You used a lot more words, but you didn’t give me any more than I gave you. Sure, expanding stuff sounds great. Giving people stuff sounds great. All we have at the moment is it’s going to cost $3.5 trillion (plus the $1.2 trillion bill) to get the great thing for which the details are sketchy.
Again, you failed to answer anything in my post, so:
I’m willing to engage those who want to discuss in good faith.
Sure, other than saying I’d need details and dollars before going past “that sounds great, but …”.
Are you wanting me to find the details and dollars for the program you support? I kind of think that should be on you.
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I’ll engage you since RW is doing the dance again. One thing that I think is missing is long-term care for Medicare benes. Or is that included, and I either overlooked it, or it’s not in the bill. I wholeheartedly support adding vision/dental/hearing to Medicare, I haven’t thought about dropping the elig to age 60 much, I’m not opposed but I feel less strongly about that one, I guess.
If I’m reading correctly, it looks like this part of the proposal will be about $60B/year, and the dems think they can get $50B/year squeezed out of drug prices. This was tried in… 2019 I think, the IPI proposal. I fully support CMS reducing drug prices in some fashion, but do the dems have the political will to piss off pharma this much? I’d also be curious to see the math behind the $50B/year savings, CMS spends what, about $180B/year on drugs between Parts B and D? So you’re talking about saving a quarter of that.
But it has to be heavily concentrated, right? I spent time in oncology, the top ten drugs are something like half of cost there. So perhaps bringing prices down on things like monoclonal antibodies and white blood cell growth factors, which are $10k/month and up, would have a significant impact. Oh, and insulin, which is less expensive but has many, many more people taking it.
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I don’t think LTC coverage is in their either - that one would be quite expensive to add to Medicare.
The $60B per year is about right, and it’s about $35B per year to add dental/vision/hearing and $25B for the lowering of the age.
The current bill does include the offset of $50B per year related to drug price reduction - the costs of both the increased spend for dental/vision/hearing and this reduction come from the CBO based on that 2019 bill - H.R. 3 (cbo.gov).
In 2019 CMS spent $37B per year on Part B drugs and $183B on Part D drugs. So yeah, actually saving $50B a year from that is not plausible politically and will get kicked down the road just like everything healthcare related does. I’d prefer it to be funded with increased Medicare payroll taxes - increasing it from 2.9% to 3.1% plus potentially a small premium ($5 a month) for the dental/vision/hearing should be able to fund the entire thing without the handwaviness of the drug spend reduction.
Not that I don’t want drug spend reduction… but cutting healthcare payments is really hard with all the lobbying dollars they spend
LTC is expensive, but I think the current system of making people wind down assets until they are nearly destitute… not optimal. So while I’d like to see it, it’s not in the bill and I won’t keep torturing it.
I hadn’t done the math on taxes, so a 0.2% increase is what it takes. Asking for a premium of $5, or even $25, doesn’t seem crazy, especially if you waive it for anyone under 200% of FPL or whatever. If we aren’t willing to negotiate drug prices, and it seems like neither party is, then I suppose we’re likely looking at taxes or deficit spending to finance this, or some combination. I haven’t paid much attention to the tax proposals, the $400k threshold keeps floating around. I have no objection to having those households pay for relatively more of this bill.
I wonder if there’s a way to squeeze at least some money out of pharma. Just go after insulin, perhaps, might be a few billion? I’m also not a fan of the ASP+6 (technically ASP +4.3 now, I know) Part B pricing and would much prefer ASP+$100 or something like that. That could also squeeze at least a few billion out.
FYI this is my back of the napkin math- Medicare members * $5 per month, and then looking at total tax revenues from that 2.9%. So may not be exactly correct but should be ballpark.
And I 100% agree on the LTC part - that stuff is expensive and bleeds a lot of people dry in their last few years.
LTC is expensive, but I think the current system of making people wind down assets until they are nearly destitute… not optimal. So while I’d like to see it, it’s not in the bill and I won’t keep torturing it.
LTC is tricky. I’m saving for retirement so I can live decently in retirement and “take care of myself financially and not be a burden to others” as I age.
If that’s the goal, what’s the point of the gov’t stepping in before I absolutely need help? It seems like that’s just being a burden on the taxpayers so my kids get a bigger windfall when I die.
OTOH, what if “I” is “we” ? We’re saving so we both can live decently and not be a burden. I think we could use a better way to protect the healthy spouse when the disabled one needs care. Maybe split the assets/income and only run down half.
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Death Panels IMO. That was one of the better parts of the original discussions for the ACA and it got absolutely torched. Why can’t we just let people die?
This could be said for cancer treatment, too. I guess it depends on whether you consider LTC health care. I think it’s at least partly health care, but it’s also part rent. Not exactly like cancer care, I’ll admit.
The current system is that you wind down your assets until you qualify for Medicaid, in many states that means your net worth falls below $10k. I don’t know… maybe LTC isn’t fully covered first-dollar by Medicare, maybe you’re subject to a 20% copay to cover the ‘rent’ portion of LTC.
It’s a cost-effective solution, for sure.
We should focus more on hospice at end of life situations rather than keeping people alive. Physician assisted suicide at end of life too. Ensuring LTC is affordable helps get rid of some of the abuse incentives associated with physician assisted suicide
Looks like you were able to find some details after all.
Looks like you still can’t comprehend what you are reading. I had the details. I was asking which details you wanted. You never responded to that.
I wanted the details for whatever it was you were supporting, Look, I can’t read your mind. You say “I support this very generic thing”. So I ask for details.
People have responded to you with details and effort. Three times now today, you have been called out for not making a good faith effort at a conversation (twice by posters other than me). You need to either step up and participate in the conversations being offered, or accept the troll status you are quickly earning. We can all get a quick fun post jab in from time to time - we don’t have time make every post content dense, but given the number of posts you have here today your time would have been better spent on one quality response that shows you are engaged in an actual conversation.
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Only 1 person gave any details.
A few things I like and I think are worthwhile, some in the plans and some not
- Working on roads and bridges
- Broadband internet access
- helping pay for daycare or expanded pre-K
- Carbon taxes
I believe work is the most important thing you can do to contribute to your society so making it easier to work is important to me. I think people that work are happier and healthier individuals and have a much greater sense of community and purpose. The more people that work the better off we all are. So daycare help and broadband internet access are really important IMO.
Roads and bridges are just a necessity. Put as much money in those as can be spent. There are projects everywhere that would make traffic flow better and fix aging structures. In Louisville it’s literally unbelievable how much better traffic flows everywhere since completion of our 2 new bridges across the Ohio and a rework of the interchange where I-65, I-64, and I-71 meet. Next we get 3 lanes in the busiest corridor of our outer ring which will help too. But when I go to places like Atlanta or Nashville and see how crappy the interstate system is in those cities and wonder how many hours of human life are wasted in traffic it boggles my mind.
Carbon taxes are the way to force the market to correct global warming. I don’t really care who they hurt because not doing it will hurt everyone more.
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I think these projects typically only help for a few years since they just encourage more people to live along the better routes.
As long as our population is growing that may still be a good thing. And newer roads are usually built much safer than older designs. Just thinking congestion may not always be a good justification for a project.