The wailing

[KD5NRH]

Or even just simplify it. Simple or Flat tax with no or very standard deductions and the cost of compliance DRAMATICALLY drops. That is money that could be going toward more productive ends.

Yup.  Unfortunately, when you dig deep enough into any big enough organization, you start to find that Dilbert isn't fictional.  

(Of course, you would put a great many accountants out of business, so I would include some retraining aid (since many went into the business at the inducement of the government) in the unlikeliest of cases that such a system actually occurs.)

They can still be consultants, charging $100k to identify $5k worth of waste, or misidentify as waste any act that doesn't directly generate an easily measurable cash return, or develop procedures that appear to be more efficient if you squint really hard and ignore all the obvious-to-anyone-with-two-brain-cells costs that they've left out to make their proposals look better.

[KD5NRH]

On the other hand, if we had the political will to go to a flat tax in Congress, a lot of other things would likely be better.

You almost had my unquestioning loyalty.

Then I realized you weren't talking about a flat tax on Congress.

[MechAg94]

That is another disagreement.  The idea that the poor are punished by paying taxes is BS IMO.  Coddling the poor would be closer to the truth.  Rich and middle class people always seem to feel guilty about supposedly "poor" people getting taxed.  As a result, they allow govt to screw them over even more.  

The current tax system is so screwed up because we build in thousands of exceptions for all the "right" reasons.  Most of them are for good sounding reasons like helping the poor, but it complicates the law and is really unnecessary.  

I don't mean to accuse anyone of being liberal, but that is where that line of thinking starts. 

[SADShooter]

Since we are a Representative Republic, isn't want we get from Washington what the simple majority of the community wants?

Letting the community fully decide would be a pure democracy and it would be mob rule. I kind of shutter to think what the USA would be like as a democracy.

Sure, if you analyze what I wrote as a gross oversimplification and ignore the Tenth Amendment.

[AJ Dual]

The reality is that a 100% free market healthcare system would have so much competition and efficiency, someone with expensive pre-existing conditions like Charby would be insurable.  Worst-case scenario, even if heart surgery etc. and other massive interventions didn't respond to the price-pressures, they'd be done as loss-leaders for medical prestige. Which they're already done now under the current system. Except it's a market where the providers compete on services, and whatever price competition there is exists hidden with insurance network negotiations.

99% of the problem is that we've got an unhinged price model, where the end-consumers know the costs of nothing but their insurance premium and deductible. We have a society that thinks nothing of researching incessantly to save $1000 on a car, or $10 on a TV, but has zero idea of what the schedule of services is with their various medical providers.

It's the exact same problem that automatic withholding causes with our income taxes. If everyone just had to pay up front and be reimbursed, or at least handle the whole bill before forwarding it to their insurance carrier, and handle all claims themselves, even that would provide price-pressure and competition.

A few other things, like mandating a breakdown of the schedule of services, and a running bill-total to the patient or responsible party be provided as real-time as possible, and cross-state licensing of all insurance providers would clean up half if not more of the "healthcare crisis" with zero cost to taxpayers.

[charby]

Sure, if you analyze what I wrote as a gross oversimplification and ignore the Tenth Amendment.

10th amendment is already ignored, been that way since the first federal law in the late 1700's.

[Ben]

On the other hand, if we had the political will to go to a flat tax in Congress, a lot of other things would likely be better.

I like the idea of a flat tax, as long as it taxes everyone. I don't care if you only make $10K a year, you still have to cough up a hundred bucks. People with skin in the game have a different philosophy on the use of tax dollars than do multi-generational welfare households. If I'm in a group that never has to pay taxes, I'll most always vote for more taxes for more services.

The fact that nearly half the voting country currently pays no taxes is a big part of our problem. I guess I don't mind pulling a couple of people in my cart, but there's a problem when I'm pulling four people in a two person capacity cart.

[charby]

99% of the problem is that we've got an unhinged price model, where the end-consumers know the costs of nothing but their insurance premium and deductible. We have a society that thinks nothing of researching incessantly to save $1000 on a car, or $10 on a TV, but has zero idea of what the schedule of services is with their various medical providers.

Problem is health care facilities don't come in the form of a big box store, where each community have several convenient options to shop around. It is a fairly monopolized industry at the local level.

[MechAg94]

Problem is health care facilities don't come in the form of a big box store, where each community have several convenient options to shop around. It is a fairly monopolized industry at the local level.

Not really true, IMO.  In this area, there are all sorts of small surgical clinics poping up that can handle some pretty advanced surgeries (partly due to regulations).  I think the big hospitals would still be there, but you could easily see more independent outfits offering services without as much overhead.  Hell, part of the problem with hospitals is they get screwed providing free emergency services and they also get screwed by Medicare cutting their reimbursement.  As a result, they keep trying to increase charges to people who can pay.

If you want to see a good example of what it might be, look at Lasik eye surgury.  Nearly hundreds of people offering it in big cities and lots of price competition.  You still have some that charge more, but some of those are the best doctors too. 

Small communities would be limited, but that only applies as long as the locals are not incentivized to travel elsewhere for services.  My home town only has 3000 people.  Many visit local doctors, but many also travel to Houston or Brenham. 

[KD5NRH]

Problem is health care facilities don't come in the form of a big box store, where each community have several convenient options to shop around. It is a fairly monopolized industry at the local level.

Not so much, outside of urgent services; in my little town of 18,000 people, I can think of four GPs in private practice, at least three more at the clinic, two pediatricians, three cardiologists, five dentists, etc.  OTOH, there are only two real grocery stores and one "big box" type retailer.  Sure, we have the only ER within 30 miles, though it's not unusual for people who can hang on for an hour or so to load up the car and head to the next one, (or for people in that area to come to ours, so whatever the reason is, it's apparently not very objective) but for regular doctor visits, there's quite a bit of choice, including driving to the mostly-retired-folks town 30 miles east that has even more selection despite being half our size, or the small clinic 30 miles south just because you like nurses that still wear starched whites.

[AJ Dual]

Problem is health care facilities don't come in the form of a big box store, where each community have several convenient options to shop around. It is a fairly monopolized industry at the local level.

Doesn't matter.

"Do I really need the 4D GE Ultrasound of our baby for Facebook, or will the regular old regular one suffice?"... "Maybe I CAN cowboy-up and overcome my claustrophobia and get in the regular MRI instead of the open-MRI."

Or at the heart of your argument... "Maybe I CAN drive 50 miles to the next town over if that doctor is $100 cheaper..."

You're setting up strawmen here, which ultimately take root in the "healthcare is a right" stance you're taking.  And if someone legitimately does live in some town that's 150 miles + from the nearest next hospital and clinic? (shrug) Constantly seeking lowest common denominator solutions for every last person in the name of "fairness" is part of the problem that got us here in the first place.

FCC spectrum and licensing rules aside, Internet, TV, telecommunications aren't a "right" per-se, yet people in small towns and isolated rural areas somehow seem to manage. Their costs may not come down as fast as high density urban areas, but their costs come down too. Do those people pay more for flatsceeens and laptops than their big city counterparts? They may pay more for broadband, have quasi-lousy DSL or satellite, or suffer with dial-up, but it is what it is. And broad savings from such a hyper-competitive market still trickle down to them.

And in a national environment of cutthroat medical competition, ancillary services, drugs, medical equipment, doctor and provider salaries, medical software and systems would all be cheaper too, so even if it was a one-clinic town, there would still be savings passed along.

[SADShooter]

10th amendment is already ignored, been that way since the first federal law in the late 1700's.

So:

1) You're original statement that we're a representative republic is meaningless if .fedgov has all the power.

2) Because it is so doesn't mean it should be.

I've got chronic health conditions, and I can't get most life insurance. I still don't believe that entitles me to government mandated health care or insurance, or that even if I did, .fedgov involvement is the best or only remedy.

[roo_ster]

You're setting up strawmen here, which ultimately take root in the "healthcare is a right" stance you're taking.

Let me repeat:
Health care is not a right.

If it were a right, it would be morally justifiable to kill someone else standing between you and it.

[charby]

Doesn't matter.

"Do I really need the 4D GE Ultrasound of our baby for Facebook, or will the regular old regular one suffice?"... "Maybe I CAN cowboy-up and overcome my claustrophobia and get in the regular MRI instead of the open-MRI."

Or at the heart of your argument... "Maybe I CAN drive 50 miles to the next town over if that doctor is $100 cheaper..."

You're setting up strawmen here, which ultimately take root in the "healthcare is a right" stance you're taking.  And if someone legitimately does live in some town that's 150 miles + from the nearest next hospital and clinic? (shrug) Constantly seeking lowest common denominator solutions for every last person in the name of "fairness" is part of the problem that got us here in the first place.

FCC spectrum and licensing rules aside, Internet, TV, telecommunications aren't a "right" per-se, yet people in small towns and isolated rural areas somehow seem to manage. Their costs may not come down as fast as high density urban areas, but their costs come down too. Do those people pay more for flatsceeens and laptops than their big city counterparts? They may pay more for broadband, have quasi-lousy DSL or satellite, or suffer with dial-up, but it is what it is. And broad savings from such a hyper-competitive market still trickle down to them.

And in a national environment of cutthroat medical competition, ancillary services, drugs, medical equipment, doctor and provider salaries, medical software and systems would all be cheaper too, so even if it was a one-clinic town, there would still be savings passed along.

...and to others

Its isn't like that in all places, I don't live in the middle of BFE but I do live within 30 minutes of about a million people, but the whole state is only 3 million people. Almost all the health care choices I have for "necessary" type health are controlled by 2-3 large health care networks which in turn prices are pretty much set by the couple not for profit health care insurance agencies in my state.

There are very few independent GP offices in Iowa, most Drs are tied into one of the health care networks. We also have a University hospital that has pretty much taken over all the really difficult health care matters.

[cassandra and sara's daddy]

The 4 d etc is less for face book and more to ward off land sharks.  Plus it boots profits and insurance pays. What's not to like?


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[charby]

Let me repeat:
Health care is not a right.

If it were a right, it would be morally justifiable to kill someone else standing between you and it.

May not be a "right" as you define it, but wouldn't the health of citizens be in the best interest of a world power?

[charby]

The 4 d etc is less for face book and more to ward off land sharks.  Plus it boots profits and insurance pays. What's not to like?


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I'm confused, please clarify a bit.

[zxcvbob]

I'm confused, please clarify a bit.

The OB docs take high-res ultrasounds to cover own their asses.  ("Why didn't you know about the birth defect??") Then they get to bill $$$ for it.  The mom-to-be doesn't care about the expense because it's paid with other people's money.  Everybody wins.

(that was an easy one)

[charby]

The OB docs take high-res ultrasounds to cover own their asses.  ("Why didn't you know about the birth defect??") Then they get to bill $$$ for it.  The mom-to-be doesn't care about the expense because it's paid with other people's money.  Everybody wins.

(that was an easy one)

Gotcha...

[mtnbkr]

The OB docs take high-res ultrasounds to cover own their asses.  ("Why didn't you know about the birth defect??") Then they get to bill $$$ for it.  The mom-to-be doesn't care about the expense because it's paid with other people's money.  Everybody wins.

(that was an easy one)

They cover 4d now?  When my daughters were born (now 6 and 11 years old), 4d was available but not covered by insurance.  I paid out of pocket for each (it was like having an early photograph).  It wasn't expensive, something like $150, but it was still completely out of pocket.

Chris

[MechAg94]

May not be a "right" as you define it, but wouldn't the health of citizens be in the best interest of a world power?

Yes, it is an interest, but govt doesn't have to run it or regulate it.  Insuring open competition and presecuting fraud should be enough.  The economy is a national interest, but I don't want the FedGov running it. 

[cassandra and sara's daddy]

I'm confused, please clarify a bit.

A lot of what gets done by docs is to cover their butt in case someone try's to sue for malpractice. We could do a lot less testing but if a doc fails to meet a "standard of care" the land sharks devour him


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[Scout26]

...and to others

Its isn't like that in all places, I don't live in the middle of BFE but I do live within 30 minutes of about a million people, but the whole state is only 3 million people. Almost all the health care choices I have for "necessary" type health are controlled by 2-3 large health care networks which in turn prices are pretty much set by the couple not for profit health care insurance agencies in my state.

There are very few independent GP offices in Iowa, most Drs are tied into one of the health care networks. We also have a University hospital that has pretty much taken over all the really difficult health care matters.

That's because Obamacare and pre-existing .gov regulations have made it prohibitively expensive for solo or even 2-3 doc/practitioner offices to continue. 
All the problems you point out that your think "need" to be solved by more .gov were in fact CAUSED by more .gov.

Allow me to by health insurance like I buy car insurance.  Look at what the free market has done there.  All you have to do is look at the TV ads, there is serious competition for my car insurance dollar.  And there is large variety of options and coverages from me to choose from.  Not only from different insurers, but even from the same insurer.  My car, home, and life insurance is not tied to my employer, why should my health insurance?

Growing up, health insurance was "Major Medical" Insurance.  It only covered things like medical treatment for accidents, major illnesses, and surgeries.   Things you went to the hospital for.   Routine doctor visits were paid out of pocket.  Then .gov started mandating "Heath" coverages.  Well-babycare, doctor visits and like.  It's like if your car insurance company had to pay for oil changes and tire rotations.   The cost of car insurance then rises and as more mandates are added (Tires, brakes, bulbs, etc.) the cost of car insurance skyrockets.   That's where we are at now.

And yes, in a hyper-competitive health insurance market, you would be able to get insurance.  Probably even cheaper then what you pay now.  Just look at the number of car insurance companies that advertise and compete for the people with bad driving records.  (Here it's called SR-22 Insurance.)     

[Fitz]

I don't understand how folks can all agree that big networks of healthcare providers and over-regulation are problems contributing to health care costs skyrocketing, and in the same breath, push for things that contribute/exacerbate that problem.

Healthcare costs rising are a direct result of anticompetitive forces. MOST of which are a direct result of increasing government involvement in healthcare.



Additionally, with the enormous increase in medicare/medicaid enrollees, you're introducing to the market a large group of people who have NO incentive to shop around (something I've certainly done for treatment), who go ahead and say "yeah, give me that open MRI," etc.

Additionally, the government FORCES doctors/hospitals to set maximum prices on these people. "That procedure can only cost XYZ dollars!", says Uncle Sugar.

Docs have to agree. And those prices are WAAAAY low. So where does Doc McScrewed make up the difference to keep his doors open?

All the folks who are either paying for service, or who have health plans that he can hit harder. Contributing in rising premiums for those folks, and higher prices for folks who pay for service.

[MillCreek]

http://money.cnn.com/video/news/economy/2014/10/21/we-the-economy-this-wont-hurt-a-bit.cnnmoney/index.html?hpt=hp_bn6&iid=obnetwork