right, so let's go over your costs.

So every time a doctor sees a patient on medicare their expectation is to lose $5?

Medicaid, not medicare. Medicaid you lose much more than $5, usually. In my line of work Medicare pays pretty well, and I'm happy to have it.

I can only speak to hospital finances, and my information is now a couple years out of date, as happily I'm no longer doing any admin stuff. In 2015, for the hospital the assumption was that if you ran a tight ship, squeezed costs and paid attention you could JUST eek out a profit on medicare. Not enough to pay for any fancy new equipment or buildings, but you could keep the lights on and pay the staff.

Medicaid varies from state to state as it's a state program. Depending on the state it pays some percentage of Medicare for primary care, obstetric care and "other" (three seperate pay tables) - ranging from 35% or so to about par (rarely). Meaning that you lose money on every patient you see. You simply can't make up the fixed costs of laundry, equipment and staffing.

Add in arcane billing issues and a general ****-the-docs mindset (for years, Medical routinely denied essentially 100% of bills submitted and made you resubmit, just to string out your payment) and it's not awesome. Until a couple of years ago our billing company advised us to not even bother billing Medical, as the cost of billing was about the same as what we collected. I understand it's marginally better now. Note that I'm speaking from the docs point of view solely as an ER doc. Dunno about other specialties.

MM MD

https://twitter.com/ASlavitt/status/875452710316912640

Could there be any greater evidence than the handling of this bill that the Congressional GOP is bought and paid for? No one wants this except the billionaire Republican donor class. These guys have to go out and justify to the press their horrible conduct to ensure the passage of this horrible bill, which even large swathes of the right wing media dislikes. But Charles Koch paid their way all this time to repeal Obamacare, and goddammit he's not gonna wait any longer.

a good rundown of the cats Mitch McConnell needs to herd, in fact he needs 9 out of the 11



https://twitter.com/Taniel/status/872231618769022980

Note that this was compiled before it was reported that Trump said the house bill was mean.

And from what I've gathered Paul is always a no. Collins is very likely to be a no, and Murkowski, it was reported today, is troubled or whatever the hell they say before they always fall in line.

https://www.vox.com/policy-and-polit...explain-please

Wherein key republicans working on the senate health bill have no clue what the bill will do or who it will effect.

Chuck Grassley has the best line where he says, basically, the bill will provide certainty by letting insurers jack rates sky high. Also admits not passing this bill would provide certainty.

Yeah I just read that Vox article as well. They have no idea what's going on.

I'll also +1 Noodle's Vox article. They would have been better off / more honest saying the bill fixes the problem of having a law named after Obama.

ETA: Murkowski and Capito's answers were okay. Murkowski actually seems like she has a clue about governance.

That vox article is amazing. Clueless dummies. They sound more clueless than the house.

They can't even say gutting what is covered would provide lower premiums. None of them understand what healthcare is or how the current laws work. There is a 100% chance their bill will be a historical disaster.

I love the picture of Bozeman with the Medicare D sign which was one of the most poorly designed pieces of legislation in history.

The donut hole was just amazing capitulation to the insurance industry and was a nightmare for hundreds of thousands and millions of older people.

By the way I Love how many of them want to lower premiums AND bring coverage back to counties that lost exchange coverage.

Besides the nonsensical goal of lower premiums (this is trivial, premiums could be $1 a month it all relates to what is actually covered) how will they get providers to provide in areas they allegedly left due to losing money by lowering premiums.

This is a complete logic failure. The Alaskan Senator is the only one who wants better coverage and lower premiums but still manages to throw in some of the impossible and illogical arguments.

Nobody is saying we need to provide BETTER and more affordable healthcare. They talk about things like competition and how they think that is magically going to solve everything like none of them understood how insurance worked before the ACA.

You know how you get coverage for people? You require the insurance companies to provide it via regulation or they can sit out of the business entirely. Whatever they come up with will suck for everyone who wants insurance coverage, it is pretty much guaranteed. It seems like they would all fail a quiz on what insurance actual is and how it works.

Sounds like they really aren't even close to crafting a bill and if they do then it would have to go back to the house again anyway.

I feel like they just wanna show their donors/special interests like Heritage, Club for Growth, grassroots groups, etc that they tried to repeal it but then eventually they won't do so. And then they will raise the subsidies, try to fix obamacare but somehow do so in a way where it can no longer be called Obamacare. That is obviously #1 for them, it has to be called something else.

I know they need to repeal for tax cut purposes but it really doesn't seem like they are very close.

Jesus Christ, I'm having flashbacks of how the UIGEA passed...

Republicans secretly working eliminating healthcare for millions of americans.
Media doesn't give a single ****.

Their excuse for being completely silent is great, too, "How can we report on it if they're doing everything in secret?"

You dip****s jerked off about a missing plane for 2 months, I think you can figure something out.

Said this before but healthcare is complex and tedious discussion. Still weird that Trump ran on insuring everyone for cheaper and there are like 5000 soundbites of that and the media doesn't even care. As far as policy goes, this is his 1st big ****up that people would actually give a **** about.

Talking about Russia is way better ratings.

https://twitter.com/sahilkapur/statu...12298022977536

The Republican PR idea of 'coverage' though is the amount of people with a plan though. Their trick is to gut preexisting conditions which at least in isolation would lower premiums and and increase 'coverage' making it a PR win, which is all they really care about. They're hoping that the political cost of people paying for essentially nothing and showing up the the ER to find out that they don't have coverage for anything would be less than the PR of announcing their giving coverage and lowering premiums. In their world in any case this is a 'win - win' because people are getting what they want, if they wanted coverage for various things they'll obviously pay for it. That that's not how the market will work out is just annoying liberal factoid, which is why they were mad at the CBO for counting stripping pre-existing conditions as losing insurance. How many people actually believe their idea of having plans that don't cover anything counts as fraud is another issue for the GOP.

I think the GOP bet is that people won't make the connection between finding out their "insurance" is worthless and the Republican Party. Sadly, I don't think they are wrong. Many will just blame "insurance companies." And a sizeable chunk of deplorables will blame libs somehow (Obamacare so terrible we can't even fix it or something)

Democratic Senators are now reading stories of constituents who would die under RepubliCare.

https://www.c-span.org/networks/?channel=c-span-2

This is exactly what I expect to happen. I think they're going to force insurance companies to sell to people with pre-existing conditions, with little to no requirements on pricing or what's covered. Thus they can say, "We preserved important protections for people with pre-existing conditions. Everyone in America has access to health insurance, which is a beautiful thing and a huge improvement over job-killing death-panel ISIS-loving Obamacare."

They'll lift regulations on what must be included in all plans, which will bring premiums down. So they'll brag on that, too. When people start figuring out that they don't actually have coverage for a lot of different illnesses/emergencies/whatever, they'll blame Obamacare and say they couldn't fix it all at once because that commie, traitor, Kenyan, Muslim, ISIS-founding Nancy Pelosi loving liberal worst POTUS of all time Barack Hussein Obama didn't care about hard working Americans.

If that doesn't work, they'll publicly take shots at the insurance industry while taking their money and giving them secret handshakes in the smoky backrooms.

When all else fails, they'll wring their hands over making sure that lazy unemployed people don't get any undeserved benefits and say that's why they can't really fix it. The lazy unemployed white Trumpers will intuitively understand that this doesn't really apply to them, and keeping pulling the lever for the good old GOP.

Well this is something I agree with you on. A lot of the media folks seem pretty weak in the area of critical thinking skills. The Republicans are going to take beating with the way they're going on this. My take, FWIW, is that overwhelmingly John Q Citizen does not want to throw people with pre-existing conditions under the bus. Overwhelmingly John Q Citizen wants people to have access to quality health care. Hobbes has made some very insightful posts in this thread in my view. Particularly about Medicare pricing. We'll see how it works out.

Look, future Veep!

https://twitter.com/GovPenceIN/status/7720153887

It befuddles trump supporters and ACA haters that if the ACA is so horrible there would be immediate relief from quick and total repeal setting the clock back to before it started.

It's ah indefensible position for them though and they just drool. That is why the AHCA has been a farce. If there was any truth in the republicans screaming repeal for years then they could have swiftly stopped the bleeding by repealing it in January.