Magox

No doubt, if Rubio hadn't have had those fateful 5 minutes from the C.C debate, he'd be the front runner right now. That's the way it goes, he'll be back for 2020.

No it doesn't So you cut the specialist pay, which is what would happen under the Medicare-for-all plan and you cut the primary care physician pay through lower reimbursement rates but somehow the lost pay of the specialists results in higher pay for the primary care physicians who had their reimbursements cut?

Nothing you mentioned addressed how drastically reduced reimbursement rates would alleviate primary doctor shortages.

Yes, because cutting their reimbursement rates like you propose is really going to help out with that shortage. BRILLIANT!!!!!

If you think we have a doctor shortage now with the ACA, it wouldn't be nothing compared to single payor "Medicare-for-all". You still have well over 70% of the insured public that is receiving health insurance through private plans not affiliated with the government, meaning that the vast majority of doctors/medical providers receive preferable negotiated reimbursement rates. Primary care physicians make less money than their colleagues, hence the shortage. Applying simple logic dictates that the shortage has a lot to do with how much they are being paid, if they are being paid less and you cut their reimbursement rates another 15-35%, will more people want to be internists/family doctors or less?

There is no perfect system. Having said that transparency would go a long way in helping contain/drive down costs.

Pharmaceutical industries, yes. Insurers, not so much. When you strip out Insurers administrative, marketing and profit margins, you could shave off around 15-20% of the price. When you factor in Medicare's administrative costs, fraud and over payments, you are talking about 13-15%. So the difference between the two is roughly about 3-5%. Steven Brill's 'Bitter Pill' is a great read.

Health reform should first focus on one issue, how to drive down medical costs. Get that in order and things get a whole lot better. A good place to start would be making all medical services/prices fully transparent. People should be able to go online and see what every hospital/medical provider is charging for every procedure/diagnostic testing/service. You thought it was a step in the right direction, I remember having these conversations with you.

Of course the former supporters of the ACA who were all defending it tooth and nail years back despite the constant barrage of analysis that showed it was destined to be a cluster !@#$ are now all walking back away from it and now wanting single payor. Just like many said the ACA wouldn't work, either would single payor here in the U.S

So what you are saying is, you want an activist government?

Cruz has earned the right to be the champion for conservatives. My argument is that I don't think he is truly as far-right as he has portrayed himself, that all along he knew the government shutdown and other actions that have alienated himself among his colleagues was an act. He knew all along that these tactics never had a shot of actually working and with the help from the conservative media hucksters (Levin, Rush, Ingraham, Hannity etc etc) that this would give him lots of cred. Judging his history before he was senator and who his wife is, I think he is more pragmatic than people believe. Having said that, his conservative purity and tactics have boxed him in for the general election. I do believe that he will attempt to moderate his tone and he would have his position on immigration if Rubio hadn't have forced him to be equivocate his opposition to legalizing the illegals. It's going to be very tough for Cruz to win states like Florida, CO, and VA. Hard to see a GOP candidate winning without at least two of those states. That's where Rubio would have had a much bigger advantage over the rest of the field, even though his positions are very conservative (aside from immigration), his tone and demeanor is that of a moderate, which is appealing to many swing voters, and that bared out with his dominance over Hillary in the polls. We'll see how this plays out, N.Y is a very important state, if Trump runs away with it and gets over 50% of the vote, he will get very close to 1237 imo. And getting very close to 1237 increases his odds of winning on the 2nd ballot. At this point it's almost a toss up who will get the nomination, Cruz's organization is really good and I see him snagging a lot more uncommitted delegates than Trump. The question is can he get above 50%? Either way, I see 2016 presidential elections as a lost cause. Never mind the deficiencies Cruz has for general election appeal, Trump has a hardcore 15-20% constituency and do you really think that most of his hard core supporters are going to vote for Cruz when they believe Trump had been robbed at the convention? Trump will very likely win a solid plurality of the votes and in their view that means he should get the nomination. People don't understand these convention rules, they just see who won the most votes. The RNC would be smart to spend a higher amount of it's resources in protecting seats relative to the presidency than in past years. I guarantee you that the Koch network will do that. This is where things stand as of now and it's not pretty.

Yeah

Yeah, well...

We know that you are a Rubio hater and I'm a supporter of his, so let's put that aside and go with the data points. He would have easily defeated her the question is by how much?

Yeah, Rubio would have been a good one. I think Rubio would have not only defeated Hillary but it could have been a landslide. Oooooh well..... Cruz is a smart guy and even though he is a purist and criticizes those "mushy moderates" that run to the middle during election years, my guess is that if he wins the nomination which its looking like he could pull it off on a 2nd or 3rd ballot at the convention, he'll pivot to the middle. I don't believe he is at heart as far out to the right as he has packaged himself and I think he calculated a presidential run even before he got into the senate. Very cunning. But I have my deep reservations about him in a general. And thanks. Good to be back

Thanks And thanks. Was kind of burnt out in arguing and I was entering into my busy time of the year.

I was speaking more broadly to the over regulation and taxes that their governments impose on their constituents, health insurance is one of the huge financial burdens that saddles them with debt and taxes. I'm not arguing against government involvement in healthcare but more so on the unintended affects of these costly programs on some of their economies. Thanks

The implementation of a one-sized all Health system. Bernie Sanders plan is essentially Medicare-for-all on Steroids. It's a popular idea for many because by-in-large medicare beneficiaries are pretty pleased with their Medicare. There are logistical nightmares for implementing such a system. Let me first start off by saying that unlike private insurers, where medical reimbursement rates are negotiated between the medical provider and insurer, the reimbursement rate is not a negotiated rate but an arbitrary fixxed rate set by the government. Which means that many doctors/specialists choose not to participate due to the lower reimbursement rate. So the mechanism they use to try to lower costs are governmental controls rather than addressing the root causes of soaring medical costs. You see a lot of this going on with ACA medical providers. Many of the quality medical providers are moving away to higher paying negotiated rates provided by off-exchange insurers. Which is why many of the ACA HMO lower premium plans which most people choose participate in networks that are very limited due to the lower reimbursement rates. It's very common to set a doctors appointment with your medical provider only to have your appointment realized 6 weeks down the road. As of right now we have about 55 million current Medicare beneficiaries, 65 million Medicaid users and approximately 200 million have private health insurance. So the idea under Bernie is to move the 200 million with private health insurance and additional 50 million that are the current uninsured to Medicare. I assume Bernie would like to do away with Medicaid an move them onto Medicare as well. So what would a one-size-fits-all healthcare system look like from where the US is right now? Well, we know that Medicare would reduce the medical reimbursement rates to doctors, specialists, hospitals etc. Meaning that there would be an arbitrary figure to determine what each medical provider should receive for their services. Considering that each medical provider has their own set of costs due to regional factors, taxes, population and population demographics it is a system that poses a lot of financial burdens to many providers who can not cope with the lower reimbursement rates. A profitable hospital in Dade county can absorb lower reimbursements whereas a hospital in a more rural county can not. Not all hospitals or medical providers are profitable. The idea that you are going to cut reimbursements by 20-35% without there being a significant unintended consequence is simply not rooted in reality.- Many hospitals would shutter, tons of medical providers wouldn't participate in the lower reimbursement insurance provided by the government and would move to either concierge medicine and/or accept the higher paying private insurers. Which is fine, except there is one little problem with this. We already have doctor shortages as it is, you add an additional 50 million uninsured people to the rolls (which I support expanded health coverage) and you have doctors moving to higher forms of reimbursements you essentially create lots of shortages in the delivery of medicine which runs counter to achieving the goals of the intended reform. What about efficiency and fraud? Right now with approximately 14% of the population currently is on Medicare, there is over $50 Billion a year in fraud, if you were to end up with 90% of the population on Medicare you are looking at over $300 B in fraud alone. The over protections for workers in governmental jobs borders on absurdity. The efficiency in most governmental held functions is much lower than the private sector, primarily due to the incentive structure within each irrespective entity to perform at higher levels. It is nearly impossible to rid of a gov. employee for low-job-performance, whereas in the private sector there is an open market for each position meaning that accountability is held at a higher premium. Accountability is big issue, which leads to higher fraud and less efficiency. What about the overall cost and where would the cost come from? Projections vary, even left leaning economists expect the cost of Bernie's proposals to be somewhere in the ballpark of $2-3 TRILLION a year. Lets add some perspective to this, the total budget of the federal government for 2017 is expected to be around $4 Trillion. We are talking about an increase of approximately 50%. I don't care how much you soak the rich there is no way you can feasibly come to that number. Bernie's proposals for "Medicare for all" consists of plans that have no premiums, no deductible no copays, just to be clear this isn't simply "Medicare for all" this is something more than what current Medicare offers. Sounds wonderful, but so do puppies and rainbows. This is simply not workable. There is no way to offset the costs under this proposal. 1) Bernie wants to increase marginal income taxes by a huge amount, I'm not going to get into the drawbacks of such a proposal because that is a whole separate argument, but even such a tax increase does little to impact the cost incurred under the plan. 2) Wants to end tax breaks for capital gains and dividends. Sounds like a good way to get Wall Sreet, right? Except it really isn't, most beneficiaries from capital gains and dividends believe it or not, are not from those 1%'ers but rather from retirees, pension funds heavily used by Unions, government workers etc. So yes, while you are hitting the rich you are also hitting many middle to upper middle class folks. 3) additional taxes for the rich of limiting tax deductions past $250k. Which would bring in $15 B a year according to Bernies figures. Even if you want to accept the idea that these taxes wouldn't have an impact on the economy, they still do very little to address the total cost of his plan. Set aside the fact that we can't come close to covering the cost of such an endeavor or the logistical nightmares that would be imposed on the delivery of medicine, what would this mean for the country moving forward? You hear the constant argument, "Well, they do it in Europe and that's what we should do" Ok. I get it, they are providing healthcare for their residents. But is it a mere coincidence that European governments all have persistent high debt, high unemployment and virtually no growth rates? If it wasn't for the influx of middle eastern refugees there would be no population growth, simply because they aren't desirable places to move to. People move to Europe and find there are few job opportunities. Look at the financial downturn, we look here at the U.S and say our economy sucks. True, it is crummy relative to where we use to be but it's still a lot better than where our European counterparts are. I could go on and on about the stifling effects of over regulation and taxation and what it does to innovation and growth but I'll save that for another day.

Sure it can and it is.

Everyone likes the idea of Medicare for all until you have to put it into practice and consider the cost and pay-for's . This is similar to the typical response I get from the Bernie supporters.

Don't get me wrong, I do think Hillary is corrupt but I also believe she won't be as feckless and weak on the FP world stage and that she would be much more willing to work across the aisle with Republicans and willing to make much-needed changes to the ACA than Obama. I could be wrong and she may govern as a complete left winger but I do believe her instincts are more to the center than Obama's. In regards to Trump supporters, you can't pigeonhole them like you can some other candidates supporters, they transcend across all socio-economic and regional demographics. My in-laws much to my horror are Trumpkins and they are both college educated folks, I've always found them to be reasonable people. However, much like the rest of the Trumpkins, when I spoke with them about his deficiencies they either A) chalked it up to bluster and didn't take it seriously and B) Didn't care because he was from the outside and he was going to "shake up the system". ughh In regards to Bernie supporters, you nailed it. I've been making the same argument for a while now. He's an idea, some people like the idea of education and healthcare being provided to them at no cost from the government. And they love the idea of those cheating 1%'ers and corporations paying for it. I can never have a rational conversation with these folks because when I go into detail and how logistically it is a wholly unworkable plan, not to mention that the total cost of his proposals are astronomically high and that his plans to soak the rich wouldn't even come close to paying for it. They hardly ever have a response to these minor details and just usually go back to "We can't keep doing what we are doing" or "We need a more educated populace and healthcare costs are higher here than anywhere else". Never mind the fact that Congress would ever go along with it not even his own colleagues in the Senate in house would have the stomach for it. By the way, has anyone read his healthcare plan? It's basically Medicare for all on steroids. I'll save that for another day

It's not that Cruz's stance on social issues are unwinnable for the general election (even though it is a negative), it's that he isn't an effective enough communicator with an inclusive enough message for those outside of conservative base to either win those middle-of-the-road voters over or at the very least appear palatable enough to offset those positions. He is as fluent as they come in right wing speak, but the general election is a whole another ball game and his appeal is limited. Make no mistake, he's a million times better than the narcissistic know-nothing Trump but Cruz is still going to get defeated pretty easily by Hillary. With Trump, it's a landslide loss, the GOP loses the senate and possibly the house. With Cruz you probably get similar presidential results of Obama/Mccain 08, and you may retain the Senate and definitely the house.

Unfortunately, no one will try to actually address this with any sort of meaningful reforms. Special interests and overzealous idealistic constituencies make things almost impossible for politicians to actually tackle problems. So what do we get? The left pushes for overly intrusive regulations and punitive taxation measures and the right will turn a blind eye. In other words, nothing gets done. Rinse and repeat.

That was quite the read up.

Whitner never lived up to where he was drafted, but he has still been better than safeties in the league. I think there is probably too much baggage between Whitner and Buffalo but we do need more safeties. Having said that, I think he's out of our price range anyway.