Leon Troutsky

"Repealing" Obamacare...campaign rhetoric meets political reality.

1,286 posts in this topic

9 hours ago, GEORGIAfan said:

But it is not via hospitals. It is via giving poor people getting free healthcare. The hospital supply is not increase. The demand for healthcare is what is increasing. Hospitals get a huge benefit, but that is because they have more customers who are actually paying for services. Supply side would probably be if they increase the number of doctors or nurses or tax breaks for hospitals treating uninsured/poor patients. I still do not see how free healthcare can be remotely considered supply side. 

It is via hospitals.  Financially, they have the most to gain by expanding Medicaid.  And full disclosure, that would benefit me personally.  I still disagree with it, however.    

Read up on supply side.  It's a lot of things.  Technically, though, it's the idea that if you improve supply of something, you increase demand which in turn creates jobs, because you need more supply.  I don't really agree that it works in healthcare as much as some of the arguments you're making, because healthcare demand is fairly inelastic.  

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3 hours ago, kicker said:

It is via hospitals.  Financially, they have the most to gain by expanding Medicaid.  And full disclosure, that would benefit me personally.  I still disagree with it, however.    

Read up on supply side.  It's a lot of things.  Technically, though, it's the idea that if you improve supply of something, you increase demand which in turn creates jobs, because you need more supply.  I don't really agree that it works in healthcare as much as some of the arguments you're making, because healthcare demand is fairly inelastic.  

They have the most to gain because they are the ones that provide the most healthcare. Tesla benefits the most from electric car tax credits, but that does not mean it is supply side. The demand is being subsidized. That still does not change the fact that supply is still the same as before. Demand is still the thing that is being increased. People now do not have to worry about the cost of healthcare because the government is paying for it, so they demand more. Jobs and financial benefits are coming out of that increase in demand and usage of healthcare services by people who were originally price out, but are now being subsidized by the government. 

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2 hours ago, GEORGIAfan said:

They have the most to gain because they are the ones that provide the most healthcare. Tesla benefits the most from electric car tax credits, but that does not mean it is supply side. The demand is being subsidized. That still does not change the fact that supply is still the same as before. Demand is still the thing that is being increased. People now do not have to worry about the cost of healthcare because the government is paying for it, so they demand more. Jobs and financial benefits are coming out of that increase in demand and usage of healthcare services by people who were originally price out, but are now being subsidized by the government. 

Your electric car analogy is a head scratcher.  The only thing the two have in common are the government(taxpayer) footing the bill on both.  

Increased coverage actually isn't increasing demand for emergency care.  PCP demand has risen and will continue to rise, but most of that demand is coming from an aging population as well as population growth.  Expanded health coverage (all coverage, not just Medicaid) is a small part of the equation.  

http://www.commonwealthfund.org/publications/press-releases/2015/feb/modest-impact-on-primary-care

As for supply side economics, you still have no idea what you're talking about.  Supply has actually increased steadily with demand.  In addition, medical staff are are being paid more and hospitals are in much better shape than they were in 2012.  That's not just our anecdotal experience in a state that didn't expand Medicaid.  It's happened everywhere.  Part of it is the ACA.  Part of it is the economy.  

Again, I'm not making an argument for supply side.  I noted trickle-down was a big component of your article links.  In particular, you noted one from KFF.  Since KFF was nice enough to provide links to their data, I decided to look it up.  Colorado in particular.  

http://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_Expansion_Full_ONLINE_052316.PDF

Go to page 19 and read it.  It flat out tells you that Medicaid expansion will create jobs within the heath care industry and those jobs will increase wages and increase the economy, according to them.  That's your links conclusion.  

 

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10 minutes ago, kicker said:

Your electric car analogy is a head scratcher.  The only thing the two have in common are the government(taxpayer) footing the bill on both.  

Increased coverage actually isn't increasing demand for emergency care.  PCP demand has risen and will continue to rise, but most of that demand is coming from an aging population as well as population growth.  Expanded health coverage (all coverage, not just Medicaid) is a small part of the equation.  

http://www.commonwealthfund.org/publications/press-releases/2015/feb/modest-impact-on-primary-care

As for supply side economics, you still have no idea what you're talking about.  Supply has actually increased steadily with demand.  In addition, medical staff are are being paid more and hospitals are in much better shape than they were in 2012.  That's not just our anecdotal experience in a state that didn't expand Medicaid.  It's happened everywhere.  Part of it is the ACA.  Part of it is the economy.  

Again, I'm not making an argument for supply side.  I noted trickle-down was a big component of your article links.  In particular, you noted one from KFF.  Since KFF was nice enough to provide links to their data, I decided to look it up.  Colorado in particular.  

http://www.coloradohealth.org/sites/default/files/documents/2017-01/Medicaid_Expansion_Full_ONLINE_052316.PDF

Go to page 19 and read it.  It flat out tells you that Medicaid expansion will create jobs within the heath care industry and those jobs will increase wages and increase the economy, according to them.  That's your links conclusion.  

 

 

In both cases the government is subsidizing the demand not the supply. Increase in demand would also account for creation of jobs in the industry as well as wages and economy. That still does not make it supply side. 

Quote

Effects of Supply Subsidies

When the government provides a supply-side subsidy to the producers of a product, the supply curve shifts to the right and the demand curve remains the same. Because they are being subsidized, producers are encouraged to produce more of a product and are able to do so for less. The price of an environmentally conscious vehicle drops and more are produced. In practice, a supply-side subsidy will cause the demand for a green vehicle to increase.

Effects of Demand Subsidies

When the government provides a demand-side subsidy to consumers, it encourages them to purchase a given product. For example, a tax rebate to consumers who purchase a green car will in theory cause the demand curve for environmentally conscious vehicles to shift up and to the right, while the supply curve stays the same. Because consumers will be paying less, producers can actually increase the price because producers can charge more and consumers are being artificially encouraged to purchase green cars, producers are encouraged to produce more. The price and the quantity produced both increase.

 

It is very clear that Medicaid expansion fits with demand subsidy more than supply subsidy. Hospitals get the main benefit the same way Tesla does because they are the main source, but health clinics are also seeing better revenue compared to non expanded states. Plus how many times have people complained about increase in costs since Obamacare has passed. That goes directly against your claim of supply side.

 

Also Hospitals are in better shape because they are getting paid for services that they give patients. The 1 billion dollar decrease in uncompensated patient care was not because the supply magically went up, but because the demand was being funded. 

 

And the conclusion of the KFF paper mentions specifically that it is an increase in demand and shortage, which makes no sense if the it was actually the supply being increased.

Quote

Conclusion

Although states only began implementing ACA Medicaid expansions about two and a half years ago, a large body of literature analyzing the effects of expansion has developed. In general, this research suggests that expansion has had largely positive impacts on coverage, access to care and utilization, as well as economic outcomes, including impacts on state budgets, the payer mix for hospitals and clinics, and employment and the labor market. Yet, some studies do not find significant impacts and some point to challenges following expansion, such as provider shortages in some areas. These challenges may make it difficult to meet the increased demand for care among the newly-eligible Medicaid population.

 

Quote
  • Studies also demonstrate that providers have experienced increases in Medicaid patient volume following expansion. While some research indicates that provider shortages are a challenge in certain contexts, many studies show that providers have expanded capacity and are meeting increased demands for care. One additional study found improvements in receipt of checkups, care for chronic conditions, and quality of care even in areas with primary care shortages, suggesting that insurance expansions can have a positive impact even in areas with relative shortages.73,74,75,76,77,78,79,80,81,82,83,84,85

 

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53 minutes ago, GEORGIAfan said:

 

In both cases the government is subsidizing the demand not the supply. Increase in demand would also account for creation of jobs in the industry as well as wages and economy. That still does not make it supply side. 

 

It is very clear that Medicaid expansion fits with demand subsidy more than supply subsidy. Hospitals get the main benefit the same way Tesla does because they are the main source, but health clinics are also seeing better revenue compared to non expanded states. Plus how many times have people complained about increase in costs since Obamacare has passed. That goes directly against your claim of supply side.

 

Also Hospitals are in better shape because they are getting paid for services that they give patients. The 1 billion dollar decrease in uncompensated patient care was not because the supply magically went up, but because the demand was being funded. 

 

And the conclusion of the KFF paper mentions specifically that it is an increase in demand and shortage, which makes no sense if the it was actually the supply being increased.

 

 

So you're just going to continue to argue something you don't understand...that's your right.  I've already shown you that the supply side is expected to benefit the economy, according to your links.  The demand for healthcare is only increasing marginally with increased coverage, and that's all coverage, not just the Medicaid expansion.  And more specifically primary care demand is what has increased, but again only marginally, and mostly driven by population growth and an aging population.  Here's a government link that says only 19% of demand growth will be driven by increased health coverage.  https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020

Here's another link that says primary care physician demand is expected to grow 17% between 2013-2025.  The ACA will account for 2% of that growth.  That puts healthcare expansion at .16% of annual demand increases.  https://www.aamc.org/download/426260/data/physiciansupplyanddemandthrough2025keyfindings.pdf

And before you jump in with an Aha!, I went ahead and checked non-surgical specialties as well.  The largest demand increase attributable to the ACA is expected to be otolaryngology, at 5.2% through 2025, or .4% annually.  

https://www.aamc.org/download/426242/data/ihsreportdownload.pdf

It's pointless for me to argue this further with you until you actually understand what it is you are saying.

 

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3 hours ago, GEORGIAfan said:

 

In both cases the government is subsidizing the demand not the supply. Increase in demand would also account for creation of jobs in the industry as well as wages and economy. That still does not make it supply side. 

 

It is very clear that Medicaid expansion fits with demand subsidy more than supply subsidy. Hospitals get the main benefit the same way Tesla does because they are the main source, but health clinics are also seeing better revenue compared to non expanded states. Plus how many times have people complained about increase in costs since Obamacare has passed. That goes directly against your claim of supply side.

 

Also Hospitals are in better shape because they are getting paid for services that they give patients. The 1 billion dollar decrease in uncompensated patient care was not because the supply magically went up, but because the demand was being funded. 

 

And the conclusion of the KFF paper mentions specifically that it is an increase in demand and shortage, which makes no sense if the it was actually the supply being increased.

 

 

Dude, kicker has proven his point very succinctly at this point.  No harm in admitting this like you admitted I was right about the election.  Heck, I've had to admit my mistakes on here from time to time.  

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1 hour ago, WhenFalconsWin said:

Dude, kicker has proven his point very succinctly at this point.  No harm in admitting this like you admitted I was right about the election.  Heck, I've had to admit my mistakes on here from time to time.  

He has still not proven that the supply of healthcare is what is increasing. 

edit: As you have pointed out, I have no problem admitting mistakes when I am wrong, and I have no problem being wrong, but it still looks like demand side subsidy. 

Quote

Bill Carpenter, CEO of LifePoint, which operates hospitals in both Arizona and Tennessee, said it's well worth it for hospitals to pay an assessment to make Medicaid expansion possible, and it's probably the best strategy to win over Republican lawmakers.

http://www.modernhealthcare.com/article/20141220/MAGAZINE/312209962

If this was supply side, then why are hospitals willing to help cover the costs of expansion. Also if we took Kicker's argument to the extreme, then single payer healthcare is a supply side solution. 

2 hours ago, kicker said:

So you're just going to continue to argue something you don't understand...that's your right.  I've already shown you that the supply side is expected to benefit the economy, according to your links.  The demand for healthcare is only increasing marginally with increased coverage, and that's all coverage, not just the Medicaid expansion.  And more specifically primary care demand is what has increased, but again only marginally, and mostly driven by population growth and an aging population.  Here's a government link that says only 19% of demand growth will be driven by increased health coverage.  https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020

Here's another link that says primary care physician demand is expected to grow 17% between 2013-2025.  The ACA will account for 2% of that growth.  That puts healthcare expansion at .16% of annual demand increases.  https://www.aamc.org/download/426260/data/physiciansupplyanddemandthrough2025keyfindings.pdf

And before you jump in with an Aha!, I went ahead and checked non-surgical specialties as well.  The largest demand increase attributable to the ACA is expected to be otolaryngology, at 5.2% through 2025, or .4% annually.  

https://www.aamc.org/download/426242/data/ihsreportdownload.pdf

It's pointless for me to argue this further with you until you actually understand what it is you are saying.

 

You still have not shown how it is supply side. You have claimed the economic benefits come from supply side, but still have not shown that expanding healthcare for poor people is a supply side tactic. Lets say I suspend my argument that it is demand side subsidy, how is it the supply side of healthcare. What supply is increasing in this regard.

Also is 2% not already a sizable increase? In one of your article, it mentioned that it would equate to 70 more patient visits per physician. That is clearly a sizable increase. That ACA has only increase health insurance coverage for about 5-6%.

gallup-healthways-2nd-quarter-2015-aca-u

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THE SUPPLY-SIDE ECONOMICS OF REFORM

 

IHPI member Tom Buchmueller views healthcare reform through the familiar prism of an economist: supply and demand. In collaboration with other IHPI members, he is observing healthcare reform from both sides of the equation.

Buchmueller is a professor of Risk Management, Insurance, Business Economics and Public Policy, and Chair of Business Economics at the U-M Stephen M. Ross School of Business. He holds a joint appointment in the Department of Health Management and Policy in the U-M School of Public Health. In 2011-2012 he served as Senior Health Economist for the President’s Council of Economic Advisors.

As he explains, both the Affordable Care Act and the Healthy Michigan Medicaid expansion are demand-side reforms, intended to put more people in a position to consume (demand) services. He notes that with the expansion of coverage, stakeholders now have a greater incentive to get serious about controlling costs — the supply side.

One major supply-side concern is whether the influx of newly-insured patients will overwhelm providers, impacting the availability, cost and quality of care. He recently led a study find out how providers react when more patients are covered by insurance. Since data from the newly-enacted reforms is not yet available, Buchmueller identified a useful surrogate for his study: dental care.

He looked at data from states that added a dental benefit to adult Medicaid coverage to see how the corresponding increase in the number of patients (the demand side) impacted the care provided by dentists (the supply side). The study revealed that with expanded coverage, more dentists accepted Medicaid patients without decreasing the number of appointment slots available to patients with private insurance. While the volume of care delivered increased, both patient wait times and the hours dentists worked increased only moderately, because dentists relied more heavily on the support of hygienists.

For health policy researchers, this study illustrates the value of looking to both at both the provider (supply) and patient (demand) sides of the equation to assess the impact of reform.

For primary care providers, the experience of their dental colleagues may hold an important lesson in how to handle additional patient volume without compromising the quality of care.

IHPIlogo.png

http://ihpi.umich.edu/initiatives/supply-side-economics-reform

Author's qualifications

Tom Buchmueller is a health economist whose research focuses on the economics of health insurance and related public policy issues. His recent work has examined the relationship between employer-sponsored insurance and labor market outcomes, interactions between the public sector and private insurance markets and consumer demand for health insurance. Before joining the Ross School faculty, Buchmueller was Professor of Economics and Public Policy at the Paul Merage School of Business at the University of California, Irvine. He was a Packer Policy Fellow at the University of Technology, Sydney (2006-2007) and was a visiting researcher at the Federal Reserve Bank of San Francisco (2005-06), INSEAD (2001-2002), the Centre de Recherche d'Edtude et de Documentation en Economie de la Sante' (2001-2002) and the University of York (1997).

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8 minutes ago, GEORGIAfan said:

He has still not proven that the supply of healthcare is what is increasing. 

You still have not shown how it is supply side. You have claimed the economic benefits come from supply side, but still have not shown that expanding healthcare for poor people is a supply side tactic. Lets say I suspend my argument that it is demand side subsidy, how is it the supply side of healthcare. What supply is increasing in this regard.

Also is 2% not already a sizable increase? In one of your article, it mentioned that it would equate to 70 more patient visits per physician. That is clearly a sizable increase. That ACA has only increase health insurance coverage for about 5-6%.

gallup-healthways-2nd-quarter-2015-aca-u

2% over a 13 year period.  No, that's a very small increase.  

I never said that expanding health insurance for the poor was a supply side tactic.  You made the comment that it would help the economy, and then you linked up a bunch of quotes saying how expanding healthcare would help the economy.  When I actually read your links, it became very obvious that, according to your links, the economic growth would be driven by the increase in health care services, which then trickle down to other parts of the economy.  That is supply side theory.  

I think the biggest problem you're having with all of this is that you think with Medicaid, the poor are actually receiving something they didn't before.  In reality, they aren't.  The hospitals are receiving the direct financial benefit, and they are taking that money and investing it into their system, which then trickles down.

Your example of Tesla is very different.  The tax credit, paid to the end consumer, is designed to increase demand, which then enables Tesla to sell more cars, employ more people and boost the economy.  

 

 

 

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4 minutes ago, GEORGIAfan said:

THE SUPPLY-SIDE ECONOMICS OF REFORM

 

IHPI member Tom Buchmueller views healthcare reform through the familiar prism of an economist: supply and demand. In collaboration with other IHPI members, he is observing healthcare reform from both sides of the equation.

Buchmueller is a professor of Risk Management, Insurance, Business Economics and Public Policy, and Chair of Business Economics at the U-M Stephen M. Ross School of Business. He holds a joint appointment in the Department of Health Management and Policy in the U-M School of Public Health. In 2011-2012 he served as Senior Health Economist for the President’s Council of Economic Advisors.

As he explains, both the Affordable Care Act and the Healthy Michigan Medicaid expansion are demand-side reforms, intended to put more people in a position to consume (demand) services. He notes that with the expansion of coverage, stakeholders now have a greater incentive to get serious about controlling costs — the supply side.

One major supply-side concern is whether the influx of newly-insured patients will overwhelm providers, impacting the availability, cost and quality of care. He recently led a study find out how providers react when more patients are covered by insurance. Since data from the newly-enacted reforms is not yet available, Buchmueller identified a useful surrogate for his study: dental care.

He looked at data from states that added a dental benefit to adult Medicaid coverage to see how the corresponding increase in the number of patients (the demand side) impacted the care provided by dentists (the supply side). The study revealed that with expanded coverage, more dentists accepted Medicaid patients without decreasing the number of appointment slots available to patients with private insurance. While the volume of care delivered increased, both patient wait times and the hours dentists worked increased only moderately, because dentists relied more heavily on the support of hygienists.

For health policy researchers, this study illustrates the value of looking to both at both the provider (supply) and patient (demand) sides of the equation to assess the impact of reform.

For primary care providers, the experience of their dental colleagues may hold an important lesson in how to handle additional patient volume without compromising the quality of care.

IHPIlogo.png

http://ihpi.umich.edu/initiatives/supply-side-economics-reform

Author's qualifications

Tom Buchmueller is a health economist whose research focuses on the economics of health insurance and related public policy issues. His recent work has examined the relationship between employer-sponsored insurance and labor market outcomes, interactions between the public sector and private insurance markets and consumer demand for health insurance. Before joining the Ross School faculty, Buchmueller was Professor of Economics and Public Policy at the Paul Merage School of Business at the University of California, Irvine. He was a Packer Policy Fellow at the University of Technology, Sydney (2006-2007) and was a visiting researcher at the Federal Reserve Bank of San Francisco (2005-06), INSEAD (2001-2002), the Centre de Recherche d'Edtude et de Documentation en Economie de la Sante' (2001-2002) and the University of York (1997).

Sigh.  Demand-side reform.  The ACA is designed to increase demand, which I've already shown you it doesn't, at least not much.  Certainly not enough to register any economic gain.  The supply side is what grows the economy in this equation.  I've already shown you that data from your own link.  I'm done here.  

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Support for the GOP healthcare bill dropped considerably:

170322_replacement-1.png

And the Morning Consult/Politico poll has amogn the highest levels of support for the bill compared to other polls out there.  The only thing that's good for the GOP is that there's still al ot of "Don't Know" responses.

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3 minutes ago, capologist said:

There's reportedly 36 Republican no's waiting for it in the Senate...

Ryan just wants to drop this bag of **** on McConnell's doorstep so he can say he did his part.

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35 minutes ago, capologist said:

There's reportedly 36 Republican no's waiting for it in the Senate...

This is being rushed though without much thought.  Of course we're talking Ryan who would gladly throw Trump under a bus.  I think he should've slowed his roll and got this thing right the first time.  By then the ACA would've completely fallen apart.  

 

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3 minutes ago, WhenFalconsWin said:

This is being rushed though without much thought.  Of course we're talking Ryan who would gladly throw Trump under a bus.  I think he should've slowed his roll and got this thing right the first time.  By then the ACA would've completely fallen apart.  

 

Trump is actively pushing for the bill to be passed ASAP.

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Just now, Psychic Gibbon said:

Trump is actively pushing for the bill to be passed ASAP.

I think this three tier process was not a good solution.  He is trying to push it through because he knows it will get better down the road.  I don't think that is a good a selling point to the American people, on this he can blame Ryan.  On the optics on the entire process I can blame Trump.  No need to rush something through that is not exactly what he promised.  Fall back, work on tax reform first.  

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26 minutes ago, WhenFalconsWin said:

I think this three tier process was not a good solution.  He is trying to push it through because he knows it will get better down the road.  I don't think that is a good a selling point to the American people, on this he can blame Ryan.  On the optics on the entire process I can blame Trump.  No need to rush something through that is not exactly what he promised.  Fall back, work on tax reform first.  

Technically this is tax reform. I forget the exact mechanisms (and someone correct me if I'm wrong) but in order to make policy changes (eg. removing state lines for insurance, like Trump campaigned for) to the ACA they would require 60 votes in the Senate. It is safe to say that everyone recognizes that they don't have a chance in **** of getting those votes so that option is stillborn. However, what they can do is a budget reconciliation of the bill to reform the taxes and funding of the ACA since that requires a simple majority.

This entire process has more or less the GOP keeping the structure of the ACA intact, since they can't really change it, trying to remove the funding which it requires to function, renaming it the ACHA, then trying to declare that this is a repeal and replace of Obamacare. They have to do something about it right away since they finally can do something about it after whipping their voters into a frenzy about the subject for nearly a decade and this is (pathetically) the best they can do and to give Trump the repeal ceremony he craves, even if the bill contains nothing he campaigned for or promised.

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Democrats have a chance to go with a single payer system now?  Where do they find these people?  When they find them are the comatose?  

 

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6 minutes ago, WhenFalconsWin said:
Democrats have a chance to go with a single payer system now?  Where do they find these people?  When they find them are the comatose?  

Gallup poll: 58% of U.S. adults support Bernie Sanders' single-payer, “Medicare-for-all” health care system, including 73% of Dems and 41% of Republicans (link)

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Just now, Billy Ocean said:

Gallup poll: 58% of U.S. adults support Bernie Sanders' single-payer, “Medicare-for-all” health care system, including 73% of Dems and 41% of Republicans (link)

No, understood.  My point is why do the democrats who have no power right now, think they have a chance to snatch a system away from the GOP?  

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53 minutes ago, Billy Ocean said:

Gallup poll: 58% of U.S. adults support Bernie Sanders' single-payer, “Medicare-for-all” health care system, including 73% of Dems and 41% of Republicans (link)

I'm down for single-payer, just not Sanders' plan. The numbers of his plan never lined up.

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52 minutes ago, WhenFalconsWin said:

No, understood.  My point is why do the democrats who have no power right now, think they have a chance to snatch a system away from the GOP?  

They can do what the GOP never bothered to do while foaming at the mouth about Obamacare: They can present an alternative plan to a problem instead of just saying a catchphrase like 'Repeal and Replace,' promote it, and champion it while campaigning.

I'm not going to hold my breath on it happening though. That seems too... what's the word? Competent? Lets just go with that.

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