Armed Polite Society
Main Forums => Politics => Topic started by: Ben on July 30, 2018, 11:12:27 AM
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Bernie is pushing "Free medical for everyone!" again (in concert with the Bronx commie). A couple of interesting notes in the link: Sanders claims that the group that came up with the $32.6 trillion price tag (apparently over four years) is run by the evil Koch brothers. When asked what their study showed, the reply was basically, "We haven't done one". A couple of other factoids: Our annual budget is $4 trillion. All the billionaires in the US combined (in case we want to tax them at 90%) are only worth $2.7 trillion.
All that land that's supposed to be converted to pot farming better get converted to moneytree farms instead.
https://twitchy.com/dougp-3137/2018/07/30/team-bernie-disputes-report-about-socialist-utopia-price-tag-and-theres-a-hilarious-catch/
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Costs of healthcare in this country is a serious problem.
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Costs of healthcare in this country is a serious problem.
Which will never be solved by socialist programs, or by ignorant political hacks who believe in "free" government programs. :mad:
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Which will never be solved by socialist programs, or by ignorant political hacks who believe in "free" government programs. :mad:
That's true. But what were are doing now is a heading for disaster.
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That's true. But what were are doing now is a heading for disaster.
Heading? I thought we were already there ........
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Heading? I thought we were already there ........
(https://static1.fjcdn.com/comments/Well+then+weve+i+have+already+gone+too+far+_d6a65a5efc0899829727f7dda6c59334.jpg)
Sadly, we have so fubared our medical system that I think that socialist programs, as seen in many countries of Europe and elsewhere, would actually provide better service at lower cost.
The government already picks up the tab for "most" high cost Americans, one way or another. All "medicare for all" would do is simplify things and help people get treatment sooner - before it is really expensive because they got sick, couldn't afford help, got sicker, ended up broke, THEN having their broke asses covered by medicare and medicaid when they were well and truly fubared, rather than getting medical help back at step 1 that would have kept them working and such.
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Which will never be solved by socialist programs, or by ignorant political hacks who believe in "free" government programs. :mad:
I guess the lessons every other developed country in the world have learned about healthcare don’t add up to much
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When you have people that will call the ambulance for extremely minor injuries, go to the ER for minor colds, etc because they have the freeloader insurance, it doesn’t work.
When the current .gov healthcare system known as the VA provides shitty care for a small portion of the population it doesn’t work
When various levels of administrators siphons off large amounts of funding before it ever hits the hospital floor it doesn’t work
But hey let’s go ahead and implement it fully I’m sure it’ll work out just fine
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At the risk of contradicting my OP and sounding like a commie, I am actually open to any and all possible alternatives to me paying $8400 a year for a physical. I just don't believe "medicare for all" is the answer.
Even, if for the sake of argument, we agreed that country "X" had an excellent government run health care program, and we wanted to emulate it, what would the chances be of the US effectively implementing it? I pessimistically predict it would turn into some Frankenstein's monster of that "ideal". Mostly because our basically binary political system would have politicians on both sides of the aisle fighting each other. We'd end up with few positives of the program and many negatives. Our politicians wouldn't look at getting things in that are positive to their base, they would look at getting things in that are negative to the other side's base.
Also much of what Boomhauer said above. People calling the ambulance because they sneezed is a big problem. It's brought up locally here all the time, because people do that to circumvent the three hour wait in the emergency room (filled with an 80% population of non-emergencies). I don't believe "free" government insurance would end that. It's a cultural problem. In fact, I believe it would increase if everyone was guaranteed a free ambulance ride to cutting in front of the line and getting immediate health care.
I don't know what the answer is. I just know that I used to have great, cheap insurance. Then the government got involved with ACA and it all went to *expletive deleted*it.
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I guess the lessons every other developed country in the world have learned about healthcare don’t add up to much
My parents lived in Scotland in the mid 1980s and from their experience, and those of their Scottish friends, I wouldn't wish the British system on an enemy. Unless it was for the common headcold.
A couple wannabe Kongresskritters now want "medicare for all". Estimates indicate it would cost 3 trillion dollars annually to do that. America's yearly budget is 4 trillion, and the country now has a > $20 trillion national debt.
So, sure, we can easily afford the government to go full socialist on us. Easy-peasy. >:D
Maybe the Aussies have managed utopia .... but those kangaroos kick nasty!
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Honestly, I'm for single payer healthcare. We haven't had a real private system in ages--the current insurance regime is just as big, more complicated, more corrupt, just as expensive, and has less oversight than what a government run program would be. And that's saying a lot because I have almost zero faith in the government to do anything right.
Fact: There will never be true private healthcare in America again. Ever.
Fact: The system we have now has us paying more than equivalent societies for no greater benefit.
Fact: Healthcare costs are spiraling even more out of control.
Fact: Perfect is the enemy of good.
Fact: If you're not middle-class or above the current system will destroy you if you have a serious illness.
I'm ready to be done with the whole thing and replace the private insurance monopolies with a government run monopoly. It will suck. It will not be optimal. There will be terrible, awful compromises. There will be corruption. There will be poor spending choices. There will be people who literally die because of decisions made at a high level.
But all those things already happen, and you're totally powerless to do anything about it unless you have a good income and you're educated/patient/mentally capable of navigating the private insurance labyrinth.
I say all of the above as someone with great insurance and a very comfortable income.
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Fact: There will never be true private healthcare in America again. Ever.
Truth. I honestly don't see true free market and private insurance ever coming back. We will at some point end up with gov run insurance. I guess it will just be between being sorta screwed or royally screwed, depending on what is implemented.
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A couple wannabe Kongresskritters now want "medicare for all". Estimates indicate it would cost 3 trillion dollars annually to do that. America's yearly budget is 4 trillion, and the country now has a > $20 trillion national debt.
So, sure, we can easily afford the government to go full socialist on us. Easy-peasy. >:D
And about a trillion less than what we pay for healthcare NOW. So you'd be trading your current healthcare spending(on average, mind you) for a smaller tax increase. Bernie isn't very good at expressing that part though.
And yes, we'd still be able to charge for ambulance rides.
I'm with mellestad here.
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And about a trillion less than what we pay for healthcare NOW. So you'd be trading your current healthcare spending(on average, mind you) for a smaller tax increase. Bernie isn't very good at expressing that part though.
And yes, we'd still be able to charge for ambulance rides.
I'm with mellestad here.
What color is the sky in your world?
In this Universe, just how is the Federal Government going to efficiently (at $1,000,000,000,000 LESS!!!!) run the healthcare system of the United States?
Don't tell me "well, other countries do it!" or "just like Medicare!"
Our government bureaucracies, especially federal, are VASTLY more inefficient than the private sector and also that the other countries' bureacracies that you are planning to use as your model. We'll end up with the STELLAR care that is provided through the VA. THAT is the model you need to look at as to how OUR government would run healthcare.
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What color is the sky in your world?
In this Universe, just how is the Federal Government going to efficiently (at $1,000,000,000,000 LESS!!!!) run the healthcare system of the United States?
Don't tell me "well, other countries do it!" or "just like Medicare!"
Our government bureaucracies, especially federal, are VASTLY more inefficient than the private sector and also that the other countries' bureacracies that you are planning to use as your model. We'll end up with the STELLAR care that is provided through the VA. THAT is the model you need to look at as to how OUR government would run healthcare.
I gotta agree with this. I think the cost estimates reported are wishful thinking. They only way that would be accomplished is through rationing and telling people no. And you can guarantee the people who should be refused service will get service. The people who legitimately need service, will get refused.
The only way out of this the problem is to get the Govt out of it. I doubt that will happen also, but it is the only thing that will work. A portion of the public will never like a free market approach because the freeloaders always have sob stories about how they can't afford stuff and some people believe them.
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That whole economics thing...
Unlimited needs and limited resources...
The whole premise that big daddy government can take care of everyone's medical needs with a finite level of medical services (or money or manpower) is asinine.
It can only lead to cuts and outright elimination to expensive, yet critical procedures.... got cancer, need an organ transplant, need a joint replacement, need back sugery, have a premature baby? Tough luck buttercup.
It will be a net benefit to everyone who doesn't produce anything or contribute to society, at least at first, but it will lead to a severe decline in health care for everyone (except the really important or wealthy people- they always get an escape hatch).
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About the government being less efficient--I think the disconnect here is that anyone thinks what we have now is "private". Blue Cross, etc. is in no way a "private" company anymore. The whole insurance system is so regulated, conglomerated, backwards, hostile, bloated, greedy, secretive, and generally messed up that it's more inefficient than a government run system would be--all we've done is make fifty competing government entities that sell us healthcare.
What we have now is totally screwed. If I'm going to be shafted, I'd rather be screwed by something I can at least vote on and have it get kind of cleaned up every 20 years when a somewhat more sane administration gets into power.
Put another way--fighting with medicare is, in my experience, actually easier than fighting with my insurance carrier. That ISN'T a complement to Medicare--just a commentary on the sad state of affairs all around.
Another argument is that, if we assume single-payer is less efficient (arguable, I'd say, for reasons above) at least the original mandate of the agency would be to help people, not fleece them. That means you can afford to lose some efficiency anyway because you just have to break even, not generate profit increases every quarter.
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Because of Medicare and HMO regulations, its the people who are privately insured that are picking up the tab for government underpayment of services.
.Gov regulations have added a MASSIVE amount of administrative overhead to health care, and none of it is free.
There is a small movement of private practice Drs who don't take medicare nor insurance, who are able to provide services for what seem to be almost absurdly low prices (at least compared the norm).
Remove government from the equation and reign in trial lawyers, and you will see the cost of medicine drop dramatically.
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You know how people love to give the military crap for being inefficient? 50k toilet seats, hahaha?
OK, you know what I can get for a million bucks in the US Army?
Five fully equipped up-armored Humvees.
or
A nice APC and some change left over.
or
Battle-ready kit for fifty infantrymen.
or
70% of a Tomahawk cruise missile.
You know what I can get for a million bucks from our "private" insurance system?
One course of cancer treatment.
and
I still lose my home.
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Because of Medicare and HMO regulations, its the people who are privately insured that are picking up the tab for government underpayment of services.
.Gov regulations have added a MASSIVE amount of administrative overhead to health care, and none of it is free.
This would be my totally selfish reason for being okay with gov healthcare if it happened. Since they'd force most middel income and higher people to pay higher taxes, distributing that cost would lower my current annual insurance costs. Being privately insured, I'm paying for me and probably a couple of other people who are getting stuff at reduced cost via ACA, or free via obamacare.
Likely taxes would have me paying for me and maybe another 1/4 person, since everyone, including those under employer provided healthcare, would be paying part of that burden.
Again, from the "selfish" perspective, not necessarily the "right" perspective.
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You know how people love to give the military crap for being inefficient? 50k toilet seats, hahaha?
OK, you know what I can get for a million bucks in the US Army?
Five fully equipped up-armored Humvees.
or
A nice APC and some change left over.
or
Battle-ready kit for fifty infantrymen.
or
70% of a Tomahawk cruise missile.
You know what I can get for a million bucks from our "private" insurance system?
One course of cancer treatment.
and
I still lose my home.
I don't think you quite understand how insurance works.... just saying.
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Once .gov controls healthcare and takes the needed steps to control cost by limiting the pay of medical professionals how many doctors will voluntarily stay in the system?
Today the costs are out of control because a good specialist can pretty well make a fortune charging all the market will bear.
The billing statements from my recent hip replacement are pretty astronomical.
My "insurance" pays 90% of costs, except when they don't. I think I've gotten all the bills by now and I'm out of pocket close to $8K. Which I'm still trying to reconcile with my $5K out of pocket maximums.
I don't know.what the solution is but if the answer is "more government" the wrong question was asked.
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Once .gov controls healthcare and takes the needed steps to control cost by limiting the pay of medical professionals how many doctors will voluntarily stay in the system?
Today the costs are out of control because a good specialist can pretty well make a fortune charging all the market will bear.
The billing statements from my recent hip replacement are pretty astronomical.
My "insurance" pays 90% of costs, except when they don't. I think I've gotten all the bills by now and I'm out of pocket close to $8K. Which I'm still trying to reconcile with my $5K out of pocket maximums.
I don't know.what the solution is but if the answer is "more government" the wrong question was asked.
Larry makes a good point.
I'm a Vietnam veteran and I get much of my health care through the VA. Some of you are probably aware that the VA has been under fire for excessively long wait times for appointments at VA facilities, so they came up with a program called (IIRC) "Veterans Choice." Under this program, if you can't get an appointment at the VA within (I think) 30 days, you can choose to have them authorize you to go to an outside doctor, and the VA pays for it.
I had an introduction to how that works recently. In December of 2017 I had a bunch of open sores on my lower legs. I called the dermatology department for an appointment, and they told me they didn't have any openings until late February. I needed help right then, so the person in dermatology told me I could go with Veterans Choice, and he gave me a number to call.
It took me a full week of exchanging voicemail messages before I was actually able to talk to someone at the Veterans Choice number. When I finally spoke with a live person, she told me that I was NOT eligible for Veterans Choice because my records at the VA hospital didn't indicate that I had been referred to the Veterans Choice program. I told her that I had most certainly been referred, that it was the dermatology department that gave me the number to call. Her view was that this wasn't a "referral." Apparently, to get a referral over not being able to get an appointment in a timely manner I would first have to get an appointment, and then have the doctor refer me to the Veterans Choice program.
But we're not done yet. I had the personal e-mail of the chief attending doctor in the dermatology department, from a complaint I had filed several years before involving one of their residents. So I e-mailed the doctor, and he brought me in and treated me personally more or less on the sly. It's all in the records, but it wasn't a normal appointment. I came when he was on the floor, and he saw me between consultations with scheduled patients. I mentioned my debacle with Veterans Choice, and he laughed. He said the program was a joke anyway. According to him, at least for dermatology nobody can get an appointment through the Veterans Choice program, because all the private dermatologists are booked solid and they aren't taking new patients. He said IF you could get an appointment, it would be three to six months in the future -- which, of course, obviates the whole point of the program.
And I'm next door to a city with a teaching hospital, so it's not like we have any shortage of physicians in the area. It must be many times worse in regions that don't have large, teaching hospitals to draw doctors from. Most of the residents at the VA hospital are drawn from the medical school. The dermatology doctor I saw is on the faculty there.
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About the government being less efficient--I think the disconnect here is that anyone thinks what we have now is "private". Blue Cross, etc. is in no way a "private" company anymore. The whole insurance system is so regulated, conglomerated, backwards, hostile, bloated, greedy, secretive, and generally messed up that it's more inefficient than a government run system would be--all we've done is make fifty competing government entities that sell us healthcare.
What we have now is totally screwed. If I'm going to be shafted, I'd rather be screwed by something I can at least vote on and have it get kind of cleaned up every 20 years when a somewhat more sane administration gets into power.
Put another way--fighting with medicare is, in my experience, actually easier than fighting with my insurance carrier. That ISN'T a complement to Medicare--just a commentary on the sad state of affairs all around.
Another argument is that, if we assume single-payer is less efficient (arguable, I'd say, for reasons above) at least the original mandate of the agency would be to help people, not fleece them. That means you can afford to lose some efficiency anyway because you just have to break even, not generate profit increases every quarter.
Is anyone here under the impression the current system is free market? I didn't think so.
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About the government being less efficient--I think the disconnect here is that anyone thinks what we have now is "private". Blue Cross, etc. is in no way a "private" company anymore. The whole insurance system is so regulated, conglomerated, backwards, hostile, bloated, greedy, secretive, and generally messed up that it's more inefficient than a government run system would be--all we've done is make fifty competing government entities that sell us healthcare.
All of what you said above is true, except the last italicized part. The reason our health care and health insurance system is so fubar is due directly to government interference. And the most egregious damage was done in the last ten years, a direct result of ObamaCare.
Thinking that government run health care (read: socialized medicine) would be more efficient is shows a hopeless naivete.
All of that said, I believe socialized medicine is where we are headed. It wouldn't surprise me if a Republican administration has a large hand in its implementation. I wish the idiots in kongress would just get it over with.
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All of what you said above is true, except the last italicized part. The reason our health care and health insurance system is so fubar is due directly to government interference. And the most egregious damage was done in the last ten years, a direct result of ObamaCare.
Thinking that government run health care (read: socialized medicine) would be more efficient is shows a hopeless naivete.
All of that said, I believe socialized medicine is where we are headed. It wouldn't surprise me if a Republican administration has a large hand in its implementation. I wish the idiots in kongress would just get it over with.
You’re using a principle “government is inefficient” to shoot down real life evidence (where every single government healthcare system in the world, including Medicare in the US, is more efficient than ‘private’ care as described by mellestad.)
Like it’s all well and good to believe ideologically that the government is inefficient, but is there any evidence at all this applies to healthcare?
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You’re using a principle “government is inefficient” to shoot down real life evidence (where every single government healthcare system in the world, including Medicare in the US, is more efficient than ‘private’ care as described by mellestad.)
Like it’s all well and good to believe ideologically that the government is inefficient, but is there any evidence at all this applies to healthcare?
Not in your universe, perhaps. In our universe, and in this country, the VA.
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Not in your universe, perhaps. In our universe, and in this country, the VA.
https://www.rand.org/news/press/2016/07/18.html (https://www.rand.org/news/press/2016/07/18.html)
The Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients, according to a new RAND Corporation study.
There’s anecdotes and principles, and then there’s evidence
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https://www.rand.org/news/press/2016/07/18.html (https://www.rand.org/news/press/2016/07/18.html)
There’s anecdotes and principles, and then there’s evidenc
Sure, a RAND study that is contradicted by literally thousands of cases of veterans being ill served for years by the VA medical system, solid evidence for which can be found by even the most casual I-net search.
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Sure, a RAND study that is contradicted by literally thousands of cases of veterans being ill served for years by the VA medical system, solid evidence for which can be found by even the most casual I-net search.
Got a link to that evidence?
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Efficient or not, the federal government should not be selling or brokering goods or services to US citizen.
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Efficient or not, the federal government should not be selling or brokering goods or services to US citizen.
Just replace 'selling' with 'providing a service' and it's the same as any other tax-funded thing the government does.
Perfect is the enemy of good. I'd rather have an imperfect system that treats healthcare like a "right" and pay for it through mass taxation than any form of what we have now, or what we had immediately before Obamacare.
This is coming from an ideological Libertarian, so I don't need convincing about the merits of a free market.
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Perfect is the enemy of good. I'd rather have an imperfect system that treats healthcare like a "right" and pay for it through mass taxation than any form of what we have now, or what we had immediately before Obamacare.
That is an interesting 'right.'
Fits right in with the 'right to a living income', 'right to housing', and a 'right to eat.'
No worries, government can provide for all of these 'rights,' and it will only cost you your economic freedom, at least at first.
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The Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients, according to a new RAND Corporation study.
There’s anecdotes and principles, and then there’s evidence
Allow me to offer a real life example of the VA Health Care system's lauded efficiency:
Back in December of 2017 I had a large number of open sores on both lower legs. They looked like I had been peppered in the shins by buckshot. I have previously posted about my experiences in trying to see a VA (and outside) dermatologist, so I won't repeat all that. But then we get to the clinical part.
After the attending dermatologist had seen me on an "urgent care" basis, I had a follow-up a week or two later with one of the residents. She prescribed two medications. One was a topical steroid, the other was Doxepin. The way my VA hospital works, you see the doctor. He/she doesn't hand you a prescription, they enter it into the computer. You have a choice: they will either mail the prescription(s) to your home, or you can proceed to the on-site pharmacy after your appointment, and pick up the medication(s) after waiting in line for a seemingly interminable time. I don't recall which option I chose, but that's not the point. The point is that, by the time you get the medication(s) with their accompanying literature explaining in excruciating detail all the horrible things that may happen to you when to use the medication as directed, you no longer have access to the doctor.
I got my meds and, because I'm "that guy," I proceeded to read the accompanying literature. It turned out that Doxepin isn't intended at all for use in dermatology. That wasn't even mentioned. Doxepin is a psychotropic, an anti-depressant. And among the side effects, as with most anti-depressant psychotropic drugs, are depression (worse than you started with -- a backfire), and suicidal thoughts. Buried deep in the fine print is the caution, "Discuss these potential side effects with your doctor."
Now remember -- this is the VA, which is dealing with a very high rate of veteran suicides. And remember thaat by the time the patient receives this information, he or she is far removed from the doctor. And trying to call your doctor, in the specialty clinics, is impossible. They're medical students from the nearby teaching hospital. They are only there on certain days, and when they're there they are hopelessly overbooked. Telephone contact is out of the question So what we have is dermatologists prescribing a psychotropic drug that is known to produce suicidal ideation as a side effect, for an off-label use, with NO discussion of the potential side effects, and no cautions about that other than the statements buried deep in a four- or five-page drug fact sheet from the pharmacy, which 99% of patients probably discard without every reading -- to a patient population known to have a higher than average problem with suicides.
What could possibly go wrong?
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Just replace 'selling' with 'providing a service' and it's the same as any other tax-funded thing the government does.
Perfect is the enemy of good. I'd rather have an imperfect system that treats healthcare like a "right" and pay for it through mass taxation than any form of what we have now, or what we had immediately before Obamacare.
This is coming from an ideological Libertarian, so I don't need convincing about the merits of a free market.
Please explain to me the concept of health care as a right.
What other rights are materially provided by government?
I have a right to Keep and bear arms but the government doesn't buy me a gun.
I have a right to a free press but the government doesn't provide me with a printing press.
"Healthcare" doesn't flow from the heavens like mana. It is the product of someone's skill, time and labor.
To demand healthcare as a right is to demand someone provide you their skill, time and labor.
The demand is for the government to provide healthcare. For the government to provide healthcare it must employ healthcare workers and pay them a wage. The government will decide what that wage will be. If Medicare is an example that wage will be considerably below going market value.
Dr. Feelgood spent 8-10 years becoming a doctor, maybe he paid for it with student loans or a trust fund or had lots of scholarships. He/she also worked very hard to become a doctor. Who gets to decide what his skill, time and labor is worth? With healthcare as a right will it be the (sort of) free market or a nameless faceless beaurocrat?
Then what happens if Dr. Feelgood and his peers decide their skill, time and labor is worth more than government will pay? Will the government force them to provide healthcare? Or will government figure out a way to ration a shrinking supply of healthcare.
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I'm old enough to recall when your parents bought "Hospitalization coverage" If something happened and you were hospitalized it paid the bills. When you went to the doctor's office or he came to your house (yes, they did that then) you paid them in cash or maybe some other item you agreed on. Farmers usually paid with eatable stuff.
When the unions began to get health care coverage for employees paid for by employers, hospitalization insurance evolved into the multifaceted thing it is now, and then the government got involved in '65 and things really started to change and the system became bloated and the hospitals started building fancy buildings and campii and all the attendant worker bees to do all the paperwork inter alia. Good or bad? Who knows.
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I'm old enough to recall when your parents bought "Hospitalization coverage" If something happened and you were hospitalized it paid the bills. When you went to the doctor's office or he came to your house (yes, they did that then) you paid them in cash or maybe some other item you agreed on. Farmers usually paid with eatable stuff.
When the unions began to get health care coverage for employees paid for by employers, hospitalization insurance evolved into the multifaceted thing it is now, and then the government got involved in '65 and things really started to change and the system became bloated and the hospitals started building fancy buildings and campii and all the attendant worker bees to do all the paperwork inter alia. Good or bad? Who knows.
The problem now is that we have such a bastardized hybrid system of socialized and "private" insurance that it's almost socialized medicine with private administration. And they're taxing me for other folks medical anyway.
I'm all for a private solution, I think it'd work best. But I'm also increasingly coming to the conclusion it's a pipe dream and modern America on both sides of the isle simply do not want and would not accept an actual private system. And I'm slowly getting to the point where I really don't think single payer could be any worse than the totally screwed bastardized system we have now, and for admittedly selfish reasons has the perks of not being bankrupt and the like if something major hits. And I can't think up many practical reasons I'd run into under single payer to fight whatever government office is administrating it, that I wouldn't have to likewise fight with my insurance company on anyway.
Sent from my Pixel XL using Tapatalk
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Got a link to that evidence?
Look for the evidence yourself. It's plentiful, not hard to find. I'm done supporting your latest batch of trolling.
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There’s anecdotes and principles, and then there’s evidence
Allow me to offer a real life example of the VA Health Care system's lauded efficiency:
Now remember -- this is the VA, which is dealing with a very high rate of veteran suicides. And remember thaat
That is a bad story - but one commonly told of the private system as well. It’s not like these things don’t happen at privately run places and that’s why statistical evidence is important to look at.
Even APS has numerous tales of the insanity and pain of dealing with private health companies and trying to get care. On a population level the evidence is clear that it costs more and the results for people are no better to have private medicine
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Efficient or not, the federal government should not be selling or brokering goods or services to US citizen.
The constitution is not a suicide pact. Never mind that the founding fathers were absolutely not free market capitalists - the selling point of capitalism is that it makes life better. Turning around that proposition and saying we should all endure poorer healthcare for the sake of capitalism mistakes the entire purpose of markets.
Theyre supposed to serve humans, not the other way around.
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The constitution is not a suicide pact. Never mind that the founding fathers were absolutely not free market capitalists - the selling point of capitalism is that it makes life better. Turning around that proposition and saying we should all endure poorer healthcare for the sake of capitalism mistakes the entire purpose of markets.
Theyre supposed to serve humans, not the other way around.
"The Constitution is not a suicide pact" is one of the greatest cliches used to justify ignoring it that has ever been developed.
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The problem is the people using the services are not the ones paying the bills.
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The problem is the people using the services are not the ones paying the bills.
How to fix that with appropriate investment in medicine?
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Turning around that proposition and saying we should all endure poorer healthcare for the sake of capitalism mistakes the entire purpose of markets.
We do not have poor healthcare. We have excellent healthcare at a sometimes high price for some people. It is simple supply and demand. Everyone wants cheap healthcare and wants someone else to pay for it, but there is a limited availability of providers. You want cheaper prices for everyone? Lower the demand or increase the supply.
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Don't tell me "well, other countries do it!" or "just like Medicare!"
You do realize that you're sounding like a flat earther, anti-vaxxor, young-earth creationist here, right?
"Convince me, but you're not allowed to use any of the common evidence points!" - IE nothing I say can convince you.
How about this? Prove that other countries that have effective universal health coverage are somehow vastly more efficient than the US government.
Sure, we can use the VA as an example. It's messed up. So aren't all the other single payer systems. They're just less FUBAR than our system, which I view as a careful combination of the WORST aspects of public and private healthcare. Or we could use medicare, medicaid, tricare, etc... Starting to see the picture?
We and the government end up paying for all of it eventually. We're not saving any money by not providing care. If nothing else, because people eventually get sick enough that they lose their job and end up on medicaid anyways. Now, just with a much more advanced and expensive illness.
How would it save money primarily? By ending the cold-war between "insurance" companies providing health service plans(I dislike calling it insurance), and medical providers. Right now, the fight that the medical plan providers are engaged in to pay as little as they can get away with the providers to get the money they need consumes about 20% of your medical dollars. Many providers have more billing employees than they do nurses and doctors.
I mean, I'd prefer a privatized and deregulated(largely) medical system, hell, just moving back to regular insurance and doing something such that people care about their medical bills and can exert pressure to save money would help. But I don't see that happening.
Also much of what Boomhauer said above. People calling the ambulance because they sneezed is a big problem. It's brought up locally here all the time, because people do that to circumvent the three hour wait in the emergency room (filled with an 80% population of non-emergencies). I don't believe "free" government insurance would end that. It's a cultural problem. In fact, I believe it would increase if everyone was guaranteed a free ambulance ride to cutting in front of the line and getting immediate health care.
Okay, this is a uniquely USA problem for the most part. Why? Because in the other nations they can get an appointment with a PCM quicker, and it is actually cheaper than the emergency room.
The thing with people getting an ambulance because they sneezed is exaggerated, and generally only used by those who aren't going to pay anyways! This creates a negative feedback because we have mandated that emergency rooms see everybody, and those costs have to be spread over those who will actually pay. Thus the sky-high charges if you can/will actually pay. The poor? Just declare bankruptcy occasionally.
The constitution is not a suicide pact. Never mind that the founding fathers were absolutely not free market capitalists - the selling point of capitalism is that it makes life better. Turning around that proposition and saying we should all endure poorer healthcare for the sake of capitalism mistakes the entire purpose of markets.
Theyre supposed to serve humans, not the other way around.
This is a very good point. Most of your posts have been very good. For every bad story about the VA, there are multiple ones about private insurance.
Amy - I agree with what you say. In the USA, the way it typically works is that you go get health care. "Your" insurance pays for it. However, who's paying your insurance? Not you, not mostly. Your work is paying for the insurance. Or maybe the government. I wouldn't be surprised if the government is paying for the healthcare of over 50% of people right now. Children, retired people, government employees, veterans, people on welfare, etc... It adds up.
Ideally, you'd go in and pay yourself. Then you'd have the incentive to conserve. But we have a lot of people who would die if that were the case, because their medical bills are vastly higher than average. So you still need insurance. But we don't have insurance now, we have coverage plans that are the equivalent of your auto insurance covering routine maintenance of your car.
We do not have poor healthcare. We have excellent healthcare at a sometimes high price for some people. It is simple supply and demand. Everyone wants cheap healthcare and wants someone else to pay for it, but there is a limited availability of providers. You want cheaper prices for everyone? Lower the demand or increase the supply.
We have healthcare no better than nations with single payer, at something approaching 200% of the cost.
Cheaper prices for everyone? Get rid of the cruft somehow. We could save 20% merely by eliminating the fighting between providers and insurance companies.
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It is not a fact that we can never have private health insurance again.
That is what is called a proposition.
Plenty of folks disagree with that proposition.
Hopefully Trump will get his turn at this knotty problem. He has a way of cutting through self limiting conventional “wisdom”.
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The Obamacare website was a couple of billion and didn't work. I'm not holding my breath on the government suddenly becoming competent at running the rest of the healthcare industry when it can't even manage web development.
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Amy - I agree with what you say. In the USA, the way it typically works is that you go get health care. "Your" insurance pays for it. However, who's paying your insurance? Not you, not mostly. Your work is paying for the insurance. Or maybe the government. I wouldn't be surprised if the government is paying for the healthcare of over 50% of people right now. Children, retired people, government employees, veterans, people on welfare, etc... It adds up.
Reality check:
Medicare (for retired people) pays for a very basic level of health care. Anyone I know on Medicare also pays for a Medicare supplement plan. The year I had my heart surgery I had a fairly basic supplemental plan, and the operation for follow-up still cost me a big chunk of change. The next year I charged to a supplement plan that pays more and has a lower annual deductible, but costs me quite a bit more every month.
I'm also a Vietnam veteran and I get some of my health care through the VA. When I first signed on with the VA, their system didn't talk to Social Security/Medicare or private insurance. Now they do -- the cost of my VA care goes against my Medicare just as a visit to a private (non-VA) hospital would.
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Reality check:
Medicare (for retired people) pays for a very basic level of health care. Anyone I know on Medicare also pays for a Medicare supplement plan.
Good point. I think my dad's supplement is like $600/mo. for the most basic supplement that Anthem, offers. I can't get him to go to the doctor for anything, so he never really uses the "supplemental services". It's mostly for catastrophic care if that's needed, but of course the supplement, due to ACA, is for a lot more than catastrophic care. He just has to suck that extra stuff up for the catastrophic coverage, because relying solely on Medicare for that would have him bankrupt pretty darn quickly.
It seems Medicare, and in CA MediCal, mostly benefit people with no real assets. If you are elderly and own your home or have other assets, you're kinda stuck with the supplement to protect yourself financially.
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To follow up on Hawkmoon's point, We don't have to look at other countries. We have perfectly good examples of what US Government run healthcare looks like.
VA Care: Been beat to death many times, and while some studies say you it's not bad, true, they still do things like give a bunch of folks HIV by accident, and the backlog to be seen is still measured in years.
TriCare: The gov run system to care for Active Duty troops and their families was so bad they hired a private company to run it. And TriCare, while you will eventually get care is notorious among soldiers for long wait times, byzantine rules for referrals to see the provider you actually need, not enough providers at whichever facility you are at, and ER's chocked full of folks with colds.
Medicare: Doesn't provide enough care to meet the needs of it's members. Requires at least one (prescription coverage) and usually two extra, private insurance plans to provide what most folks consider "OK" health care. Also in an effort to remain solvent engages in price fixing that is leading providers to refuse it's members care totally, unless they have cash.
Medicaid: I confess I don't know much about this programs effectiveness, but I know of no one that sings it's praises and considers it a good alternative to "private" insurance.
As one of the VAST majority of Americans that enjoys fast access to really very good healthcare (it is expensive, true, but it is available, and really quite good care) I'd like to see the proponents of a Single Payer government run system work well for it's members at anything approaching the efficiencies they claim they will get before I turn loose of my expensive private care.
Before you come in here trying to sell the benefits of "Medicare for All" make Medicare work for ANY, without supplements. To my Congress critters I say: "Don't try to sell me on how good it might be. Make one of your existing systems good, and SHOW me how good it is."
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Haven't read the entire thread, but as a matter of math, there about 250million adults in the country. At $3trillion/year that's $12k per adult. So SWMBO and I would be forking over $24k per year. Compared to a current ACA compliant policy that's probably pretty close.
However, in 2009 I had a policy that covered my family for $330/month with a $5k deductible and probably a $10k out of pocket max. Even if we hit that out of pocket max EVERY year that's only $14k. Even if you add 9 years of inflation it's still only $18k.
So please, someone explain to me why socialized medicine would be preferable to just going back to the pre-0bamacare status quo?
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https://data.oecd.org/healthres/health-spending.htm (https://data.oecd.org/healthres/health-spending.htm)
In public systems you get fast care and good results at something like half to one third of those prices sump.
Dogmush - what’s missing from your post are comparative cost and outcomes data. The vast majority of Americans do not in fact get faster or better quality care than those public systems. They do however pay a lot more.
Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.
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We do not have poor healthcare. We have excellent healthcare at a sometimes high price for some people. It is simple supply and demand. Everyone wants cheap healthcare and wants someone else to pay for it, but there is a limited availability of providers. You want cheaper prices for everyone? Lower the demand or increase the supply.
This is in fact not true. The United States has one of the worst performing health systems overall, even when considering only medicine available to people with insurance. It’s not terribly behind, but you’d think ant double or triple the price it would at least have better average outcomes.
https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-mortality-rates-fallen-steadily-u-s-comparable-countries (https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-mortality-rates-fallen-steadily-u-s-comparable-countries)
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https://data.oecd.org/healthres/health-spending.htm (https://data.oecd.org/healthres/health-spending.htm)
In public systems you get fast care and good results at something like half to one third of those prices sump.
Dogmush - what’s missing from your post are comparative cost and outcomes data. The vast majority of Americans do not in fact get faster or better quality care than those public systems. They do however pay a lot more.
Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.
Not US public systems.
The public systems extant in the US today provide inferior care than the ...whatever the hell most Americans have. That's why no one uses them unless they have too, and supplements them when they do use them.
Even the article you posted claiming the VA is OK had this disclaimer:
The RAND study found there was too little information related to timeliness, equity, efficiency and patient-centeredness to reliably draw conclusions about how the VA system compared to others across these dimensions.
Those are some important factors to gloss over with a hand wave. However:
VA facilities had similar or superior quality to non-VA facilities with respect to preventive, recommended and end-of-life
Never fear if you need a Flu Shot, or to die, they got you covered. It's anything in between that's a problem.
I'm not saying it couldn't work. But so far, in this country, it doesn't. And since I have very good, albeit expensive, health care I see no reason to consider changing that until the US government manages to run a better socialized system in the US. I also use both TriCare and the VA for some things, so I get first hand knowledge of which system(s) provides better care. (Hint: it's United Healthcare)
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However, in 2009 I had a policy that covered my family for $330/month with a $5k deductible and probably a $10k out of pocket max. Even if we hit that out of pocket max EVERY year that's only $14k. Even if you add 9 years of inflation it's still only $18k.
This has been my biggest pet peeve in all this ACA government intervention. While I'm a firm believer in preventative care, I (and I think most people), can fork over $100-200 for a physical and bloodwork once a year. I'm happy to fork over several thousand to ten thousand dollars in a year if something serious happens to me (I realize not everyone can). What I can't afford without taking a big financial hit is say, being run over by a bus and getting $100K in bills in a year.
We used to have catastrophic care as a cost-effective option to take care of the really big stuff for those who can afford to pay out of pocket for the little to medium stuff. I've harped on this before, but it sure seems having catastrophic care available as an option would reduce health costs for a good chunk of the population. Forcing me to have pregnancy coverage, mental health coverage, etc., on my insurance seems like the opposite of cost effective.
I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.
I was piping in on another forum that it would be interesting if someone like Amazon came up with "Prime group health insurance" open to individual Prime members.
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Hey, experts. Any information on how much cheaper it would be if our health care benefits were restricted to legal residents?
Asking for a friend.
Terry
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TriCare: The gov run system to care for Active Duty troops and their families was so bad they hired a private company to run it. And TriCare, while you will eventually get care is notorious among soldiers for long wait times, byzantine rules for referrals to see the provider you actually need, not enough providers at whichever facility you are at, and ER's chocked full of folks with colds.
You're not the first person I've heard complain about TriCare. It's actually surprising to me that they can suck so bad. On the civilian side, I spent my entire time on one or another of the GEHA plans. That was great and reasonable insurance. Even after I separated, I kept it for the 18 months, and paying the whole shebang myself was still way cheaper than what I'm paying now for my limited coverage, high deductible private insurance.
I had a major surgery while on GEHA. I recall the hospital bill being something like $200K and I paid $100 of it. I don't understand how they can make GEHA so good yet suck with TriCare.
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Hey, experts. Any information on how much cheaper it would be if our health care benefits were restricted to legal residents?
Asking for a friend.
Terry
>:D [popcorn]
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When you have people that will call the ambulance for extremely minor injuries, go to the ER for minor colds, etc because they have the freeloader insurance, it doesn’t work.
This is why ambulances should have a minimum injury level for transport (outside of car wrecks, OTJ injuries and other situations where liability and/or hidden injury issues make it best to have the person in the hands of EMS ASAP and insurance is already covering it) and if you don't have that when they show up, they get to give it to you.
"You broke a fingernail? Wait here while I get my +3 Cricket Bat of Qualifying."
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In public systems you get fast care and good results at something like half to one third of those prices sump.
Then why is it that many people from countries with socialized medical care (like England) come to the U.S. when they really need to have a problem fixed?
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Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.
My story isn't a story about the failure of the private system. Quite the contrary. I had to go into the private doctor market (via Medicare supplement) because at the VA hospital they had clear and convincing evidence that I had a rapidly deteriorating coronary problem, but they wouldn't let me see a cardiologist. If I hadn't been old enough to have Medicare as a backup, I'd be dead now. When I finally went outside of the VA system to a real doctor, they put me right into the hospital STAT, and a week later I was under the knife. But, because I had been regarding Medicare and the Medicare supplement as a backup to the VA, I had chosen a supplement plan with low premiums but higher out-of-pocket costs. Now that it's too late, I have switched to a plan with higher premiums, but if I ever need to use it again my out-of-pocket will be less.
But the sorry saga began in the VA "Health Care" system, which is a close analog to public, socialized medicine in other countries. In the VA system, you can't just call and get an appointment with a specialist. You must be referred by your primary care physician.
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Socialism fails at the primary purpose of civilization.
Providing for those who are unable to provide for themselves while controlling for the free rider problem.
Rationed care, death panels and slow, poor service are the result of free riders in health care.
Paying customers won’t tolerate it and if other options are available they use them.
Socialized systems always try and outlaw competition.
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https://data.oecd.org/healthres/health-spending.htm (https://data.oecd.org/healthres/health-spending.htm)
In public systems you get fast care and good results at something like half to one third of those prices sump.
Reading comprehension fail, again. I said $18k, if I hit my out of pocket maximum every year. If I don't, and on average people will only hit their out of pocket max a couple years in their entire life, it would be MUCH less than that. Premiums alone were about $4k. Figure since I had 2 kids at the time we'd have been on the hook for maybe $1000/year in expenses subject to the deductible (and typical yearly checkups were not subject to the deductible) that's $5k. Or closer to 1/5 of the "Medicare for all" costs.
Actual free market reforms would have reduced that cost considerably too.
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Please explain to me the concept of health care as a right.
Mellard put it in quotes, so I don't think they actually think that it is a right, merely acknowledging that some/many supporters of universal single payer to view it as such.
I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.
Personally, I'd say that to handle this you'd handle it like the VA and "service connected disability". It'd increase premiums quite a bit initially, but here's how I'd handle it:
The Insurance that you have when you get or are diagnosed with a condition is on the hook to pay for it - forever. Even if you switch providers or lose coverage. Lose your job because of cancer? You got the cancer while covered, right? It's covered. It's like if your car is in an accident. Let's say that it's an antique, parts are hard to get, but you paid through the ass for a "repair covered at all costs" policy. If you're hit and it's going to take 6 months to repair, no matter what, even if 3 months in you transfer to a new auto insurance company, they still have to pay the ongoing bills for repairing that accident.
Now, as a matter of convenience, I'd allow them to "buy" your next healthcare provider taking over the payments for a pre-existing condition. Buy they'd have to pay the anticipated costs to the new insurance provider. Let them figure out the exact details involving averages, actuarial tables, discounts for future costs, etc...
Socialized systems always try and outlaw competition.
We aren't necessarily talking about a true socialist system. We could have universal coverage like Germany, where "Medicaid" has more or less been expanded to cover everybody without other coverage. There are still private companies out there, but they have to compete with Medicaid, so you don't see the insane costs as you see here, because they actually have competition to worry about.
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(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fimg.photobucket.com%2Falbums%2Fv635%2Fbrimic%2FMobile%2520Uploads%2FEB683172-7FF2-44EA-97E4-58ACB7BEC5BE_zpshyxfhvpx.jpg&hash=8055d059784daadff0aa7b472372ff3e0ac150e8) (http://smg.photobucket.com/user/brimic/media/Mobile%20Uploads/EB683172-7FF2-44EA-97E4-58ACB7BEC5BE_zpshyxfhvpx.jpg.html)
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https://www.seattletimes.com/nation-world/too-little-too-late-bankruptcy-booms-among-older-americans/?utm_source=RSS&utm_medium=Referral&utm_campaign=RSS_all
Medical bills are a major contributing factor to the elderly filing for bankruptcy.
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Can we please stop using the dishonest term "single-payer"? Under a "single-payer" system, every tax-payer pays the price. "Single-payer" is a lie.
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The "single payer" is the government. It can print the money ... ALL THE MONEY .... it will need. [tinfoil]
Noting will go wrong. Nothing CAN go wrong.
It's our GOVERMENT. They know best.
If you believe the above, then I have a bridge in NYC that's for sale ... cheap.
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By single payer what they really mean is EVERY SINGLE ONE OF US will pay.
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I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.
Errr...
We used to have catastrophic care as a cost-effective option to take care of the really big stuff for those who can afford to pay out of pocket for the little to medium stuff. I've harped on this before, but it sure seems having catastrophic care available as an option would reduce health costs for a good chunk of the population. Forcing me to have pregnancy coverage, mental health coverage, etc., on my insurance seems like the opposite of cost effective.
You kind of have a solution right there, no?
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Errr...
You kind of have a solution right there, no?
Only if we got catastrophic care back as a widely available option, and then if it covered pre-exisisting. It used to not do that.
I had high hopes for Idaho when they looked at offering "affordable insurance" (I think they are currently being blocked by the courts). I looked at the affordable options they were going to provide and was sorely disappointed in what I saw. It was affordable, yes, but it was almost the opposite of catastrophic care. There were still large deductibles, but stuff like hospital stays was capped at something like $30K, and lifetime benefits were in the low hundreds of thousands.
That's practically like not having insurance. I guess it would be okay for young, healthy people that never got into any serious accidents, but otherwise it seemed kinda worthless. I'll take the overly expensive policy I have now over that any day of the week. My annual physical may cost me eight grand, but at least if I'm hit by a bus I'm fully covered after my large, yet manageable (for me), deductible is exceeded.
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Can we please stop using the dishonest term "single-payer"? Under a "single-payer" system, every tax-payer pays the price. "Single-payer" is a lie.
No, because it isn't dishonest, it merely means that all the medical providers are being paid by the same payer.
It may niggle you like "medical insurance" niggles me, but do either of us have a better term?
I had high hopes for Idaho when they looked at offering "affordable insurance" (I think they are currently being blocked by the courts). I looked at the affordable options they were going to provide and was sorely disappointed in what I saw. It was affordable, yes, but it was almost the opposite of catastrophic care. There were still large deductibles, but stuff like hospital stays was capped at something like $30K, and lifetime benefits were in the low hundreds of thousands.
And if you get that sick, you end up bankrupt and on the government dime anyways...
Or putting it on our backs by ignoring the bills coming in, declaring bankruptcy, forcing the providers to increase their rates to get the necessary income from those who do pay.
It's just that the load of those that don't pay is such a high percentage it is doubling our bills or more, because the insurance companies are negotiating to not cover them.
Add in the expense of all the paperwork involved in trying to collect money from broke clients, and it starts getting ridiculous.
It's why there are "direct primary care" (https://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3) medical clinics out there that promise to handle all the basic stuff for very reasonable flat monthly rates. Eliminate all the paperwork and billing nonsense? Substantial savings.
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No, because it isn't dishonest, it merely means that all the medical providers are being paid by the same payer.
It may niggle you like "medical insurance" niggles me, but do either of us have a better term?
I don't think that's what "niggle" means.
If you want a better term, why not "tax-funded," or "government health care," or "socialized medicine," "government-subsidized," "fully-subsidized," "health control," or "government-run health care"?
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I don't think that's what "niggle" means.
Niggle:
cause slight but persistent annoyance, discomfort, or anxiety.
or
a trifling complaint, dispute, or criticism.
Seems accurate to me.
If you want a better term, why not "tax-funded," or "government health care," or "socialized medicine," "government-subsidized," "fully-subsidized," "health control," or "government-run health care"?
1. We already have tax-funded. Most people get it to some level
2. There are like six different government healthcare systems already
3. Socialized medicine might be good, but there's still other forms of it.
4. Again, we have government subsidized already, it's not necessarily single-payer
5. fully-subsidized isn't accurate
6. Health control isn't it. We already have way too much health control. It doesn't imply paying
7. too long. Also, like with #2, we have like six different systems already. Bringing that down to 1-2 would save money.
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Single payer will not result in superior care.
Don’t listen to the leftists, they always confuse their good intentions with good results.
You don’t solve the free rider problem by making everyone free riders.
How ignorant of human nature do you have to be to recommend such a delusional idea?
Single payer is unsustainable like all socialist scams.
Reject being scammed.
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Single payer will not result in superior care.
Don’t listen to the leftists, they always confuse their good intentions with good results.
You don’t solve the free rider problem by making everyone free riders.
How ignorant of human nature do you have to be to recommend such a delusional idea?
Single payer is unsustainable like all socialist scams.
Reject being scammed.
So what’s your solution, and where is one example of it working?
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https://www.nytimes.com/2018/07/22/us/politics/medicare-payments-trump.html
The current Administration has a very Socialist proposal: pay a flat rate for a Medicare office visit, regardless if it is for a rash or lung cancer. If it goes through, specialists will not be enthused to see Medicare patients.
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So what’s your solution, and where is one example of it working?
The only real solution is to double down and let it fail catastrophically.
Let the Leftists give us the British system (while .gov exempts themselves from the restrictions).
Give the people what they want, good and hard.
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So what’s your solution, and where is one example of it working?
Each person is responsible for himself. He has to provide for his own medical care and can not make others do it for him.
Works everywhere, because free-market.
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Each person is responsible for himself. He has to provide for his own medical care and can not make others do it for him.
Works everywhere, because free-market.
Agreed. It almost always ends up being the system with the most efficient use of resources. And with the enormous amount of charitable giving in this country, there will be a lot of groups helping those who cannot afford the more expensive treatments. Also, providers and pharmaceutical companies will have to rethink how they are selling and charging for their products/services (compared to now).
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Each person is responsible for himself. He has to provide for his own medical care and can not make others do it for him.
Works everywhere, because free-market.
But then we can’t feel good about helping “everyone”.
“We” have to do something via the federal government because we can’t leave people to their own devices.
Even if it doesn’t work at least we had good intentions.
I want to feel good.
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But then we can’t feel good about helping “everyone”.
Even if it doesn’t work at least we had good intentions.
I want to feel good.
Drink some beer
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A long time ago we used to have these things called "Mutual Aid Societies". Most were church or religion based. They helped when people were unemployed, sick/hurt or when a member passed away. Usually you paid into each month whatever you could afford so that you had a combination of life, medical, and disability insurance.
I'm not sure why something like that couldn't work again.
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A long time ago we used to have these things called "Mutual Aid Societies". Most were church or religion based. They helped when people were unemployed, sick/hurt or when a member passed away. Usually you paid into each month whatever you could afford so that you had a combination of life, medical, and disability insurance.
I'm not sure why something like that couldn't work again.
There is Medishare for medical issues: https://www.medishare.org/ppc/?utm_source=bing&utm_medium=cpc&utm_campaign=&utm_term=medi%20share&mkwid=PLftcsqc_dc&pcrid=73873564851669&pmt=be&pkw=medi%20share&utm_source=bing&utm_medium=cpc&utm_term=medi%20share&utm_campaign=Brand%20-%20MediShare%20-%20New%20Domain%20-%20B&leadsource=Internet-Search%20Engine&custentity_urlreferralid=Brand%20-%20MediShare%20-%20New%20Domain%20-%20B&custentity_urlreferralid=medi%20share&_vsrefdom=Bing-B&intent=Brand-Medishare
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"Medicare for allz!" The nomenklatura, of course, get the good stuff. The rest of us get the doctor's office in the back of the DMV. Take a number.
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A long time ago we used to have these things called "Mutual Aid Societies". Most were church or religion based. They helped when people were unemployed, sick/hurt or when a member passed away. Usually you paid into each month whatever you could afford so that you had a combination of life, medical, and disability insurance.
I'm not sure why something like that couldn't work again.
Just to go further on that, they also to care of widows, orphans, and the destitute.
An example near me: http://www.mooseheart.org/history/
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A long time ago we used to have these things called "Mutual Aid Societies". Most were church or religion based. They helped when people were unemployed, sick/hurt or when a member passed away. Usually you paid into each month whatever you could afford so that you had a combination of life, medical, and disability insurance.
I'm not sure why something like that couldn't work again.
I have to wonder if some of it is not feasible simply because with today's medical costs, potential bills for serious conditions can vastly outweigh money collected in the pool. Even adjusting for inflation, I'm guessing there was nothing like $10K/day hospital stays, and single surgeries that can cost $200K or more, back when these programs were more popular.
If we could get some of those costs under control, medical pools would possibly have a better chance of working and remaining solvent.
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Even adjusting for inflation, I'm guessing there was nothing like $10K/day hospital stays, and single surgeries that can cost $200K or more, back when these programs were more popular
You're right, those expensive treatments are a new phenomenon, because the technology didn't exist back then. If you want the best-in-class medical team to replace your fat-clogged arteries, you're going to pay for it big time.
The newest and best technology is always the most expensive.
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You're right, those expensive treatments are a new phenomenon, because the technology didn't exist back then. If you want the best-in-class medical team to replace your fat-clogged arteries, you're going to pay for it big time.
The newest and best technology is always the most expensive.
Certainly that's a data input. If you had fat clogged arteries that needed replacing 100 years ago, you mostly just died. Many of the most expensive procedures today are sophisticated and life saving or life extending.
There are still some ridiculous costs for non-sophisticated procedures though, IMO mostly centered around what medical facilities can get from insurance companies. Not unlike the whole college textbook scam, where students have to buy a $30 book for $100. There are lots of examples, some given by members here, of people making cash deals with doctors that are sometimes 50% of the going rate for insurance covered stuff. Physicals for example.
When I was working and had dental insurance, my dentist always gave me I think 25% off for stuff not covered by the insurance if I would pay for it up front.
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That's another problem. No one knows what anything in a hospital REALLY costs anymore. Medicare pays at one rate, Medicaid at another (very low) rate, each insurance company has their own deals with each hospital/Medical group. And since the end consumer/user never really sees a bill, other than for their deductible, they don't know what they were billed for. How many stories have we've read where where people get the same procedure done (without any follow-on complications) and the costs are completely different (wasn't there a guy in New York, IIRC, that is suing to find out ?)
I remember when I had surgery when I was twelve and my mom arguing with the hospital billing department about the bill she received and the prices of various things. This was before the day of assigning benefits and having the hospital bill the insurance company direct. They billed the patient (or their family) who had to pay first and THEN that person had to submit to the insurance company for re-reimbursement. Now, you don't get an actual bill, you get a "statement of benefits", from the insurance company, long after everything is done and paid.
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I have an idea. The law should require all hospitals to charge patients exactly the same per service, no matter how they pay. They must present the costs before treatment, and the patient must agree. These prices should be placed online where anyone can compare prices.
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I have an idea. The law should require all hospitals to charge patients exactly the same per service, no matter how they pay. They must present the costs before treatment, and the patient must agree. These prices should be placed online where anyone can compare prices.
Yes, We price shop cars, insurance, electronics, everything else, and mostly on-line. We compared the prices even of Amazon resellers. We should be able to shop hospitals and doctors.
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We should be able to shop hospitals and doctors.
Yes.
The law should require all hospitals to charge patients exactly the same per service, no matter how they pay.
No. Absolutely not. Do you want the FedGov to prevent companies from negotiating for better prices?
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Yes.
No. Absolutely not. Do you want the FedGov to prevent companies from negotiating for better prices?
"Cash Price
Procedure A at Hospital X is $Q
Procedure A at Hospital Y is $R
Contact your insurance company as they may be able to get you a better price"
We as consumers need to knw the costs to make good decisions. Also competition will go a long toward reducing costs.
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There are still some ridiculous costs for non-sophisticated procedures though, IMO mostly centered around what medical facilities can get from insurance companies. Not unlike the whole college textbook scam, where students have to buy a $30 book for $100. There are lots of examples, some given by members here, of people making cash deals with doctors that are sometimes 50% of the going rate for insurance covered stuff. Physicals for example.
$30 book for more like $450 these days. $100 is cheap for a college text these days.
When I was working and had dental insurance, my dentist always gave me I think 25% off for stuff not covered by the insurance if I would pay for it up front.
Indeed. My brother has gotten discounts of 50% or more in healthcare by negotiating cash up front. He even developed a list of clinics willing to work for cash.
What really needs to be banned are the insurance deals of "X% below cash price".
The deal that an insurance company strikes with the provider should not affect the deals other customers get.
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"Cash Price
Procedure A at Hospital X is $Q
Procedure A at Hospital Y is $R
Contact your insurance company as they may be able to get you a better price"
We as consumers need to knw the costs to make good decisions. Also competition will go a long toward reducing costs.
That is the proper way to do it. Just leave the government out of it.
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Here's a problem with auto insurance to add to the mix. In Michigan we have NoFault auto insurance with unlimited medical benefits. Hospitals and doctors charge, and actually have admitted in court, that they bill the auto insurer at 150 to 175% of the actual cost of treatment. That is because of all the bargaining that has occurred by the Fed and private insurers. The auto insurance companies wanted a level playing field on uniform charging. The Judge ruled that is was OK for the medical community to continue to overcharge in order to cover potential losses from the other side. We have the highest auto insurance rates in America as a result. We also have a secret organization set up by the state and staffed by auto insurance executives that charge each auto a fee for catastrophic injury claims. It's called the Michigan Catastrophic Claim Association and the information on how much money is in that pool and how it is paid out is withheld from the public. Currently it's around $170.00 per car per year. There is around 3.5 million cars in Michigan. Do the math and then understand no one can be privy to any the information about where that money goes and how it's spent. Insurance companies only have to pay up to $250,000 of the unlimited medical coverage and the MCCA kicks in. Another example of how government interference in stuff causes more trouble than it's worth.
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The other part that needs change is the requirements for hospitals to care for everyone regardless of ability to pay with legal liability attached. People should not be able to use the hospital as their free clinic. Hospitals should be able to give them the minimum care needed to keep them alive another day and then kick them out. I know a lot of people don't like that idea, but it is a form of welfare handout that needs to change. There has to be a way to get hospitals out of that cost/liability trap and force people to pay their own way.
It is difficult to do because Americans are generally compassionate and don't want people to be left without care. I just think it is a cost we are all paying for via Govt/Taxes that is greatly magnified by the way it is done.
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The other part that needs change is the requirements for hospitals to care for everyone regardless of ability to pay with legal liability attached. People should not be able to use the hospital as their free clinic. Hospitals should be able to give them the minimum care needed to keep them alive another day and then kick them out. I know a lot of people don't like that idea, but it is a form of welfare handout that needs to change. There has to be a way to get hospitals out of that cost/liability trap and force people to pay their own way.
It is difficult to do because Americans are generally compassionate and don't want people to be left without care. I just think it is a cost we are all paying for via Govt/Taxes that is greatly magnified by the way it is done.
The unfortunate part of making that point is it is just turned around as one of the benefits of single payer. If everyone is covered by uncle sugar then no one goes to the ER without the hospital getting paid.
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The unfortunate part of making that point is it is just turned around as one of the benefits of single payer. If everyone is covered by uncle sugar then no one goes to the ER without the hospital getting paid.
That's because the people turning it around are morons.
The hospital gets paid, but there are a lot more people going to the ER instead of Urgent Care or a PCP. Real cost "savings" there.
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That's because the people turning it around are morons.
The hospital gets paid, but there are a lot more people going to the ER instead of Urgent Care or a PCP. Real cost "savings" there.
I never said it was a good argument lol.
My insurance this year actually now has it where using the emergency room for a non emergency isn't covered, period, it's on you for being a jackass and going to the ER cause you have the sniffles.
If you go the the ER with chest pains and it turns out to just be swamp gas or something like that where it turns out to be nothing, that's cool cause you had a legitimate reason to feel there was an emergency. But show up with the sniffles and you can pay the stupidly high bill on your own.
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Hospitals should be able to give them the minimum care needed to keep them alive another day and then kick them out. I know a lot of people don't like that idea, but it is a form of welfare handout that needs to change. There has to be a way to get hospitals out of that cost/liability trap and force people to pay their own way.
That's actually the current system, more or less, and it has turned out to be extremely expensive. Because they show up with a critical condition, because they wouldn't or couldn't get care earlier when it would have been cheaper, the hospital spends a lot of resources saving their life, then because there isn't any followup care they end up back in the emergency room next week.
It's like how it has been determined that homeless people are actually extremely expensive, it's cheaper to house them.
As for forcing people to pay their own way, remember the phrase "cannot get blood from a stone"? Medical bankruptcy is one of the leading types of bankruptcy. People are literally going broke paying their own way, and a lot of these people have insurance, but are going broke from copays and other uncovered expenses.
It is difficult to do because Americans are generally compassionate and don't want people to be left without care. I just think it is a cost we are all paying for via Govt/Taxes that is greatly magnified by the way it is done.
We don't need single payer, I think, but we do need "insurance of last resort", I think. Because people ARE going to get medical care one way or another, even if they have to rob a bank to get it in prison. Yes, that sort of stuff has happened. Prison is expensive on top of the medical expenses, better to just cover it first.
If you go the the ER with chest pains and it turns out to just be swamp gas or something like that where it turns out to be nothing, that's cool cause you had a legitimate reason to feel there was an emergency. But show up with the sniffles and you can pay the stupidly high bill on your own.
Here's a question. Why does an ER visit need to be so much more expensive than a Urgent Care visit during the same sort of hours? Sniffles are sniffles, right? Just expand the ER a bit so that it has a sniffles section that is seen on it's own time.
The answer, I think? The ER is legally mandated to provide care, and this mandate isn't funded. Urgent care centers aren't. That means that the ER needs to charge for all those that don't pay, on those that do pay. Thus, outrageous bills. Many hospitals will take any excuse to close their ER down, because it is a money sink.
Fix that, and prices can come down a lot.
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I have to wonder if some of it is not feasible simply because with today's medical costs, potential bills for serious conditions can vastly outweigh money collected in the pool. Even adjusting for inflation, I'm guessing there was nothing like $10K/day hospital stays, and single surgeries that can cost $200K or more, back when these programs were more popular.
If we could get some of those costs under control, medical pools would possibly have a better chance of working and remaining solvent.
Much of those exorbitant healthcare costs have come about due to the ever expanding pool of insurance dollars available to pay for it. Increase the available dollars, costs will go up accordingly to absorb those dollars. Self-perpetuating after a fashion.
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Have you spent any time in a a ER ?? At least around here, if you go in it's all Medicaid and Illegals in there. That's the problem. Not Suzie Soccermom bringing in Little Timmy with the Sniffles. It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them. I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.
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You get some really bizarre administrative/bureaucratic nonesense, too.
In October, I had a house guest for a week, a woman from my late wife's native country. She had been an exchange student in the U.S. when she was in high school, and wanted to come back for a visit. She takes medication for something heart-related. She lost the medications she had brought with her. Obviously, a pharmacy couldn't just give her a supply without a prescription ... but we asked anyway, and got the expected response. I called my cardiologist and asked if he could write an emergency prescription to carry her for ten days. Nope -- not allowed.
Next, we went to an urgent care clinic that is affiliated with the hospital in a nearby city. A doctor there told us that she could not write the prescription there in the urgent care setting, but if we were in the hospital ER she could.
So, next we went to a hospital ER. She did eventually get her prescription, but the ER charge for entering her into their computer, having a nurse take her vital signs, and then having a doctor ask her what the medication was and give her a prescription came to several hundred dollars.
And then she received a separate bill (sent to my address, after she had returned to South America) for two or three hundred dollars for the doctor. Apparently that hospital (and I suppose this is becoming the norm) isn't employed directly by the hospital, he's an independent contractor. I suppose this is for liability insurance reasons, but to me it stinks. In the end, my wife's friend's lost pill bottle cost her almost $1,000 ... for about 15 minutes in the ER, and a ten-day emergency supply of the medication.
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Very few physicians are directly employed by the hospital any more. The hospitalist service, anesthesiology, radiology, pathology and the emergency department are almost always staffed by independent contractors or a staffing agency. This means you get separate physician bills for these services.
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Have you spent any time in a a ER ?? At least around here, if you go in it's all Medicaid and Illegals in there. That's the problem. Not Suzie Soccermom bringing in Little Timmy with the Sniffles. It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them. I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.
I went in a few years ago due to a particularly bad laceration.
There were many hispanic people waiting, some older folks, and a few crazies/drug seekers.
After about 30 minutes in the waiting room I had managed to get the bleeding to more or less stop by keeping pressure on it, so I went home.
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Have you spent any time in a a ER ?? At least around here, if you go in it's all Medicaid and Illegals in there. That's the problem. Not Suzie Soccermom bringing in Little Timmy with the Sniffles. It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them. I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.
Honestly, the last time I was in the ER as a patient I didn't see anyone there that would raise any suspicion of being Hispanic much less here illegally. Then again, being in a county that is 89.3% White and only 5.7% Hispanic could have something to do with that. I guess here you just replace Hispanic with "tweaker" and it is about the same ;)
bob
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I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.
Actually, I saw another English speaker at the ER once. College kid with a radial fracture to the tibia that he'd kept quiet about all weekend so as not to spoil his girlfriend's birthday.
Dude was clearly in some serious pain, and could finally whimper and hobble in to get it taken care of after she'd headed home. Hope she turned out to be worth it.
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Have you spent any time in a a ER ?? At least around here, if you go in it's all Medicaid and Illegals in there. That's the problem. Not Suzie Soccermom bringing in Little Timmy with the Sniffles. It's Pedro and Maria bringing in Little Jose with the Sniffles, because they don't have insurance, nor even Medicaid, but the ER is "Free"...to them. I've been to the ER a couple times for legit reasons, and I'd bet any amount that 1) I'm the only person there with Insurance and 2) I'm the only person there that speaks English.
You're causing my kidney stone PTSD to flair up. That was exactly how it went. Here I am, pissing kool-aid and wanting to die, in a room full of *expletive deleted*ing illegals and their anchor babies. Gotta wait my turn, Jorge has a cold or something. good times.
Similar thing after I stopped a piece of angle iron at work with my skull, requiring 23 stitches. Bloody terry cloth towel be damned, wait your turn and the doc will see you when he can.
Hooray. Build the *expletive deleted*ing wall.
End rant.
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Much of those exorbitant healthcare costs have come about due to the ever expanding pool of insurance dollars available to pay for it. Increase the available dollars, costs will go up accordingly to absorb those dollars. Self-perpetuating after a fashion.
Confirmed. A little off topic, but over the decades, I've often stated that insurance always causes service costs to rise. What the hell, insurance is paying for it, so let's charge some little extra, the customer won't complain. My data mostly comes from observing automobile insurance rates. For decades. Not to drift the thread, but I've been looking at the bigger picture regarding insurance and I can confirm RocketMan's thesis.
Terry
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Yes.
No. Absolutely not. Do you want the FedGov to prevent companies from negotiating for better prices?
Yes. When my wife was going to have our first child, I asked the hospital how much it would cost.
"$9000"
:mad:
"Oh, you have insurance? It will be $5000 then."
I oppose letting hospitals screw over people unlucky enough to not have insurance... for the same procedure.
I also oppose the gov requiring hospitals to treat non-paying customers.
Charge everyone the same per procedure, with the price clearly stated and published before treatment is given.
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Charge everyone the same per procedure, with the price clearly stated and published before treatment is given.
I hope you don't use any discounts you are offered from your workplace. Or from coupons. Or because you are a frequent shopper at a business.
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That's actually the current system, more or less, and it has turned out to be extremely expensive. Because they show up with a critical condition, because they wouldn't or couldn't get care earlier when it would have been cheaper, the hospital spends a lot of resources saving their life, then because there isn't any followup care they end up back in the emergency room next week.
It's like how it has been determined that homeless people are actually extremely expensive, it's cheaper to house them.
As for forcing people to pay their own way, remember the phrase "cannot get blood from a stone"? Medical bankruptcy is one of the leading types of bankruptcy. People are literally going broke paying their own way, and a lot of these people have insurance, but are going broke from copays and other uncovered expenses.
You went past my point. The emergency room should not be free to anyone. If the hospital was allowed to require people to pay up front or get out, the people who really needed help would come up with the money. Those who didn't have an actual emergency would either pay or find a less expensive alternative like they should in the first place. Right now, all those people using the ER for free health care are a drain on the system and ramping up the cost for everyone else.
I have a relative who nearly got their arm cut off in a tractor accident a few decades ago. He had no insurance and couldn't pay for it all. However, he talked to the hospital and others and just paid what he could when he could and eventually paid it all off. It is possible handle this stuff rationally. We just need to figure out how to get our system back into a rational form.
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One thing no one is really talking about in this lunacy is the back side of the equation. Everyone is looking at the "how do we pay for it" part. Because as bad as that is, the reimbursement rate part of it is actually worse. Because you've already got doctors and clinics who are not taking new Medicare patients. Medicare, in many cases, does not pay enough to even cover costs. An example in my industry - a $1200 ambulance bill may get $400 of it paid. May. Oh, and the balance? we're not allowed to go after the patient for the remainder, we have to accept Medicare's payment as payment in full and write off the rest. I cannot think of any clinic, hospital, or other healthcare service that could survive on a 100% Medicare patient load.
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One thing no one is really talking about in this lunacy is the back side of the equation. Everyone is looking at the "how do we pay for it" part. Because as bad as that is, the reimbursement rate part of it is actually worse. Because you've already got doctors and clinics who are not taking new Medicare patients. Medicare, in many cases, does not pay enough to even cover costs. An example in my industry - a $1200 ambulance bill may get $400 of it paid. May. Oh, and the balance? we're not allowed to go after the patient for the remainder, we have to accept Medicare's payment as payment in full and write off the rest. I cannot think of any clinic, hospital, or other healthcare service that could survive on a 100% Medicare patient load.
According to the practice management consultants, in ambulatory care, for the typical private practice clinic, you cannot allow your Medicaid/Medicare patient mix to get much above 30% for very long, otherwise you will go out of business. The private insurers (Blues, Aetna, Optum, etc.) are what keep private practice afloat. The sticky wicket is that the private insurers use Medicare rates as a basis for setting their own reimbursement schedules.
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You went past my point. The emergency room should not be free to anyone. If the hospital was allowed to require people to pay up front or get out, the people who really needed help would come up with the money. Those who didn't have an actual emergency would either pay or find a less expensive alternative like they should in the first place. Right now, all those people using the ER for free health care are a drain on the system and ramping up the cost for everyone else.
I have a relative who nearly got their arm cut off in a tractor accident a few decades ago. He had no insurance and couldn't pay for it all. However, he talked to the hospital and others and just paid what he could when he could and eventually paid it all off. It is possible handle this stuff rationally. We just need to figure out how to get our system back into a rational form.
The Federal law requiring hospitals/ERs to provide this care is called EMTALA: The Emergency Medical Treatment and Active Labor Act. It was passed precisely to avoid hospitals turning away patients based on inability to pay. So if you can get that overturned, we can go back to performing a wallet biopsy at the door to the hospital and denying care accordingly.
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What is this "Free ER" everyone is speaking of? The care isn't free, it's stolen.
If 40% of the population ate out once a week and skipped their restaurant bill, we wouldn't be crying about "Free Food" running our costs up, we'd be crying about thieves stealing food. That's an important distinction.
If one goes to an ER and accepts healthcare for what ails them, knowing either, they can't pay, or they are on a government program that won't pay for this visit, that person is a thief. And should be treated as such.
As far as I am aware the only thing ER's are required to provide is an appropriate Medical Screening Evaluation. At that point they can, and should, say "OK, this is what's wrong, and here is an estimate of the cost to treat it. Cash or Credit?"
Barring actual emergency care (bleeding out, heart attack, stroke, etc.) There's time to get payment details before treatment.
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As far as I am aware the only thing ER's are required to provide is an appropriate Medical Screening Evaluation. At that point they can, and should, say "OK, this is what's wrong, and here is an estimate of the cost to treat it. Cash or Credit?"
Barring actual emergency care (bleeding out, heart attack, stroke, etc.) There's time to get payment details before treatment.
Unfortunately, you are wrong. EMTALA not only requires hospitals to provide a medical screen, but also to provide treatment to resolve or stabilize an emergency medical condition or active labor, or to transfer the patient to another facility if they cannot be treated or stabilized. In many cases in which the patient is without insurance or assets, the hospital ends up eating the cost. This is a driving factor in many (especially smaller) hospitals closing down the emergency department.
http://newsroom.acep.org/2009-01-04-emtala-fact-sheet
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Unfortunately, you are wrong. EMTALA not only requires hospitals to provide a medical screen, but also to provide treatment to resolve or stabilize an emergency medical condition or active labor, or to transfer the patient to another facility if they cannot be treated or stabilized. In many cases in which the patient is without insurance or assets, the hospital ends up eating the cost. This is a driving factor in many (especially smaller) hospitals closing down the emergency department.
http://newsroom.acep.org/2009-01-04-emtala-fact-sheet
True, and while I knew that I glossed over it and phrased my post poorly.
This thread had a bunch of folks up in arms about people in the ER for colds and sniffles. That's not free, and isn't required. There's a lot of stuff that happens at ER's that isn't required by EMTALA. My wife (RN) tells me it's more complicated than it seems, because there's some programs where if a patient comes back for the same thing within 30 days the .gov programs that give them some money take that money back. So hospitals sometimes provide more than the minimum treatment required by law in the hopes that they can get some reimbursement.
None of which changes my point. The care isn't free, even if it's required to be provided. The folks using ER's with no intention of paying are thieves.
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^^^Readmission penalties for Medicare patients are a very real thing and is something we worry about a lot. On the one hand, there is pressure to get the patient out of the hospital as soon as possible. On the other hand, if they come back within 30 days for the same thing, the Feds take money back, don't pay for the second admit, or impose penalties. So we have to discharge people quicker and sicker and then cross our fingers. If the patient can be seen in followup by a provider within a week, or arrange for home health care, the odds are better.
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On the one hand, there is pressure to get the patient out of the hospital as soon as possible.
Thank CMS (Center for Medicare and Medicaid Services) who came up with a system where a diagnosis is assigned a number (DRG) that translates into days the .gov will pay for. Some can have comorbidities that increase the stay but often not. because them DRG length of stay is all the .gov pays for many (all) of the private insurances will also go by those guidelines. You have to be a pretty sick camper to get a DRG that goes over 5 days, unless it is a psychiatric diagnosis. :(
bob
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In regards to patients not paying for their care, here is a Washington appellate court decision that just hit my inbox: http://www.courts.wa.gov/opinions/pdf/767208.pdf
A patient tried to get out of paying his hospital bill by claiming that he signed an open-ended consent to care, rather than a definite amount that he would be billed. The Court rejected his claim.
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Sounds like there are factors that increase cost on all sides. It shouldn't surprise anyone that costs are high.
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^^^Readmission penalties for Medicare patients are a very real thing and is something we worry about a lot. On the one hand, there is pressure to get the patient out of the hospital as soon as possible. On the other hand, if they come back within 30 days for the same thing, the Feds take money back, don't pay for the second admit, or impose penalties. So we have to discharge people quicker and sicker and then cross our fingers. If the patient can be seen in followup by a provider within a week, or arrange for home health care, the odds are better.
Do you get the same penalties if they die?
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Do you get the same penalties if they die?
It would be super if they held off dying until at least day 31 after discharge.
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Do you get the same penalties if they die?
I am glad you asked this. ;)
Short answer is yes.
The real penalties come if a hospital does not meet required measures for an item called 30 day mortality. If a patient is hospitalized and then dies within 30 days of discharge (any cause of death not just what they were hospitalized for) it is a ding against the hospital. Too many of those and CMS can take a hard look at decreasing or removing funding from your facility until you get your act together. Do a good job and under the Value Based Purchasing system that Medicare uses the hospital could get a little extra, do very poorly and you may get a visit from the CMS inspectors trying to find out why your patients are kicking the bucket after you send them home and subsequently lose federal dollars.
bob
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Much of those exorbitant healthcare costs have come about due to the ever expanding pool of insurance dollars available to pay for it. Increase the available dollars, costs will go up accordingly to absorb those dollars. Self-perpetuating after a fashion.
Very similar to what was found with college tuition: the more money the feds made available, the higher tuition climbed
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I had prostate cancer in 2005. I went to the University of Michigan hospital in Ann Arbor. They had the #2 ranked guy (according to the internet) in America who knew how to do the radical prostatectomy using the DaVinci robot. That machine is awesome. The doc told me that if we had a DaVinci in Grand Rapids, he could actually do the surgery from Ann Arbor. They wouldn't actually do that, but he said it would be possible.
My health care accepted me going to U of M because they were an in network hospital and the fact that DaVinci prostatectomy is less invasive, hospital stay is short, blood loss is less etc. The surgery was to occur in the AM, but U of M is around 3 hours away. They actually have a hotel in the hospital, so we checked into the U of M hospital hotel the afternoon before. They did my surgery at 10AM on the clock the next morning. They discharged me at 10AM the next day. 24 hours was all I could be hospitalized unless there was a problem. When they kicked me loose, my wife wheelchaired me back the hotel room where we stayed over night. I drove home the next day. Driving home with a pee bag and the remnants of all the wonderful drugs made that experience memorable. (There was a Meijer Grocery semi on the interstate and I knew he'd be going back to near home, so I put the car on cruise and tailgated him all the way.) I paid out of pocket for the 3 nights in the hospital hotel at around $100.00 a night. The whole hospital stay/surgeryrecovery thing cost around $60,000-$70,000 iirc. I think I had $250.00 out of pocket.
So, I paid for 3 hotel nights and a $250.00 deductible. I was in the hospital 24 hours. Took up a bed and attention of a couple nurses and some pre-surgery drugs. Surgery was done using the DaVinci robot by a skilled surgeon and staff along with whatever else goes on in the operating room. Then recovery room in the afternoon with another guy who had the same surgery. Stayed overnight with whatever drugs the machine I was hooked to would allow and when as well as having a nurse stop by now and then. Then out the door by 10AM in the morning.
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Reading all this, I don’t see a single concrete proposal that is likely to reduce healthcare costs apart from simply copying a medical system that is already proven to reduce costs and deliver quality outcomes.
Lots of blame - illegals, people who use the ER, the requirement to treat the sick and not let them just die, and insurance companies all seem to blame from comments here. The government is mysteriously to blame but apart from not paying the high prices charged by private medicine I’m not sure there’s even been speculation as to how that increases cost.
I think this is a topic where people have been so heavily propagandised by the health insurers that it’s simply hard to have a rational debate. They even managed to convince people that Obamacare was something other than a gift to the largest players in the sector.
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Reading all this, I don’t see a single concrete proposal that is likely to reduce healthcare costs apart from simply copying a medical system that is already proven to reduce costs and deliver quality outcomes.
Lots of blame - illegals, people who use the ER, the requirement to treat the sick and not let them just die, and insurance companies all seem to blame from comments here. The government is mysteriously to blame but apart from not paying the high prices charged by private medicine I’m not sure there’s even been speculation as to how that increases cost.
I think this is a topic where people have been so heavily propagandised by the health insurers that it’s simply hard to have a rational debate. They even managed to convince people that Obamacare was something other than a gift to the largest players in the sector.
You left out medical litigation where people will sue at the drop of a hat and juries will hand out ridiculously large awards whether deserved or not. IMO, usually not.
bob
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You went past my point. The emergency room should not be free to anyone. If the hospital was allowed to require people to pay up front or get out, the people who really needed help would come up with the money.
Well, that or they die. Good luck if you're in a car accident, unconscious, wallet goes missing between the car and hospital, and nobody can confirm your identity/ability to pay.
Those who didn't have an actual emergency would either pay or find a less expensive alternative like they should in the first place. Right now, all those people using the ER for free health care are a drain on the system and ramping up the cost for everyone else.
Now here you're just agreeing with me.
We just need to figure out how to get our system back into a rational form.
Indeed. My point is that people who really need medical care are going to figure out how to get it somehow. My thought is that we need our incentives to be structured to get them to get treatment earlier, when it is drastically cheaper.
If one goes to an ER and accepts healthcare for what ails them, knowing either, they can't pay, or they are on a government program that won't pay for this visit, that person is a thief. And should be treated as such.
So we put them in jail or prison where we have to not only provide free medical care, but housing and food as well?
This is a driving factor in many (especially smaller) hospitals closing down the emergency department.
I think that the lack of emergency departments is a problem. Of course, I'm also wary of hospitals being able to turn people away to basically die on their doorstep.
It is my belief that IF the federal government is going to mandate that emergency rooms provide treatment regardless of ability to pay, THEN it should step in and fund/pay for the requirement.
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Well, that or they die. Good luck if you're in a car accident, unconscious, wallet goes missing between the car and hospital, and nobody can confirm your identity/ability to pay.
Either I'm getting soft in my old age, or I'm becoming a bleeding heart commie, because this is my point as well.
If you're talking about turning people away from the ER because of a sniffle, I'm right there with you, whether they're insured or not. Going to the ER for stuff you shouldn't even need a doctor for is a big part of the problem, IMO.
To Firethorn's point: If you're going to implement "only paying customers" in the ER, for REAL ER cases, how will you do it? The three Bens:
Ben #1: Insured Ben is out running. Ben is hit by a bus, but is brought to the ER conscious. Ben carries nothing but a phone with him while running, and the phone went flying when the bus hit. ER asks Ben if he's insured, and he says yes. Is that good enough to get him through the door?
Ben #2: Same scenario as above, but with uninsured Ben. So if I'm at death's door, is it really tough luck, go die now? If I chose not to be insured because I'm a tightwad, or because I use the $1000/mo for the insurance on hookers and blow, then maybe I should die. What about if I'm just temporarily down on my luck? Should I still die?
Ben #3: Insured Ben is out running with no ID and hit by a bus. Insured Ben is brought to the ER unconscious. Now what? If the hospital turns away unconscious insured Ben, and Ben lives, I'm pretty sure he'd be sitting on easy street after the lawsuit. Also what if unconscious, uninsured Ben is "uninsured" because he's a bajillionaire and self-insured?
So we can keep debating about turning people away from the ER for many ailments, but I don't think in a reasonable society, that we can turn away critically injured people at the ER, say after a building is bombed, or a train derails, or if it's just a one vehicle car wreck. Or some shmuck hit by a bus.
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We use the framework that exists already.
Step 1:
You come in to the ER, and are go through triage.
If you are unconcious and/or need help RIGHT NOW then they do give you help.
If something's wrong but we don't know what then they do some tests to see if it's a heart attack or indigestion.
If it's you came to the ER because you don't have a Primary Care and you will clearly be fin until business hours they say that.
In any case, at some point you are no longer Emergent Care, and are going to just medical care. That might be when you get out of surgery, when you hit the triage desk, or when you die. At some point it's not an emergency. At that point, there's time to get payment for service rendered, and plan for the payment of the rest of your care. Sniffles? Give me a credit card or get out. Ben #2? You just drew the short straw, and are racking up bills while you try and find a government program or charity to help out. Maybe you want to think about exactly how much surgery you can afford. 8 cutting edge surgeries that 50/50 save the leg, and no insurance? Pay up front. Otherwise Medicaid will probably cover the amputation and prosthetic.
Paying for treatment up to that Go/No Go point remains an issue, but a smaller one, and Perhaps fed.gov is on the hook for that. It's their rules that require the care.
So we put them in jail or prison where we have to not only provide free medical care, but housing and food as well?
That same point can be made about literally every other form of thievery. And yet we still prosecute and imprison thieves. Yes, we should lock-up people that willfully steal medical care. Or seizing assets to pay for the care. If nothing else, people seem to value their freedom. If a trip to the ER for stitches you can't pay for had a real risk of losing a tax "return"* or 6 months in jail for fraud, perhaps some first aid would be learned.
*Return is in quotes in case the folks in question didn't actually pay all that money, but were getting some wealth redistribution.
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Reading all this, I don’t see a single concrete proposal that is likely to reduce healthcare costs apart from simply copying a medical system that is already proven to reduce costs and deliver quality outcomes.
Lots of blame - illegals, people who use the ER, the requirement to treat the sick and not let them just die, and insurance companies all seem to blame from comments here. The government is mysteriously to blame but apart from not paying the high prices charged by private medicine I’m not sure there’s even been speculation as to how that increases cost.
I think this is a topic where people have been so heavily propagandised by the health insurers that it’s simply hard to have a rational debate. They even managed to convince people that Obamacare was something other than a gift to the largest players in the sector.
What system do you think we should copy? I'm open to ideas. It seems like single payer options tend to have serious problems with rationing and/or quality though. I don't know the best thing to do. I do know that costs are in the US system are a serious problem that congress is refusing to address.
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You left out medical litigation where people will sue at the drop of a hat and juries will hand out ridiculously large awards whether deserved or not. IMO, usually not.
bob
Those awards are largely based on actual medical expenses
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What system do you think we should copy? I'm open to ideas. It seems like single payer options tend to have serious problems with rationing and/or quality though. I don't know the best thing to do. I do know that costs are in the US system are a serious problem that congress is refusing to address.
How about we copy France? Or Canada to make the manuals easier? Both have equivalent quality
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We use the framework that exists already.
Step 1:
You come in to the ER, and are go through triage.
If you are unconcious and/or need help RIGHT NOW then they do give you help.
If something's wrong but we don't know what then they do some tests to see if it's a heart attack or indigestion.
If it's you came to the ER because you don't have a Primary Care and you will clearly be fin until business hours they say that.
In any case, at some point you are no longer Emergent Care, and are going to just medical care. That might be when you get out of surgery, when you hit the triage desk, or when you die. At some point it's not an emergency. At that point, there's time to get payment for service rendered, and plan for the payment of the rest of your care. Sniffles? Give me a credit card or get out. Ben #2? You just drew the short straw, and are racking up bills while you try and find a government program or charity to help out. Maybe you want to think about exactly how much surgery you can afford. 8 cutting edge surgeries that 50/50 save the leg, and no insurance? Pay up front. Otherwise Medicaid will probably cover the amputation and prosthetic.
Paying for treatment up to that Go/No Go point remains an issue, but a smaller one, and Perhaps fed.gov is on the hook for that. It's their rules that require the care.
That same point can be made about literally every other form of thievery. And yet we still prosecute and imprison thieves. Yes, we should lock-up people that willfully steal medical care. Or seizing assets to pay for the care. If nothing else, people seem to value their freedom. If a trip to the ER for stitches you can't pay for had a real risk of losing a tax "return"* or 6 months in jail for fraud, perhaps some first aid would be learned.
*Return is in quotes in case the folks in question didn't actually pay all that money, but were getting some wealth redistribution.
So your theory is that if debt collection for medical expenses was more like what you’d see in a Dickens novel, costs of healthcare would go down???
Or do you not care about price per service? Seems to me the purpose of capitalism is to make life better for people, not to make an essential service like medicine so expensive that only by threatening Dickensian punishments can it be rationed to serve even some people
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DeSelby, even if all the other countries did -- or have -- adopt (ed) a wonderfully efficient single payer socialized medical system, it would not happen in America. The closest we have is the VA Administration and that has been an embarrassing mess for decades.
After five decades of watching the American Government adopt one program after another, and projecting it's costs into the future only to actually find that, decades later, the real expense was five, ten times or more than original estimates, I cannot believe that it is possible for us to do it right (accepting, a priori, that other countries actually do it right) given demonstrated history.
Obamacare was promised to cut health insurance costs. I'm told for a few, maybe it did. My costs, however, have skyrocketed, and everyone I know has experienced the same.
Please stop telling me about other countries' wonderful systems. I suppose a few countries can pull it off. Years ago my parents spent several years in Scotland, and had need to use their system. I wouldn't wish what they went through on a mortal enemy.
Well, maybe I would if they could do it more efficiently ..... but they couldn't. Okay, that's one story. I could tell you what their Scottish friends said if you like anecdotal horror stories, but then I cannot provide the footnotes and ibids you hold so dear, so I'll save myself the effort.
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Those awards are largely based on actual medical expenses
Speaking as the only person on this board who actually does medical malpractice claims, from the defense side, not so much. As you know, part of the special damages allocation may well be based on actual medical expenses; but the general damages allocation (pain and suffering and emotional distress) are granted on whatever basis the judge or jury chooses. In some cases, juries like to pick a multiple of the special damages amount (medical expenses, loss of earnings, additional expenses, impairment of future earning capacity) and in other cases, they seemingly pull a number out of the hat.
Speaking from an overall perspective however, the costs of medical litigation (insurance, legal indemnity and legal expenses) are a small contributor to overall medical costs. There is lots of reputable literature on this.
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Speaking from an overall perspective however, the costs of medical litigation (insurance, legal indemnity and legal expenses) are a small contributor to overall medical costs. There is lots of reputable literature on this.
I note your list doesn't take into account "defensive medicine".
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I note your list doesn't take into account "defensive medicine".
Attempts have been made to quantify defensive medicine and have generally failed miserably. You usually aren't going to find providers who will say 'I ordered that test only to keep from being sued'. What they say instead is 'I ordered that test to reduce diagnostic uncertainty' or 'to refine my diagnosis and treatment plan'. So trying to put a number on defensive medicine, as opposed to doing your clinical due diligence is difficult.
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So your theory is that if debt collection for medical expenses was more like what you’d see in a Dickens novel, costs of healthcare would go down???
Or do you not care about price per service? Seems to me the purpose of capitalism is to make life better for people, not to make an essential service like medicine so expensive that only by threatening Dickensian punishments can it be rationed to serve even some people
Was it a "Dickensian punishment" when we sent Enron Executives to jail for fraud?
There are multiple issues driving our healthcare costs, and each issue will need it's own solution. One of the issues is people using healthcare services (I even separated emergency services in the post you quoted, to be more egalitarian) with no intention of paying for them. That drives up costs for those of us that do pay, because those expenses have to be recouped. That should be treated like a crime. As I said in my post (again, that you quoted, so one assumes you read) that we emergent up to stabilization care should be provided before we hit the paywall, but that shouldn't be "Whatever you want the Doctors to try" or "The ER was convenient so I went in for a sprained ankle."
You need food to live, but we don't pretend it's OK to just go into a grocery store and take whatever you want. We arrest people for shoplifting.
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The other problem with Medicare for All is my mother (and there are many like her). She has a supplemental policy that covers what Medicare doesn't, so her hobby for the past 15 years has been "Let's go to the Doctor." So she's visiting one type of doctor or another at least once a month, sometimes twice or three times a month. All for mostly BS reasons. But hey, it's free and the place she stays at has a shuttle that will take the residents pretty much anywhere, so even though we tell mom that one of us kids needs to go with her, she'll make her own appointments and take the shuttle without telling us.
Anyway, her answer to all the doctor visits is "It's free, so why shouldn't I use it." Which is why Medicare for all will collapse/run up costs very quickly. If people think "It's Free" then they'll use more of it.
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The other problem with Medicare for All is my mother (and there are many like her). She has a supplemental policy that covers what Medicare doesn't, so her hobby for the past 15 years has been "Let's go to the Doctor." So she's visiting one type of doctor or another at least once a month, sometimes twice or three times a month. All for mostly BS reasons. But hey, it's free and the place she stays at has a shuttle that will take the residents pretty much anywhere, so even though we tell mom that one of us kids needs to go with her, she'll make her own appointments and take the shuttle without telling us.
Anyway, her answer to all the doctor visits is "It's free, so why shouldn't I use it." Which is why Medicare for all will collapse/run up costs very quickly. If people think "It's Free" then they'll use more of it.
Yep.
Got a grandfather who does that because he's just bored. And then he bitches when the diagnosis is "you're 90 and there's nothing wrong with you, it's simply high millage"
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Speaking as the only person on this board who actually does medical malpractice claims, from the defense side, not so much. As you know, part of the special damages allocation may well be based on actual medical expenses; but the general damages allocation (pain and suffering and emotional distress) are granted on whatever basis the judge or jury chooses. In some cases, juries like to pick a multiple of the special damages amount (medical expenses, loss of earnings, additional expenses, impairment of future earning capacity) and in other cases, they seemingly pull a number out of the hat.
Speaking from an overall perspective however, the costs of medical litigation (insurance, legal indemnity and legal expenses) are a small contributor to overall medical costs. There is lots of reputable literature on this.
I do a fair amount of research on how judgments affect insurance markets. I find data like this report useful for keeping track: https://www.insurance.wa.gov/sites/default/files/documents/2017-med-mal-annual-report.pdf (https://www.insurance.wa.gov/sites/default/files/documents/2017-med-mal-annual-report.pdf)
Certainly there are random cases, but on average general damages are not the majority of costs.
Economic loss payments totaled $363 million, an average of $150,520 per paid claim. On average, insurers and self-insurers
attributed 58.7 percent of each claim payment to economic loss.
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Was it a "Dickensian punishment" when we sent Enron Executives to jail for fraud?
There are multiple issues driving our healthcare costs, and each issue will need it's own solution. One of the issues is people using healthcare services (I even separated emergency services in the post you quoted, to be more egalitarian) with no intention of paying for them. That drives up costs for those of us that do pay, because those expenses have to be recouped. That should be treated like a crime. As I said in my post (again, that you quoted, so one assumes you read) that we emergent up to stabilization care should be provided before we hit the paywall, but that shouldn't be "Whatever you want the Doctors to try" or "The ER was convenient so I went in for a sprained ankle."
You need food to live, but we don't pretend it's OK to just go into a grocery store and take whatever you want. We arrest people for shoplifting.
How would you feel about the free food market if routine food was unaffordable to half the population?
This is actually a good comparison. Food production is heavily regulated and subsidised - more so than in most of the rest of the world. US farming is as close to socialist medicine as our economy gets, and as a result we have some of the cheapest and most available food in the world.
So that’s an excellent example but not for the moralising you’re trying to do with it.
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I contribute data to the Washington Insurance Commissioners annual medmal report and I helped set up the reporting format and data! The one sticky wicket in the figure you cited is that in many of the settlements and verdicts, the special damages figure is an estimated allocation by the insurer. It is more straight-forward when you have a jury verdict form and the jury actually allocates a known figure for special damages. In many cases, however, I would argue that wage loss and impairment of future earning capacity is more of a driver of the total special damages figure than medical costs. If my provider kills a 35 year old Boeing engineer making $ 150,000 a year, 30 years wage loss increasing at 3% per year, will make up a larger chunk of special damages than the $ 55,000 hospital bill.
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How would you feel about the free food market if routine food was unaffordable to half the population?
This is actually a good comparison. Food production is heavily regulated and subsidised - more so than in most of the rest of the world. US farming is as close to socialist medicine as our economy gets, and as a result we have some of the cheapest and most available food in the world.
So that’s an excellent example but not for the moralising you’re trying to do with it.
Capitalism builds a system with a huge surplus and you want to attribute that to a few subsides? I farm. The "regulated and subsidized" bits are the exception. You're delusional.
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Capitalism builds a system with a huge surplus and you want to attribute that to a few subsides? I farm. The "regulated and subsidized" bits are the exception. You're delusional.
https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances.aspx (https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances.aspx)
Theres data on this. $20 billion in direct subsidies and $172 billion worth of other investment and value seems pretty significant to me. And this is in an industry that was basically entirely revolutionised by Roosevelt.
To suggest capitalism built US farming is delusional. People get paid subsidies in socialist systems - just because some folks get billions in payments and then get to sell a product on top doesn’t make it capitalism.
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Roosevelt mucking around with Agriculture has only made things more expensive. And yes, capitalism, in the form of labor saving machinery has made modern farming what it is today. If the .gov got out of the farming business, food would be cheaper. It's plentiful an we can easily feed the entire world, with much left over, despite what the doom and gloom prophets were predicting in the latter half of the 20th Century.
And it's not socialism that did that. I remember when we were sending food to the Soviets on a pretty much annual basis, because the experienced a bad harvest every year going back to 1917. Now, the Ukraine, Belorus, and Russia are net exporters of grain. I wonder what caused that change.
And of course no one is mentioning the elephant in the room. How many hundreds of people died because the NHS couldn't respond to the flu outbreak in Britain earlier this year. The Brits won't come out and admit the problems with the bureaucratic inertia that delayed a quick response to the unfolding crisis. Which showed they learned nothing from 2009 or the winter of 2010/11 when they also had flu pandemics.
And anyone who thinks that single payer is so great go deal with the VA. I farkin' dare you. It's an absolute Byzantine nightmare compared to dealing with an insurance company.
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The VA isn't single payer though? It isn't even the best example of the federal healthcare programs? I mean just on the government side alone we could also look at Medicare, Medicaid, Tricare, and more. There are private insurances, and the VA will attempt to bill them if you have them.
Etc...
As such, the argument could be made that the VA is too small and serves too specific of a group to be a good metric for healthcare. Medicare serves a lot more people. Medicaid serves more.
VA: 9 Million.
Medicare: 44 Million
Medicaid: 70 Million
Etc...
Part of the argument is that when you start going true "single payer", start putting the politicians on the program, they can't continue to allow the programs to be horrible. Plus, in this case, we'd be eliminating two of three parallel bureaucracies.
But I'm going to go back to what I said earlier: I don't think we need single payer, we need an insurance of last resort. Start combining all the government healthcare systems into it, with some added bits for the military system because it needs to be able to deploy.
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If such a thing were to happen, the best plan would be to require the politicians to get care in their home districts. They would still end up getting special treatment, but at least there wouldn't be some special D.C. treatment clinic.
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This is actually a good comparison. Food production is heavily regulated and subsidised - more so than in most of the rest of the world. US farming is as close to socialist medicine as our economy gets, and as a result we have some of the cheapest and most available food in the world.
Mass starvation usually happens in socialist economies, not capitalist ones. Note the current food crisis in Venezuela.
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https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances.aspx (https://www.ers.usda.gov/topics/farm-economy/farm-sector-income-finances.aspx)
Theres data on this. $20 billion in direct subsidies and $172 billion worth of other investment and value seems pretty significant to me. And this is in an industry that was basically entirely revolutionised by Roosevelt.
To suggest capitalism built US farming is delusional. People get paid subsidies in socialist systems - just because some folks get billions in payments and then get to sell a product on top doesn’t make it capitalism.
Wow. I am certain you didn't build that, but I am pretty sure a lot of farmers did. Be better if we knew exactly who that money was actually getting paid to.
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I contribute data to the Washington Insurance Commissioners annual medmal report and I helped set up the reporting format and data! The one sticky wicket in the figure you cited is that in many of the settlements and verdicts, the special damages figure is an estimated allocation by the insurer. It is more straight-forward when you have a jury verdict form and the jury actually allocates a known figure for special damages. In many cases, however, I would argue that wage loss and impairment of future earning capacity is more of a driver of the total special damages figure than medical costs. If my provider kills a 35 year old Boeing engineer making $ 150,000 a year, 30 years wage loss increasing at 3% per year, will make up a larger chunk of special damages than the $ 55,000 hospital bill.
What is often not factored in is how liability affects decision making at every level. It seems just about every decision by upper level managers involves taxes and liability in one way or another. It warps our economy in ways I am not sure can be accounted for.
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The VA isn't single payer though? It isn't even the best example of the federal healthcare programs? I mean just on the government side alone we could also look at Medicare, Medicaid, Tricare, and more. There are private insurances, and the VA will attempt to bill them if you have them.
But it's, in overall effect, single provider. It's a huge HMO, in which your primary care physician is your gate keeper. You can't see a specialist unless and until your primary makes a referral. That's what almost killed me in 2014. I started having heart rhythm problems. (Actually, they had started a few years before, and the VA doc said it was nothing to be concerned about.) My primary changed the dosage of my blood pressure medication. Arrhythmia got worse. She changed the medication. Arrhythmia got worse. She changed the dosage on the new medication. Arrhythmia got worse ... Nowhere along the way did she send me to see a cardiologist.
Meanwhile, I was to the point that I barely had enough energy to get out of bed. I finally woke up and remembered that I'm on social security, I have Medicare, and I had a Medicare supplement plan. So I called a general practitioner doctor in town and went in to see them. Didn't even get to the doctor -- the PA said I needed to see a cardiologist STAT -- to the point that she made an appointment for me for first thing the next morning. When I got to the cardiologist, he said I belonged in the emergency room. He wanted me to go there directly from his office, but I'm a widower, I live alone, and I had custody of my daughter's toy poodle. So he told me to make arrangements for the dog and go the the ER first thing the next morning. I did so, and a week later they sawed open my chest.
The VA finally contacted me about an appointment with a cardiologist about six weeks after my heart surgery, while I was at home, recuperating.
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I finally woke up and remembered that I'm on social security, I have Medicare, and I had a Medicare supplement plan.
So your solution to one government healthcare provider screwing up was to use a different government healthcare provider. Got it.
Also, all your "evidence" is anecdotal. There's plenty of horror stories out there for private healthcare insurance, remember?
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^^^^ This just came through on my MedPage newsfeed: https://www.cnn.com/2018/08/15/health/cancer-survivor-insurance-denial-battle/index.html
Interesting side topic: I interviewed with the Seattle proton therapy center for their quality/risk director, and turned them down due to their financials. I suspect they will be out of business in a few years. They have local competition, and the lack of insurance reimbursement for proton therapy is weeding out centers. So far, the literature suggests that proton therapy is useful in only certain narrow indications, and the insurers are refusing to pay for anything other than those indications.
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So your solution to one government healthcare provider screwing up was to use a different government healthcare provider. Got it.
Also, all your "evidence" is anecdotal. There's plenty of horror stories out there for private healthcare insurance, remember?
Oh, there's tons of evidence of the VA killing patients. While privat4 insurance companies can be a PITA to deal with at times, they haven't actively kill people to the extent of the VA's willful neglect.
We've all seen the NHS in Britain deny treatment to children suffering from rare diseases (including refusing to allow the parents to take a child to a a country that offered free treatment). Plus the reports of the NHS actively killing children and old people. http://www.dailymail.co.uk/news/article-2161869/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html
Now come reports from Belgium of their health service euthanizing patients. http://www.lifenews.com/2018/07/25/belgium-euthanizes-hundreds-of-disabled-and-mentally-disabled-people-including-three-children/
But you have to break a few eggs to have healthcare for everyone....
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Oh, there's tons of evidence of the VA killing patients. While privat4 insurance companies can be a PITA to deal with at times, they haven't actively kill people to the extent of the VA's willful neglect.
We've all seen the NHS in Britain deny treatment to children suffering from rare diseases (including refusing to allow the parents to take a child to a a country that offered free treatment). Plus the reports of the NHS actively killing children and old people. http://www.dailymail.co.uk/news/article-2161869/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html
Now come reports from Belgium of their health service euthanizing patients. http://www.lifenews.com/2018/07/25/belgium-euthanizes-hundreds-of-disabled-and-mentally-disabled-people-including-three-children/
But you have to break a few eggs to have healthcare for everyone....
Okay, so in response to studies you post media. Surely you can see firethorns point - if he comes back with four articles about private hospitals killing children, would he have a stronger case than youve posted?
Or should we maybe just look for research on average outcomes and go from there?
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Mass starvation usually happens in socialist economies, not capitalist ones. Note the current food crisis in Venezuela.
True. No socialist country has come up with a regulatory and subsidy framework as vast or well funded as the USA.
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I contribute data to the Washington Insurance Commissioners annual medmal report and I helped set up the reporting format and data! The one sticky wicket in the figure you cited is that in many of the settlements and verdicts, the special damages figure is an estimated allocation by the insurer. It is more straight-forward when you have a jury verdict form and the jury actually allocates a known figure for special damages. In many cases, however, I would argue that wage loss and impairment of future earning capacity is more of a driver of the total special damages figure than medical costs. If my provider kills a 35 year old Boeing engineer making $ 150,000 a year, 30 years wage loss increasing at 3% per year, will make up a larger chunk of special damages than the $ 55,000 hospital bill.
Those are great reports - do you know any sources for data that give a firmer picture of the breakdown of awards?
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So your solution to one government healthcare provider screwing up was to use a different government healthcare provider. Got it.
No, my point was that in order to see the specialist I needed, I had to go out of the VA system. I was specifically responding to a comment about the VA. And I doubt that either my private sector cardiologist or the local university teaching hospital would consider itself to be a government provider.
Also, all your "evidence" is anecdotal. There's plenty of horror stories out there for private healthcare insurance, remember?
Of course my story (I didn't call it "evidence") is anecdotal. I never said it was anything else.
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What is often not factored in is how liability affects decision making at every level. It seems just about every decision by upper level managers involves taxes and liability in one way or another. It warps our economy in ways I am not sure can be accounted for.
It is important to recognise that liability is costs imposed on other people - it is not warped to take it into account
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Those are great reports - do you know any sources for data that give a firmer picture of the breakdown of awards?
I do not; I am unaware of any data source that gets to that level of granularity. It is difficult to find any data that even breaks out special vs. general damages.
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I do not; I am unaware of any data source that gets to that level of granularity. It is difficult to find any data that even breaks out special vs. general damages.
The insurance returns at that link have at least an approximation. I’ve seen academic examples of local judgment research before but wouldn’t have time to dig on WA. Law student project worthy I reckon.
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Okay, so in response to studies you post media. Surely you can see firethorns point - if he comes back with four articles about private hospitals killing children, would he have a stronger case than youve posted?
Or should we maybe just look for research on average outcomes and go from there?
Sure, if he can post 4 articles about hospitals (not a single deranged person, but the leadership of said hospital conspiring and) willing to kill children and old people.
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Sure, if he can post 4 articles about hospitals (not a single deranged person, but the leadership of said hospital conspiring and) willing to kill children and old people.
That's moving the goalposts Amy. Heck, I'd say it is such a move, and of such specificity, that you are still missing the point. Even the NHS system? Reading between the lines, that is hospice care. You kind of need that, I think. Now, one can have the argument of whether everybody moved into it is actually ready for it. But several of my grandparents received it before the end, here in the USA. But phrase it wrongly, and it certainly sounds like the healthcare system sentenced my grandparents to death.
My core point is that once you remove the anecdotal, outcomes are remarkably similar between "first world" nations, despite the United States spending vastly more. Marginally better in a few metrics, marginally worse in others, etc...
It doesn't need to be the leadership of the hospital conspiring to kill people. Nice catch on restricting it to leadership and conspiracies, by the way. Gotta keep that goalpost shuffling, and make my job difficult as threading a needle because I can't even pick conspiracies against people of average age. Can't include plain old incompetence because the hospital admins are simply too cheap. Can't include deaths due to people not seeking treatment because they can't afford it. Etc... Instead, I'll deny your goalpost move and stick to my original point.
How about hospital errors killing 440k people a year (http://www.hospitalsafetygrade.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow) in the USA? That rate of death would kill every person in the VA system every 20 years.
Or that lack of health coverage kills 45k/year? (https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/)
That people are avoiding healthcare due to high cost? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/)
The CDC reports that, on average, about 11% of Americans (https://www.cdc.gov/mmwr/volumes/66/wr/mm6604a9.htm) delay or do not receive medical care due to cost the previous year. And we complain about delays in universal systems?
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That's not moving the goalposts. That's setting the parameters so that same data is being used for both sides, not anecdotes. For every Nurse Rachet in the US smothering patients, there is a Nurse Rachet in the UK injecting them with a lethal dose of morphine. (relative to population). Nice try a deflecting the argument. I'm just trying to compare apples to apples.
I'm referring to the Hospital Administration picking and choosing who lives and who dies (or gets operations). Mostly due to money.
And there is also a huge difference between an individual who writes an Advance Directive regarding their care, or a family making end of life decisions for a loved one; versus a bunch of hospital bureaucrats sitting around a conference table deciding who gets an operation and who gets the Bobby Sands treatment. (and without involving the family/loved ones in that decision.)
And no, the outcomes aren't comparable between us and the UK. Far from it in fact.
https://www.theguardian.com/society/2015/jul/14/avoidable-deaths-nhs-hospitals-study
That would be same as if 3,750 people in the US died needlessly in Hospitals in US each month. That would be a national scandal. Oh wait, it was with the VA.
https://www.theguardian.com/society/2013/sep/12/hospital-death-rates-england-higher-us
Seems their death rate is 45% higher then ours. I wouldn't consider that "Similar outcomes."
https://www.telegraph.co.uk/news/health/news/8668906/NHS-delays-operations-as-it-waits-for-patients-to-die-or-go-private.html
Yeah, I'm sure Millcreek will confirm that his hospital does this all the time...
Even the NHS says that they kill more patients the US hospitals do: https://www.nhs.uk/news/medical-practice/death-rate-much-higher-in-english-than-us-hospitals/
Here's the tl;dr version. The NHS death rate is 4 times higher then the US'. Again. Not a similar outcome by 4x.
How about 15,000 "excess" deaths in the NHS. That would translate into 75,000 in the USA (our population is roughly 5 times the UK's). And look at the outcry over Veteran's Death caused by the VA. https://www.bbc.com/news/health-39204681
And you can do your own research on the woeful response (and the "Zero effectiveness" flu vaccine) of the NHS to their flu outbreak earlier this year.
Regarding your links:
1. Are your trying to tell me that there are no medical errors in the UK. You really expect me to believe that ?? (See above links)
2. As has been frequently discussed here and elsewhere. No one is the US is denied Healthcare, so that argument is a non-starter.
3. There is HUGE difference in ME deciding what healthcare I or my family choose to use or forego, versus some nameless/faceless bureaucrat(s) making those decisions (see article from the Telegraph above).
4. Again, people are making their own decisions versus some nameless/faceless bureaucrat(s) doing it. And I will again point out that I don't need the .gov to select my car insurance, life insurance, or which repair shops I chose to have my car serviced, nor can they deny me changing my oil whenever I want.
And yes,
Here's something interesting from one study I saw regarding the increase in mortality rates in the UK.
The period July 2014 to June 2015 saw an additional 39 074 deaths in England and Wales compared with the same period the previous year. While mortality rates fluctuate year-on-year, this was the largest rise for nearly 50 years and the higher rate of mortality has been maintained throughout 2016 and into 2017. These recent trends contrast with the long-term decline in age-specific mortality rates throughout the 20th and 21stcenturies. The majority of these additional deaths were in frail elderly individuals.
The increase in mortality rates has occurred during a crisis in the National Health Service (NHS). The number of NHS trusts with budget deficits has increased sharply since 2014/2015, as did waiting periods for elective surgery in 2015. Issues within the NHS are being compounded by problems with the provision of adult social care to support individuals leaving NHS care7 and pressures of increased demand.
Bolding mine. To quote Maggie Thatcher Socialism works great, until you run out of other people's money.
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And I can't fathom your belief that government can do it better and cheaper. Name one thing that government does better and/or cheaper then the private sector.
ANd just to help shatter your rose colored glasses. Here's what the US Government projected as the costs of Medicare versus the Actual results:
In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.
In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.
In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.
Yeah, not a good track record.
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And I can't fathom your belief that government can do it better and cheaper. Name one thing that government does better and/or cheaper then the private sector.
And I can't fathom your belief that the private sector has all that much to do with our health care system. Consider what we've seen in this thread. People complaining about the VA - so they went to medicare. Which one of these is private sector or even just not government?
Again, moving the goal posts. I've never said that a private sector/free market solution wouldn't be cheaper and more cost efficient than a government solution. However, as I've pointed out before, I believe that our current system is a careful blend of the worst aspects of government control and private sector. As a result, a more governmental solution can indeed be cheaper than our current system.
Here's a stark little fact: For no appreciable gain in outcomes, the United States Governments already spends enough money to provide single payer universal coverage for everybody in the USA if we could get our costs down to the median of Europe.
As in your taxes don't need to go up 1 cent. Spending remains even or even goes down. All private payments vanish.
That said, I'm arguing this because you pushed me into this position. Go back to my previous posts. Remember how I've made statements not in support of universal single payer coverage, but in "insurance of last resort"? How my only concession for single payer is "cheaper than our current system"? Which I've said isn't free market?
That's not moving the goalposts. That's setting the parameters so that same data is being used for both sides, not anecdotes. For every Nurse Rachet in the US smothering patients, there is a Nurse Rachet in the UK injecting them with a lethal dose of morphine. (relative to population). Nice try a deflecting the argument. I'm just trying to compare apples to apples.
Incorrect. You are moving the goalposts in order to try to get a better result for your side. I'm merely moving them back to their original position. That position is "Which group gets the best results". One side could have more serial killers in it(though both have had them), but if it still gets better results, on average, it is the better system.
And there have been lots of comparison studies. On average, countries with some form of universal health coverage, not necessarily single payer by the way, have results that are more or less indistinguishable from our own in all aspects except one. Cost.
So really. If you want to convince me what you need is charts like this. (https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-mortality-rates-fallen-steadily-u-s-comparable-countries) That actually show the USA in the best positions, not the worst.
If you are paying something between 40% and 100% more for your care, you don't want to settle for average do you?
I'm referring to the Hospital Administration picking and choosing who lives and who dies (or gets operations). Mostly due to money.
Again, you're attempting to pick out specifics in order to make your side look better. What about people who decide to not get the operation due to money before it reaches the hospital administration? What about the insurance companies that refuse to pay, to much the same result?
versus a bunch of hospital bureaucrats sitting around a conference table deciding who gets an operation and who gets the Bobby Sands treatment. (and without involving the family/loved ones in that decision.)
Look up what happened in the early days of dialysis.
And no, the outcomes aren't comparable between us and the UK. Far from it in fact.
And here we see that you still refuse to compare apples with apples. Instead you show a barrel of rotten UK apples and don't show anything at all for the US.
Let's see, 750 avoidable deaths a month. That's 9k/year. Vs the US standard of 440k/year. The population of England vs the USA is more 6X than 5X.
Still, 54k vs 440k is beating our socks off.
https://www.theguardian.com/society/2015/jul/14/avoidable-deaths-nhs-hospitals-study
That would be same as if 3,750 people in the US died needlessly in Hospitals in US each month. That would be a national scandal. Oh wait, it was with the VA.
US figure for needless hospital deaths is 37k/month. 1/10th that looks very good...
https://www.theguardian.com/society/2013/sep/12/hospital-death-rates-england-higher-us
Seems their death rate is 45% higher then ours. I wouldn't consider that "Similar outcomes."
Of course, the question comes up why you're concentrating on the UK so much... They also said that the UK was beat by, well, everybody else. I mention Europe, Japan, Canada, and others when I talk about this stuff. Okay, we copy Holland, Japan, and Canada instead of the UK for this.
Of course, they mention in the article that you can't necessarily compare the two systems:
The US has lower life expectancy – two years less than that in the UK – and millions of uninsured people who struggle to find healthcare, so the finding was combustible.
I mean, people might be dying in the hospital in the UK because, well, they can actually be in the hospital! And people live for an average of 2 years longer there!
https://www.telegraph.co.uk/news/health/news/8668906/NHS-delays-operations-as-it-waits-for-patients-to-die-or-go-private.html
Yeah, I'm sure Millcreek will confirm that his hospital does this all the time...
Again, different systems = different problems. You're insisting on measuring individual components in radically different systems, not the overall system.
Now, please post a study that shows that delays in the UK system are longer and/or more systematic than delays in the US system working through HMOs or attempting to gather money for their surgery.
Because, again, only presenting the problems of ONE side is utterly unmoving to me.
Even the NHS says that they kill more patients the US hospitals do: https://www.nhs.uk/news/medical-practice/death-rate-much-higher-in-english-than-us-hospitals
Let's look at that article:
However, no further methodology has been provided for England or other countries, so we can't say whether the methods used to collect data on HSMRs over the past 10 years were appropriate. Professor Jarman's analysis does not appear to have been peer-reviewed.
So you're depending on an analysis by ONE professor, that cannot be duplicated, where the appropriateness of the data is in question, and hasn't even been peer reviewed.
Sorry, into the junk science pile that study goes. It's not that I'm disagreeing with its findings, mind you, I just think that there isn't enough support to believe that they're worth anything.
Here's the tl;dr version. The NHS death rate is 4 times higher then the US'. Again. Not a similar outcome by 4x.
]]
tl;dr: When I used the figures you posted vs the figures I posted, NHS death rate from hospital error is 1/10th that of the US, population adjusted.
How about 15,000 "excess" deaths in the NHS. That would translate into 75,000 in the USA (our population is roughly 5 times the UK's). And look at the outcry over Veteran's Death caused by the VA. https://www.bbc.com/news/health-39204681
15k, 75k, vs 440k that I posted earlier. 45k dead due to not seeking medical care when they should have, due to cost. Etc...
They're living 2 years longer on average.
And you can do your own research on the woeful response (and the "Zero effectiveness" flu vaccine) of the NHS to their flu outbreak earlier this year.
Again, you're not looking at overall results, but at specific negative outcomes. Any flu vaccine is something of a crapshoot. It isn't their response, or lack of it, in any specific situation that you have to look at. It's how they do overall. The problem you have debating me on this is that I've already done my research. It's like going into a debate against Crowder in a "change my mind", who's already done the research and has a binder of responses.
So, once more, you'd need to show some contrast between their flu response and the USA's response to it. Was the USA's better? Worse? About the Same? Same results at double the cost?
1. Are your trying to tell me that there are no medical errors in the UK. You really expect me to believe that ?? (See above links)
Nope. Expecting you to compare rates.
2. As has been frequently discussed here and elsewhere. No one is the US is denied Healthcare, so that argument is a non-starter.
Sure they are, they're stabilized in the ER and kicked out. Often at drastically higher cost than what simply treating the condition earlier would have cost.
They're denied any further care. 45k people die a year due to not being able to pay for it.
3. There is HUGE difference in ME deciding what healthcare I or my family choose to use or forego, versus some nameless/faceless bureaucrat(s) making those decisions (see article from the Telegraph above).
Nameless bureaucrat in a business denying your insurance payment is just as bad.
4. Again, people are making their own decisions versus some nameless/faceless bureaucrat(s) doing it. And I will again point out that I don't need the .gov to select my car insurance, life insurance, or which repair shops I chose to have my car serviced, nor can they deny me changing my oil whenever I want.
Never said that I'd band private healthcare, insurance, etc... Merely said that we need an insurance program of "last resort".
Since you so like giving me orders about what evidence you'll take and such, I'll give you the same back. Every single one of your examples was the UK.
I charge you to find four OTHER first world universal coverage countries that are as bad or worse.
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Sure, if he can post 4 articles about hospitals (not a single deranged person, but the leadership of said hospital conspiring and) willing to kill children and old people.
Look at the horror - thousands of dead kids, mothers left to be maimed, and euthanasia on a scale not seen since Germany in the 30’s. All proven by double the number of pieces of “evidence” you posted.
https://www.nytimes.com/1997/06/28/us/passive-euthanasia-in-hospitals-is-the-norm-doctors-say.html
The American Hospital Association says that about 70 percent of the deaths in hospitals happen after a decision has been made to withhold treatment. Other patients die when the medication they are taking to ease their pain depresses, then stops, their breathing.
https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/
Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease. An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths, as the uninsured are more likely to go without needed care. Another factor contributing to the widening gap in the risk of death between those who have insurance and those who do not is the improved quality of care for those who can get it.
https://www.ncbi.nlm.nih.gov/books/NBK221019/
Undiagnosed and untreated conditions that are amenable to control, cure, or prevention can affect children's functioning and opportunities over the course of their lives. Such conditions include iron deficiency anemia, otitis media, asthma, and attention deficit–hyperactivity disorder.
https://www.nytimes.com/2008/04/11/opinion/11krugman.html
Not long ago, a young Ohio woman named Trina Bachtel, who was having health problems while pregnant, tried to get help at a local clinic.
Unfortunately, she had previously sought care at the same clinic while uninsured and had a large unpaid balance. The clinic wouldn’t see her again unless she paid $100 per visit — which she didn’t have.
Eventually, she sought care at a hospital 30 miles away. By then, however, it was too late. Both she and the baby died
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And I can't fathom your belief that government can do it better and cheaper. Name one thing that government does better and/or cheaper then the private sector.
ANd just to help shatter your rose colored glasses. Here's what the US Government projected as the costs of Medicare versus the Actual results:
Yeah, not a good track record.
The house committee in the 1960s could not have imagined the degree of regulatory capture that would occur. In those days other countries were building public medicine which drove down costs worldwide.
Of course the estimates were wrong - they didn’t realise the degree to which private health would inflate peices
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I think you guys are getting too deep in the weeds here.
My general philosophy is to keep the government out of my personal life. That includes guns, sex, drugs, health care, etc., because no matter how well a law or program is intended, sometime in the future that law will be completely turned on it's head and used to abuse the people it is intended to help. The fact we are arguing so much about whether the government should be involved should be a big, red warning flag to us all.
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I think you guys are getting too deep in the weeds here.
My general philosophy is to keep the government out of my personal life. That includes guns, sex, drugs, health care, etc., because no matter how well a law or program is intended, sometime in the future that law will be completely turned on it's head and used to abuse the people it is intended to help. The fact we are arguing so much about whether the government should be involved should be a big, red warning flag to us all.
In other words - ignore the evidence. We don’t like government so the poor healthcare system we have now must be the right one.
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Like the evidence that the US Government can't successfully run a Health Care system that provides acceptable care for even a fraction of the population, much less the whole county? We should ignore that evidence?
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In other words - ignore the evidence. We don’t like government so the poor healthcare system we have now must be the right one.
Do you mean the evidence of how efficiently and fairly the government runs everything else they have their hands in? Like Social Security, and the military, TSA, ATF, FBI, CIA, NSA, Obamacare, gerrymandering elections, etc? That kind of evidence?
The evidence you are ignoring is that the USA is not a socialist state, despite how hard you and others try to make it that way. We are a capitalist Representative Republic founded on the idea of individual freedom which makes the US the best damn country on Earth. Freedom of the individual to achieve his best or succumb to his worst without government intervention or interference and without burdening others along the way.
If you really want to improve the healthcare market, get the government out of the way.
edited to add "capitalist"
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Do you mean the evidence of how efficiently and fairly the government runs everything else they have their hands in? Like Social Security, and the military, TSA, ATF, FBI, CIA, NSA, Obamacare, gerrymandering elections, etc? That kind of evidence?
The evidence you are ignoring is that the USA is not a socialist state, despite how hard you and others try to make it that way. We are a capitalist Representative Republic founded on the idea of individual freedom which makes the US the best damn country on Earth. Freedom of the individual to achieve his best or succumb to his worst without government intervention or interference and without burdening others along the way.
If you really want to improve the healthcare market, get the government out of the way.
edited to add "capitalist"
QFT.
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DeSelby is, and has consistently been, an advocate of tyranny and an opponent of freedom. That is especially evident in discussions about health care and insurance policy since that is such a huge component of the economy. Control of health care delivery plus media and education and you can control the majority of the people.
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I think you guys are getting too deep in the weeds here.
My general philosophy is to keep the government out of my personal life. That includes guns, sex, drugs, health care, etc., because no matter how well a law or program is intended, sometime in the future that law will be completely turned on it's head and used to abuse the people it is intended to help. The fact we are arguing so much about whether the government should be involved should be a big, red warning flag to us all.
Which is pretty much what I said above:
There is HUGE difference in ME deciding what healthcare I or my family choose to use or forego, versus some nameless/faceless bureaucrat(s) making those decisions
And I'm not advocating for our mess of a healthcare system. I want the .gov OUT of it.
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Which is pretty much what I said above:
And I'm not advocating for our mess of a healthcare system. I want the .gov OUT of it.
How is an insurance company employee any more accessible than government???
You can at least call your congressman about the .gov. Try getting something an insurance company doesn’t want to give you sometime.
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How is an insurance company employee any more accessible than government???
You can at least call your congressman about the .gov. Try getting something an insurance company doesn’t want to give you sometime.
BTDT, After a year of not finding out what was causing my kidneys to fail, my doc suggested I try the Mayo Clinic. UHC said no, out of network.
Doc wrote the the Insurance Company a letter. They agreed to cover it as in-network.
See De Selby, here's the main difference. If I don't like what an Insurance company does, I can work my way up the food chain, even to the CEO if necessary. I can also go to the state Insurance commissioner and complain. And I can change companies when it comes time to renew.
If the .gov says no, I'll get lost in a byzantine system, of "Not my job." and rerouted back to where I began. (See the Obamacare website as an example.) And there's no "outside agency" to use as a last resort. Remember, the only power a bureaucrat has is the power to say "No".
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BTDT, After a year of not finding out what was causing my kidneys to fail, my doc suggested I try the Mayo Clinic. UHC said no, out of network.
Doc wrote the the Insurance Company a letter. They agreed to cover it as in-network.
See De Selby, here's the main difference. If I don't like what an Insurance company does, I can work my way up the food chain, even to the CEO if necessary. I can also go to the state Insurance commissioner and complain. And I can change companies when it comes time to renew.
If the .gov says no, I'll get lost in a byzantine system, of "Not my job." and rerouted back to where I began. (See the Obamacare website as an example.) And there's no "outside agency" to use as a last resort. Remember, the only power a bureaucrat has is the power to say "No".
In with “Ackshually That’s Just An Anecdote” first...
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https://twitter.com/CNNPolitics/status/1030469801066426370/video/1