On the Future of Health Care

[Ben]

Sadly, this article hits the nail on the head IMO. At this point, the Rs have shown all they want to do is give away different free stuff, because they're afraid of what will happen to them if they take away free stuff. So as the article says, I also predict it will be a fight for the amount of free stuff in some version of Obamacare as the "conservative solution" vs single payer. The Rs have lost a free market solution.

http://hotair.com/archives/2017/08/04/poll-majority-americans-support-single-payer-heavy-majority-republicans-oppose/

[TommyGunn]

Well, the country has begun circling the drain.   Dramamine, anyone?

[dogmush]

I think you're correct Ben, the "Health Care is a Right!!" narrative caught enough people that I think, for better or worse, the US will be at some crappy version of single payer in the next couple decades.  It will be very hard to quantify how many cures we don't discover because we've disincentive a medical career and that genius became a lawyer or tech guy instead.

Well, the country has begun circling the drain.   Dramamine, anyone?

The county med board has determined that you aren't in enough need and that dose has been given to someone more deserving.  They were having acute motion sickness after 12 hours in a box truck for the drive up from Guadalajara.

[Scout26]

So we'll all be working for the Twentieth Century Motor Company.   Joy.

When everyone gets the service of the VA, it'll be too late.

[Sideways_8]

http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb

But the British system is so much better right? Right? Anybody?

[Firethorn]

I think you're correct Ben, the "Health Care is a Right!!" narrative caught enough people that I think, for better or worse, the US will be at some crappy version of single payer in the next couple decades.

I think that's only half the problem.  The fact that our healthcare is so ridiculously more expensive without commensurate results is also a concern.

I've mentioned it before - our healthcare is so crazy expensive that, if we could get costs down to the median of the other first world countries, that the federal government already spends enough to cover over 90% of the nation's healthcare needs.  And the state governments more than cover the other 10%.

Which means that, if we could get proper cost controls in place, the feds could quite easily provide single-payer insurance without spending an extra cent.

The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:

• Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
• Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
• Adjust regulations to better ease insurance companies operating across state lines.
• Throw open HSPs to everybody.  Make them easier to use.
• Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
• Allow medications and equipment to be more easily imported
• Make it so that all government healthcare programs can negotiate prices on things like drugs.
• Eliminate mandates to buy drugs from specific providers(like schools and epipens)

[agricola]

http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb

But the British system is so much better right? Right? Anybody?

It is cheaper.  We pay less per capita for the entire NHS than you pay just for Medicare and Medicaid. 

[mtnbkr]

http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb

But the British system is so much better right? Right? Anybody?

Key details not mentioned by you:

Under the latest restrictions, patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight.

and

The ban will not apply to cancer patients, or those with some conditions that could becoming life-threatening, or if exceptional circumstances can be shown.

So, there are loopholes around the ban and it only applies to non-life-threatening conditions.  Yeah, it sucks they're doing this, but it's not "zomg they are killing smokers and fat people!!!111!!".

Chris

[Fly320s]

but it's not "zomg they are killing smokers and fat people!!!111!!".

Yet.

It starts by restricting the outcasts: smokers and fatties.  Then druggies.  Then old people who are dying anyway.  Then coma patients.  Then stage 4 cancer patients.  Then whoever else the government deems unworthy.

The US system has many faults, but if a person can pay, that person can get treated sooner rather than later. 

[JN01]

I think that's only half the problem.  The fact that our healthcare is so ridiculously more expensive without commensurate results is also a concern.

I've mentioned it before - our healthcare is so crazy expensive that, if we could get costs down to the median of the other first world countries, that the federal government already spends enough to cover over 90% of the nation's healthcare needs.  And the state governments more than cover the other 10%.

Which means that, if we could get proper cost controls in place, the feds could quite easily provide single-payer insurance without spending an extra cent.

The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:

• Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
• Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
• Adjust regulations to better ease insurance companies operating across state lines.
• Throw open HSPs to everybody.  Make them easier to use.
• Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
• Allow medications and equipment to be more easily imported
• Make it so that all government healthcare programs can negotiate prices on things like drugs.
• Eliminate mandates to buy drugs from specific providers(like schools and epipens)

Your suggestions make a lot of sense.  Unfortunately, they will never be adopted, so under a US single payer system, we will be stuck with the same inefficient, overpriced system with Federal bureaucracy and incompetence added, resulting in disaster.

[JN01]

Key details not mentioned by you:
and

So, there are loopholes around the ban and it only applies to non-life-threatening conditions.  Yeah, it sucks they're doing this, but it's not "zomg they are killing smokers and fat people!!!111!!".

Chris

You might have missed this part:

The decision, described by the Royal College of Surgeons as the “most severe the modern NHS has ever seen”, led to warnings that other trusts will soon be forced to follow suit and rationing will become the norm if the current funding crisis continues.  Chris Hopson, the head of NHS Providers, which represents acute care, ambulance and community services, said: “I think we are going to see more and more decisions like this.

And:

Reports of rationing have emerged after NHS England admitted in May that its provider sector overspent by £2.45 billion in 2015-16,  more than a threefold increase on the previous year.

The figure, which was described as conservative by think-tanks, prompted some hospital chief executives to question the future viability of free universal healthcare.

Mr Hopson called for a “realistic national conversation” about how much should be spent on the health service, and said that if procedures had to be restricted, the reduction should be managed on an NHS-wide basis.

The system seems to be unsustainable as it currently operates.

[mtnbkr]

The US system has many faults, but if a person can pay, that person can get treated sooner rather than later. 

They can in the UK as well.  Unless things have changed in the last few years, a person can buy their own private insurance, giving them access to non-NHS care.  Anecdotally, most don't though.  None of the Brits I know have issues with the level of care they get through the NHS.

Chris

[mtnbkr]

You might have missed this part:

Nope, I saw it.  However, it doesn't materially change what I said.  So far, the identified restrictions are only to non-essential procedures.  When they start refusing life-saving procedures to obese or smokers, let me know.

And:
The system seems to be unsustainable as it currently operates.

No doubt there.

Chris

[Hawkmoon]

Yet.

It starts by restricting the outcasts: smokers and fatties.  Then druggies.  Then old people who are dying anyway.  Then coma patients.  Then stage 4 cancer patients.  Then whoever else the government deems unworthy.

The US system has many faults, but if a person can pay, that person can get treated sooner rather than later. 

And then cases like Charlie Gard -- "We won't let you take your son elsewhere for treatment because we want him to be as comfortable as possible [until we let him die] while we [don't] treat him."

[Hawkmoon]

The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:

• Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
• Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
• Adjust regulations to better ease insurance companies operating across state lines.
• Throw open HSPs to everybody.  Make them easier to use.
• Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
• Allow medications and equipment to be more easily imported
• Make it so that all government healthcare programs can negotiate prices on things like drugs.
• Eliminate mandates to buy drugs from specific providers(like schools and epipens)

One other would be to revise the guidelines that say all medications must be discarded after one year. In another classic instance of "Do as we say, and not as we do" the U.S. military has been quietly working with the FDA to test the long-term efficacy of a number of drugs commonly used by the D.o.D. and they've found that most of them are good for at least ten (and usually fifteen or more) years past the original "expiration" date. But the FDA can't admit that publicly because allowing people to keep prescription medication longer than a year would impact the profits of pharmaceutical companies.

My wife was extremely allergic to bee stings -- and our house is in the country. She always carried an epipen. I found it a year or so after she died, and I offered it to a friend whose son is also highly allergic. He declined, because it was passed the "expiration" date. I can't really blame him -- you don't want to play roulette with your son's life -- but the fact is that an epipen is probably good for several years, not just one. But the military hasn't (as far as I know) put epipens through their long-term evaluation program, so there's no way of knowing.

Any time you have a few hours to kill, look up those tests, and read the FDA and pharmaceutical companies' rationalizations for why they don't test efficacy longer than one year.

[Scout26]

Just getting the .gov out of healthcare would cause huge reductions in the costs.

[agricola]

The system seems to be unsustainable as it currently operates.

The key bit here being "as it currently operates". 

When the New Labour government came to power in 1997, it had a difficult choice to make between delivering promised investment into the NHS and delivering the promise of balanced public accounts.  Like all the difficult choices that Tony Blair was faced with as PM, he cheated - in this case by adopting the "Private Finance Initiative", which basically contracted the private sector to build and/or run a hospital (or series of hospitals)*.  This had the advantage of keeping the cost of building off the Blair government's books whilst ensuring that the governments that followed faced considerable cost (the final total will be around £80 billion if they aren't bought out - this is for premises that are worth £11 billion).  At the moment the annual NHS PFI bill is £2 billion a year (and will rise to £2.7 billion p.a. before the costs start to taper off around 2030), which accounts for the bulk of the overspend you point to. 

* "run" in this case means operate the facilities only, all the medical side of things is still provided by the NHS.

[Firethorn]

My wife was extremely allergic to bee stings -- and our house is in the country. She always carried an epipen. I found it a year or so after she died, and I offered it to a friend whose son is also highly allergic. He declined, because it was passed the "expiration" date. I can't really blame him -- you don't want to play roulette with your son's life -- but the fact is that an epipen is probably good for several years, not just one. But the military hasn't (as far as I know) put epipens through their long-term evaluation program, so there's no way of knowing.

The problem here is that 'carried with you' is a far harsher environment than the climate controlled warehouses the DoD keeps the vast majority of its medical stockpile in.  

Oh, and had another thought - set up some government supported healthcare cooperatives.  Give the insurance companies some more competition.

[Fly320s]

Oh, and had another thought - set up some government supported healthcare cooperatives.

Government supported means taxpayer funded. 

[Firethorn]

Government supported means taxpayer funded.  

Sadly, yes.  At least at first.  Healthcare is too complicated of a mess and too expensive today for cooperatives to get their start like the USAA and Farmer's did back in the day.

And supported can mean more than straight up 'funding'.  There are various means of support that don't mean giving them cash directly, but they all do have a cost.

Hell, something like favorable terms under federal law would be relatively cheap and could be a major benefit to a cooperative.

Though I'm picturing something more along the lines of the cooperative running it's own clinic to start with, eventually its own hospital.

Basically, growing out of those doctors that let you pay a monthly fee directly to a clinic and have the ability to see them as much as necessary for basic services.  It can actually work out drastically cheaper than going through insurance.

[MillCreek]

^^^This is exactly how Kaiser and Group Health Cooperative started back in the day.  Kaiser recently acquired Group Health in Washington state, and now they are just another insurance company with a healthcare system attached.

[MechAg94]

This just underscores the need to identify the worst R Senators and try to make sure they don't survive their primary next time around.  Trump can help with that if he wants to.

[Firethorn]

This just underscores the need to identify the worst R Senators and try to make sure they don't survive their primary next time around.  Trump can help with that if he wants to.

just remember, if you include Murkowski in that that she managed to win by write-in.  She isn't considered vulnerable.

[Scout26]

Sadly, yes.  At least at first.  Healthcare is too complicated of a mess and too expensive today for cooperatives to get their start like the USAA and Farmer's did back in the day.

And supported can mean more than straight up 'funding'.  There are various means of support that don't mean giving them cash directly, but they all do have a cost.

Hell, something like favorable terms under federal law would be relatively cheap and could be a major benefit to a cooperative.

Though I'm picturing something more along the lines of the cooperative running it's own clinic to start with, eventually its own hospital.

Basically, growing out of those doctors that let you pay a monthly fee directly to a clinic and have the ability to see them as much as necessary for basic services.  It can actually work out drastically cheaper than going through insurance.s

Sadly no.  I've heard ads on the Radio for a Born Again Christian Heath Insurance cooperative.* They didn't need any government funding to get started.  In fact, my understanding is that they were started because some folks vehemently disagreed with their government and the ACA.   So they decided to "go their own way" via a loophole in the ACA. 

It did kinda start like USAA, with people agreeing to insure one another.  Funny that.  And not using any .gov money, but thumbing their nose at the .gov instead.  Again, asking the .gov for help, is allowing the camel's nose under the tent. 



*- Found it.   https://mychristiancare.org/medi-share/  Seems it was in response to the ACA and making people pay for coverages and treatments that contradicted their religious beliefs.   Googling it also uncovered a few others as well.

[Ben]

I just ran into this story this morning. It's only five people, and I think the story is slanted in favor of single payer. The couple of points that were of interest to me across the five countries were:

1) They all seem to kind of say the same thing - they like it and you can see a doctor right away, well, except for if you have an illness (preventative medicine rules) and then you may have to wait a couple of months for an MRI or whatever. I'd actually prefer to wait a couple of months for preventative medicine appointments. Having a need for an MRI or other advanced mechanism means there's a chance you have something more serious. I'm not keen on hearing, "Oh, sorry Ben. If you'd only gotten in a couple of months earlier, we might have been able to treat the cancer."

2) Even the interviewees with advanced education pull the, "It's free because the government pays for it" routine. No, you pay with your taxes, so you pay for it. To tie it in to point one, they seem to be okay waiting months for certain procedures because "it's free, so that's still a good deal". If they realized it was a service they paid for that they are not getting in a reasonable time, maybe they wouldn't be so happy with the bad service. But then it has been around so long in some of these countries that if you're born into it, you just don't see a problem. Kinda like with gun rights, where some people born into GCA 1968 don't really gripe about what was lost because they never lost it. it's just always been that way for them.

https://www.youtube.com/watch?v=siIukVsG3vs