ‘Art of the Deal’

    [​IMG]
    AP Photo/Evan Vucci

    by JOEL B. POLLAK24 Mar 2017

    Exactly two weeks ago, this author predicted the defeat of the American Health Care Act — and explained that it was a step towards the final, actual deal that will repeal and replace Obamacare.[/paste:font]
    President Donald Trump faces three irreconcilable factions: the GOP establishment, conservatives, and Democrats. He must bring them together — to “deliver the goods,” a key rule in The Art of the Deal. But first he must show them “the downside” — and convince them they will fail on their own.

    The most difficult faction to deal with is the Republican establishment — not because they are politically strong, but because on policy issues like health care, they are convinced that they have all the answers and that Trump just does not understand.

    So he let them make the first move — and he exposed two things about them: first, that they had not come up with a plan that was ready for prime time; second, that they had not done any of the political legwork necessary to sell their plan to voters.

    Trump gave Speaker Paul Ryan and the House Republican leadership enough rope to hang themselves. Instead of dictating terms to him, they will now depend on him to save them, politically. They must accept whatever plan he will put forward.

    But Trump will not make the next move. He will let the conservatives move first. They are the big winners in the first round — much more so than the Democrats, who are enjoying the spectacle of Republican dysfunction but have no role to play yet.

    The conservatives will proceed with their demand for a full repeal of Obamacare. And then they will face the ire of voters who are deeply unhappy with Obamacare but upset about losing the paltry, expensive health insurance they currently have.

    That, too, will strengthen Trump, and convince conservatives they need his leadership.

    Whereupon Trump will turn to the moderate Democrats and offer them a deal — perhaps catastrophic health coverage in exchange for repealing Obamacare.

    Democrats would take that deal because they would see a government-backed catastrophic insurance system as a possible path to the universal health care system of their dreams. Republicans would take that deal — after exhausting all of the other options — because it would leave enough room for the free market to provide insurance for most health issues, and for states to experiment with their own policies. And the more health care stakeholders who can be brought into the process, the better.

    To quote Morpheus, from the Matrix Reloaded: “What happened, happened, and couldn’t have happened any other way.”

    Joel B. Pollak is Senior Editor-at-Large at Breitbart News. He was named one of the “most influential” people in news media in 2016. His new book, How Trump Won: The Inside Story of a Revolution, is available from Regnery. Follow him on Twitter at @joelpollak.
     
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  23. hammerhead

    hammerhead Not just a screen name Gold Chaser

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    Well that's that. Trump just cleansed his hands of Obambanation Care. It would have been foolish to replace it. But it will keep on destroying jobs and wallets. My fear is that when it all falls down, what people are going to look to .gov to give them.
     
  24. ErrosionOfAccord

    ErrosionOfAccord #1 Global Warmer Gold Chaser Site Supporter ++

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    If I wanted to sound like a trumpeter I would say the following.

    Trump had this planned all along. He knew Ofare lite would never pass but couldn't get it done his way so he marched onward with the malformed bill. Despite his public support, he loathed the bill. Now he comes out with a public defeat but a private win and Ocare can die as it should. When the maggot infested raisin drops from the vine the president will have it his way and make 'merica great again.

    I suppose that's about all the hope I can provide for a day. Time to turn the hate back on.

    Edit; funny I was writing that while Irons was posting the above
     
  25. GOLDBRIX

    GOLDBRIX God,Donald Trump,most in GIM2 I Trust. OTHERS-meh Site Supporter Platinum Bling

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    SEVEN years of so-called REPEALS and these LAWYERS who can not make money as Lawyers so they play on the .gov tit and talk shit.
    If they would have done in correctly like they told We the People they WOULD do. OBAMACARE would have been gone and we would at least be working with a clean slate.

    Let ObamaCare collapse. Blame the DEMS for their failure once and for all. See what their parasite followers/voters do then.
     
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  26. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    I keep hearing that from everyone......just let it collapse,

    problem is, no one can explain how it will collapse, what the ramifications of that look like

    the .gov is on the hook to pour millions in to this libtard wet dream, and not one utterance of defunding it, removing it, etc.

    so how can it collapse if the funding continues on?

    they think people are going to stand up and state 'enough'?

    that isn't happening,

    if anything, the libtards are just waiting to pounce and go full .gov on it and change it to .gov controlled single payer.
     
  27. Ensoniq

    Ensoniq Midas Member Midas Member Site Supporter ++

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    from the don't put all your eggs in the same basket files..

    Ukraine was keeping all their munitions in a single depot

    Which was the bigger explosion today? I'd say the healthcare bill

     
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  28. GOLDBRIX

    GOLDBRIX God,Donald Trump,most in GIM2 I Trust. OTHERS-meh Site Supporter Platinum Bling

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    ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
    The Russians Did it. :dduck:
     
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  29. edsl48

    edsl48 Silver Member Silver Miner

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    My wife had to go to the ER a month or so back and jut like the days before Obamacare it was packed with the same old usual ones hanging around for free health care and/or drugs. Nothing has really changed other than higher prices
     
  30. Fanakapan

    Fanakapan Midas Member Midas Member Site Supporter

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    Not so sure on the 'Defeat' angle there ?

    On immigration, all its going to take is an outrage along the lines of the late London/Parliament one, and the guys holding up President Trumps plans will be hammered flat by public opinion.

    On healthcare, I've little doubt that both the Democrats, and the HealthCo's were thinking that President Trump would 'Have' to pull their chestnuts out of the fire ? His walking away from their mess leaves them in some pretty sh1t for sure ? In fact its almost guaranteed that the Democrats are going to have to beg to be released from the Albatross around their necks that ObamaCare will shortly become. As for the HealthCo's, yeah they can stick up prices, but at some point (if we're not already past it) folk will drop out of their racket simply of necessity (think blood and stones). And its going to hit them where it hurts most, the bottom line.

    Rather than these being defeats, use the property developers view. President Trump has picked up a couple of lots that have the near certain potential to become infinitely more valuable than they appear to be today. And remember 'Real' politics is a much longer game than the likes of Pelosi and CNN would have people believe :)
     
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  31. solarion

    solarion Gold Member Gold Chaser Site Supporter

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    Agree. Think the Dems still own the immigration and obarrycare issues even if the repukes are right there helping fuel the fires of dysfunction.
     
  32. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    I disagree 100% with you 2,

    No way in hell the dems own it now. As stated, the avg slave won't see it that way.
    They will be begging for single payer

    see post #70 by D, which states it all real simply

    ----------------
     
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  33. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    again and again I post this one:


    The Wild and Free Pigs of the Okefenokee Swamp
    based on a telling by George Gordon
    Some years ago, about 1900, an old trapper from North Dakota hitched up some horses to his Studebaker wagon, packed a few possessions -- especially his traps -- and drove south.

    Several weeks later he stopped in a small town just north of the Okefenokee Swamp in Georgia.

    It was a Saturday morning -- a lazy day -- when he walked into the general store. Sitting around the pot-bellied stove were seven or eight of the town's local citizens.

    The traveler spoke. "Gentlemen, could you direct me to the Okefenokee Swamp?"

    Some of the old timers looked at him like he was crazy.

    "You must be a stranger in these parts," they said.

    "I am. I'm from North Dakota," said the stranger.

    "In the Okefenokee Swamp are thousands of wild hogs." one old man explained.

    "A man who goes into the swamp by himself asks to die!"

    He lifted up his leg. "I lost half my leg here, to the pigs of the swamp."

    Another old fellow said, "Look at the cuts on me; look at my arm bit off!"

    "Those pigs have been free since the Revolution, eating snakes and rooting out roots and fending for themselves for over a hundred years. They're wild and they're dangerous. You can't trap them. No man dare go into the swamp by himself."

    Every man nodded his head in agreement.

    The old trapper said, "Thank you so much for the warning. Now could you direct me to the swamp?"

    They said, "Well, yeah, it's due south -- straight down the road."

    But they begged the stranger not to go, because they knew he'd meet a terrible fate.

    He said, "Sell me ten sacks of corn, and help me load it in the wagon." And they did.

    Then the old trapper bid them farewell and drove on down the road. The townsfolk thought they'd never see him again.

    Two weeks later the man came back. He pulled up to the general store, got down off the wagon, walked in and bought ten more sacks of corn.

    After loading it up he went back down the road toward the swamp.

    Two weeks later he returned and again bought ten sacks of corn.

    This went on for a month. And then two months, and three.

    Every week or two the old trapper would come into town on a Saturday morning, load up ten sacks of corn, and drive off south into the swamp.

    The stranger soon became a legend in the little village and the subject of much speculation. People wondered what kind of devil had possessed this man, that he could go into the Okefenokee by himself and not be consumed by the wild and free hogs.

    One morning the man came into town as usual. Everyone thought he wanted more corn.

    He got off the wagon and went into the store where the usual group of men were gathered around the stove. He took off his gloves.

    "Gentlemen," he said, "I need to hire about ten or fifteen wagons. I need twenty or thirty men."

    "I have six thousand hogs out in the swamp, penned up, and they're all hungry. I've got to get them to market right away."

    "You've WHAT in the swamp?" asked the storekeeper, incredulously.

    "I have six thousand hogs penned up. They haven't eaten for two or three days, and they'll starve if I don't get back there to feed and take care of them."

    One of the old-timers said, "You mean you've captured the wild hogs of the Okefenokee?"

    "That's right."

    "How did you do that? What did you do?" the men urged, breathlessly.

    One of them exclaimed, "But I lost my arm!"

    "I lost my brother!" cried another.

    "I lost my leg to those wild boars!" chimed a third.

    The trapper said, "Well, the first week I went in there they were wild all right."

    "They hid in the undergrowth and wouldn't come out. I dared not get off the wagon."

    "So I spread corn along behind the wagon. Every day I'd spread a sack of corn."

    "The old pigs would have nothing to do with it."

    "But the younger pigs decided that it was easier to eat free corn than it was to root out roots and catch snakes. So the very young began to eat the corn first."

    "I did this every day. Pretty soon, even the old pigs decided that it was easier to eat free corn."

    "After all, they were all free; they were not penned up. They could run off in any direction they wanted at any time."

    "The next thing was to get them used to eating in the same place all the time. So I selected a clearing, and I started putting the corn in the clearing."

    "At first they wouldn't come to the clearing. It was too far. It was too open. It was a nuisance to them."

    "But the very young decided that it was easier to take the corn in the clearing than it was to root out roots and catch their own snakes. And not long thereafter, the older pigs also decided that it was easier to come to the clearing every day."

    "And so the pigs learned to come to the clearing every day to get their free corn."

    "They could still subsidize their diet with roots and snakes and whatever else they wanted. After all, they were all free. They could run in any direction at any time. There were no bounds upon them."

    "The next step was to get them used to fence posts."

    "So I put fence posts all the way around the clearing. I put them in the underbrush so that they wouldn't get suspicious or upset."

    "After all, they were just sticks sticking up out of the ground, like the trees and the brush. The corn was there every day. It was easy to walk in between the posts, get the corn, and walk back out."

    "This went on for a week or two. Shortly they became very used to walking into the clearing, getting the free corn, and walking back out through the fence posts."

    "The next step was to put one rail down at the bottom. I also left a few openings, so that the older, fatter pigs could walk through the openings and the younger pigs could easily jump over just one rail."

    "After all, it was no real threat to their freedom or independence. They could always jump over the rail and flee in any direction at any time."

    "Now I decided that I wouldn't feed them every day. I began to feed them every other day."

    "On the days I didn't feed them the pigs still gathered in the clearing. They squealed, and they grunted, and they begged and pleaded with me to feed them."

    "But I only fed them every other day. And I put a second rail around the posts."

    "Now the pigs became more and more desperate for food. Because now they were no longer used to going out and digging their own roots and finding their own food. They now needed me. They needed my corn every other day."

    "So I trained them that I would feed them every day if they came in through a gate. And I put up a third rail around the fence."

    "But it was still no great threat to their freedom, because there were several gates and they could run in and out at will."

    "Finally I put up the fourth rail."

    "Then I closed all the gates but one, and I fed them very, very well."

    "Yesterday I closed the last gate. And today I need you to help me take these pigs to market."

    -- end of story --


    The price of free corn...may be our liberty!
    "Federal welfare, in its myriad forms, has reduced not only individuals to a state of dependency. State and local governments are also on the fast track to elimination, due to their functions being subverted by the command and control structures of federal "revenue sharing" programs. [Within the story] if you use [the words] federal handouts in place of corn and [the words] people in place of the pigs - how close are the American people to having the final rail put in place?" "Just say NO to federal corn." The bacon you save may be your own." NHCCS thanks Rachel Thomas for sending us this educational story.
     
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  34. gnome

    gnome Platinum Bling Platinum Bling

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    This really doesn't have to be this hard.

    [​IMG]
     

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  35. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    Fwiw, I think they are still on track to go to single payer system
     
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  36. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    Not all smiles

    Japan’s health-care system is the envy of the world. It is also in crisis

    Sep 10th 2011 | TOKYO

    THE Japanese spend half as much on health care as do Americans, but still they live longer. Many give credit to their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this year. Its virtues are legion. Japanese people see doctors twice as often as Europeans and take more life-prolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three times as long as the rich-world average. Life expectancy has risen from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortality rates in the world. Yet Japanese health-care costs are a mere 8.5% of GDP.

    Even so, the country's medical system is embattled. Although it needs a growing workforce to pay the bills, Japan is ageing and its population is shrinking. Since kaihoken was established in 1961, the proportion of people over 65 has quadrupled, to 23%; by 2050 it will be two-fifths of a population that will have fallen by 30m, to under 100m. “The Japanese health system that had worked in the past has begun to fail,” Kenji Shibuya of the University of Tokyo and other experts write in a new issue of the Lancet, a British medical journal, devoted to kaihoken. “The system's inefficiencies could be tolerated in a period of high growth, but not in today's climate of economic stagnation.”

    By 2035 health care's share of GDP will roughly double, according to McKinsey, a consultancy. The burden falls on the state, which foots two-thirds of the bills. Politicians are unwilling to raise taxes, so they squeeze suppliers instead: more than three-quarters of public hospitals operate at a loss.

    Like other service industries in Japan, there are cumbersome rules, too many small players and few incentives to improve. Doctors are too few—one-third less than the rich-world average, relative to the population—because of state quotas. Shortages of doctors are severe in rural areas and in certain specialities, such as surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country's low birth rate, but practitioners say that they really arise because income is partly determined by numbers of tests and drugs prescribed, and there are fewer of these for children and pregnant women. Doctors are worked to the bone for relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100 hours a week. “How can I find time to do research? Write an article? Check back on patients?” he asks.

    On the positive side, patients can nearly always see a doctor within a day. But they must often wait hours for a three-minute consultation. Complicated cases get too little attention. The Japanese are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.

    Some doctors see as many as 100 patients a day. Because their salaries are low, they tend to overprescribe tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping patients in bed. Simple surgery that in the West would involve no overnight stay, such as a hernia operation, entails a five-day hospital stay in Japan.

    Emergency care is often poor. In lesser cities it is not uncommon for ambulances to cruise the streets calling a succession of emergency rooms to find one that can cram in a patient. In a few cases people have died because of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big hospitals. Doctors prefer them because they can work less and earn more.

    The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make medical tourism a pillar of future economic growth, as the government plans.

    The Japanese are justly proud of their health-care system. People get good basic care and are never bankrupted by medical bills. But kaihoken cannot take all the credit for the longevity of a people who eat less and stay trimmer than the citizens of any other rich country. And without deep cost-cutting and reform, the system will struggle to cope with the coming incredible shrinking of Japan.

    This article appeared in the Asia section of the print edition

    http://www.economist.com/node/21528660
     
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  37. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    more on this particular system:

    Japan's Health-Care System Has Many Advantages, but May Not Be Sustainable



    By Blaine Harden
    Washington Post Foreign Service
    Monday, September 7, 2009


    TOKYO -- Half a world away from the U.S. health-care debate, Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart. It does so by banning insurance company profits, limiting doctor fees and accepting shortcomings in care that many well-insured Americans would find intolerable.

    The Japanese visit a doctor nearly 14 times a year, more than four times as often as Americans. They can choose any primary care physician or specialist they want, and surveys show they are almost always seen on the day they want. All that medical care helps keep the Japanese alive longer than any other people on Earth while fostering one of the world's lowest infant mortality rates.

    Health care in Japan -- a hybrid system funded by job-based insurance premiums and taxes -- is universal and mandatory, and consumes about 8 percent of the nation's gross domestic product, half as much as in the United States. Unlike in the U.S. system, no one is denied coverage because of a preexisting condition or goes bankrupt because a family member gets sick.

    But many health-care economists say Japan's low-cost system is probably not sustainable without significant change. Japan already has the world's oldest population; by 2050, 40 percent will be 65 or older. The disease mix is becoming more expensive to treat, as rates of cancer, stroke and Alzheimer's disease steadily increase. Demand for medical care will triple in the next 25 years, according to a recent analysis by McKinsey & Co., a consulting firm.

    Japan has a stagnant economy, with a shortage of young people that hobbles prospects for growth and strangles the capacity of the debt-strapped government to increase health-care spending. Without reform, costs are projected to double, reaching current U.S. levels in a decade, according to the Organization for Economic Cooperation and Development (OECD).

    For generations, Japan has achieved its successes by maintaining a vise-like grip on costs. After hard bargaining with medical providers every two years, the government sets a price for treatment and drugs -- and tolerates no fudging.

    As a result, most Japanese doctors make far less money than their U.S. counterparts. Administrative costs are four times lower than they are in the United States, in part because insurance companies do not set rates for treatment or deny claims. By law, they cannot make profits or advertise to attract low-risk, high-profit clients.

    To keep costs down, Japan has made tradeoffs in other areas -- sometimes to the detriment of patients. Some are merely irritating, such as routine hour-long waits before doctor appointments. But others involve worrisome questions about quality control and gaps in treatment for urgent care.

    Japanese hospitals experience a "crowding out" effect, with space for emergency care and serious medical conditions sometimes overwhelmed by a flood of patients seeking routine treatment, said Naohiro Yashiro, a professor of economics and health-care expert at International Christian University in Tokyo.

    "Patients are treated too equally," he said. "Beds are occupied by less-urgent cases, and there are no penalties for those who over-use the system."

    The government has largely been unable to reduce the length of hospital stays, which are four times as long in Japan as in the United States. Hospital doctors are often overworked and cannot hone specialized life-saving skills, according to recent reports by McKinsey. Statistics show that the Japanese are much less likely to have heart attacks than people in the United States, but that when they do, their chance of dying is twice as high.

    There are shortages of obstetricians, anesthesiologists and emergency room specialists because of relatively low pay, long hours and high stress at many hospitals, doctors and health-care analysts said. Emergency room service is often spotty, as ER beds in many hospitals are limited and diagnostic expertise is sometimes lacking. In a highly publicized but not unprecedented incident, a pregnant woman complaining of a severe headache was refused admission last year to seven Tokyo hospitals. She died of an undiagnosed brain hemorrhage after giving birth.


    more here:
    http://www.washingtonpost.com/wp-dyn/content/article/2009/09/06/AR2009090601630.html
     
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  38. Oldmansmith

    Oldmansmith Midas Member Midas Member

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    Cost will never be reigned in until we have a free market in drugs. Obamacare was basically a government subsidy of the pharmaceutical industry, and Trumpcare will be no better.
     
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  39. Scorpio

    Scorpio Скорпион Founding Member Board Elder Site Mgr Site Supporter ++

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    Health Care in Germany

    by Christina Geyer on August 18, 2009 · 52 Comments


    This is the first post in a series on universal health care, addressing the concerns that have been brought up in the current debate on health care reform in the US. This post describes the German health care system.

    How do health statistics compare between Germany and the US?

    Looking at the World Health Organization’s Core Health Indicators, Germany has better numbers than the US in most health care related statistics. Here are some highlights:

    • Life expectancy at birth, for both sexes combined, is 80 years in Germany and 78 in the US
    • Healthy life expectancy at birth, for both sexes combined, is 72 years in Germany, 69 years in the US
    • Infant mortality rate (per 1000 births) for Germany is 4.0, the US is 7.0
    • Hospital beds (per 10000 people) is 83 in Germany and 32 in the US
    • Physician density (per 10000 people) is 34 in Germany and 26 in the US
    • Total expenditure on health as percentage of GDP for Germany is 10.7%, the US is 15.2%
    • and Per capita expenditure on health is $3250 in Germany and $6350 in the US
    What kind of health care system does Germany have?

    Germany has universal health coverage for all qualifying residents. In fact, it has the oldest universal health care system in the world, whose origins date from Otto von Bismarck’s social legislation of the 1880s. The German government does not insure people, instead it requires by law that residents have health coverage and has a multi-payer health insurance system. There two types of insurance providers: Public “statutory funds” and Private.

    Statutory health insurance funds are non-profit and not run by the government. They must provide coverage following tight government regulations. The statutory insurance premium is based on a percentage of salary which varies depending on the fund you choose, but is typically around 15% of your gross monthly salary, or €570 a month, whichever is lower, with employees and employers contributing about half each. Some lower income workers can qualify to pay a lower percentage of salary.

    Family members earning less than €400 a month are covered by the statutory funds at no additional cost. Approximately 72 million people are covered by the public statutory funds (Germany’s population in 2009 was a little over 82 million people). The statutory funds are also funded in part by taxes to support the coverage of people who have never been employed or paid into the system.

    Some people can opt out of the public statutory funds and be covered by private “for-profit” insurance companies. Not everyone can do this, you must make over €50,000 a year or be self-employed. Some government employees, called Beamter, are reimbursed for part of their medical costs and must take out private insurance policies to cover whatever the government does not reimburse. The private insurance companies decide on the premiums, so younger, healthier people will have lower premiums than older people with pre-existing conditions. The premiums are locked in when you join, although the premium may increase if health costs in general increase. Family members can be covered, but each must pay an additional premium. Only about 10% of the German population (about 8.5 million people) is covered by private insurance.

    Does the German government provide health care?

    No. Doctors are not employees of the German government. Doctors outside of hospitals are in private practices and considered self-employed. For doctors in hospitals, it depends on the hospital ownership. Out of Germany’s 2,030 hospitals, 790 are publicly owned, while 820 are private non-profits, and 420 are private for-profit. This competition helps to keep hospital costs down and quality of care high.

    Are there long waits and rationed care?

    Here’s a chart from a Commonwealth Fund study of wait times between Australia, Canada, Germany, New Zealand, the UK and the US:

    The German Health Ministry’s page also says wait times are lower in Germany than elsewhere. My experiences agree, I have no reason to believe that wait times aren’t lower here than elsewhere. Wait times for appointments and operations, in my experience, have been the same or less than in the US, and I hear similar things from other people. I did find waiting room times at doctors offices (but not hospitals) to be long in the former East Germany (2-3 hours sometimes), but it was also common in the former East that appointments weren’t given and you just showed up and waited when you needed to be seen, so you had same day care at least. In the state of Bavaria, I’ve hardly ever had to wait more than 20-30 minutes in a waiting room and appointments are usually for the same day, and if not, they are rarely more than a week away.

    Necessary treatments are given to all patients, public and private. There are some limits made on doctors, for example orthopedists have a limited number of physical therapy sessions they can give out each quarter (per statutory fund), so for all but the most seriously affected patients, doctors might only prescribe eight physical therapy sessions per quarter, saving leftover sessions for the most in-need patients. The statutory funds might also cover 1000 screenings per month, the doctor will do more screenings if needed, but anything beyond the limits set by the funds needs to be paid for by the patient or the doctor, but is almost always paid by the doctor. Politicians have even advised that if your doctor asks you to pay for a test or procedure, you should switch doctors. However stroke or accident victims, for example, would receive all the physical therapy that they need. This is sometimes also partially paid for by retirement funds.

    If something is not covered by a patient’s public or private insurance, they can always pay for it out of pocket.

    Doctors regularly make housecalls to patients who can’t travel or when care is needed outside of normal office hours. You don’t need to go through your primary care physician to see a specialist, you can make appointments directly, and you can get as many opinions as you want.

    This all sounds great, but it must cost a fortune, right?

    Germany spends less as a percentage of GDP on health care than the US and less per person than the US, and all its residents have comprehensive health coverage. How can this be? Prevention, early treatment, and education go a long way towards lowering costs. Let’s take type II diabetes as an example. When it doesn’t cost anything to go to the doctor, you’re more likely to get regular checkups, at one of these checkups, the doctor might discover you’re pre-diabetic. You will be educated on the condition, on how to control it through diet, and the progression of the disease will be monitored. If you don’t have health care, or are under-insured, like many in the US (it’s estimated 100 million people in the US are uninsured or underinsured – that means you have insurance but can’t afford to see doctors because your co-pays and deductibles are too high), your condition may not be caught until it’s much more serious, requiring insulin, or even perhaps a hospital stay for a diabetic coma. Without proper followup and education, the condition can worsen to the point that amputation and extended hospital stays become necessary.

    There are some health screenings that aren’t covered, and the timing and frequency of other screenings are set by the insurance companies, both public and private, but additional screenings can always be paid for by the patient out-of-pocket.

    The government helps to keep costs low by negotiating prices with pharmaceutical companies and medical providers. Competition between the public and private insurances also helps, as does the fact that doctors and nurses make home visits. For easily treated conditions that occur outside normal business hours, a doctor will come to your home and treat you, saving the cost of a trip to the emergency room. Long term care is provided in the home when possible, with nurses stopping by daily when necessary, saving significantly over long hospital stays.

    Costs to doctors for malpractice insurance is lower here as well, since payouts for lawsuits are lower in general and lawsuits are more difficult to bring to court.

    The out of pocket costs to patients are also low. Public patients pay a €10 copay upon their first doctor visit a quarter. There is a small fee (I think €10 per quarter as well) for doctor home visits. Prescriptions cost €5 and are free for children.

    Private patients must pay all bills out of pocket, but are then reimbursed by the insurance company and can receive refunds from insurance if they don’t require medical care in a given year.

    Are abortions covered by health insurance in Germany?

    Abortions are covered by insurance here when they are considered medically necessary or in cases where the pregnancy was the result of a crime (rape, incest), otherwise they are considered to be selective surgery and must be paid for by the patient. Social services do sometimes help with this payment for women who cannot afford it.

    German medical personnel aren’t forced to perform any procedure they do not wish to perform.

    Are illegal immigrants given medical treatment in Germany?

    Germany is estimated to have about 1 million illegal immigrants. Because they do not have legal documents, they aren’t eligible for health insurance here. If they have an emergency however, they must be treated. The German government requires that illegal aliens be reported to authorities (this is not the case in many European countries), but many of Germany’s medical and social system personnel disagree with reporting personal information such as residency status.

    What is the quality of care in Germany?

    The quality is world class. In a 2000 WHO report, Germany’s health care system was ranked 25th in the world (the US was ranked 37th). Of course there is variation in the system, on a village level, you aren’t going to have the same care as in a top teaching hospital (similar to the difference between a small rural town in the US and Cedar Sinai Medical Center), but overall care is excellent here. Just like the US, rich oil sheiks also visit Germany for medical care, as do third world leaders, rich foreigners and celebrities (you might remember hearing on the news about how Farrah Fawcett came here for cancer treatment and U2 frontman Bono came here for back surgery).

    Can you lose your insurance if you lose your job?

    No, insurance isn’t connected to your job in that sense, only in the sense that your employer pays half of your insurance premium. If you change jobs, the new employer takes over the payment. If you are unemployed, you don’t need to pay, unemployment insurance funded by government taxes will cover you. You never lose your insurance coverage.

    So you make the German system sound perfect, is it?

    It’s not a perfect system, Germans find plenty to gripe about. Health coverage is good now, but there are going to be demographic problems here in Germany with an aging population and the low birth rate. These problems are things the US would actually not face nearly as severely were it to have such a system, as the birth rate and immigration rate is relatively high there.

    German doctors complain about low pay and sometimes leave to practice in the US or the UK, where doctors make more and where a less hierarchical society means young doctors are more respected. But to be fair, college tuition in Germany is covered by taxes, so doctors come out of med school here free of debt, while doctors in the US often owe several hundred thousand dollars in student loans.

    Drug distribution is also firmly in control of the powerful pharmacist union, so over-the-counter medications are still only available through pharmacies.

    Also, many Germans feel everyone should be in the public system and it’s unfair that the wealthy can opt out into private insurances. I tend to agree with this and think everyone should pay in to the public statutory funds and private insurances can then be bought for additional coverage. But that is a debate for another day.

    Christina Geyer has lived in Germany since 2002. She has worked as a clinical trial statistician, planning and analyzing data from pharmaceutical trials, in both the US and Germany and has also worked as a statistician in non-profit health care research in both countries.

    http://www.amiexpat.com/2009/08/18/health-care-in-germany/
     
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  40. Krag

    Krag Planet earth Platinum Bling

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    Until they deal with the greedy corporations, drug companies, nursing homes, hospitals, and other sick care entities that are paid huge money to keep people disabled and weak they will never be able to get costs down. The US is headed for financial default anyway. The political talk is just a smokescreen and the good guys will never win in that until the system is totally broken.
     
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