PDA

View Full Version : Serious Healthcare Thread



Synapse
February 27 2013, 07:24:00 PM
Because we needed it. Thread is meant for discussion of various healthcare systems, their pro's and cons, and political discussion of healthcare reform in the US and elsewhere.

Sponk
February 27 2013, 10:56:37 PM
IMO just read http://en.wikipedia.org/wiki/Health_care_systems, but whatever.



Australia (http://en.wikipedia.org/wiki/Health_care_in_Australia):

tldr is:

* Costs ~10% of GDP
* Paid for by 1.5% income levy, plus dipping into general revenue
* Universal access
* Government pays for: 100% of in-hospital costs, 75% of General Practitioner and 85% of specialist services
* Wait times can be long for public access, but private healthcare can be purchased
* Private healthcare is reasonably priced (http://www.medibank.com.au/healthcover/insurance/hospital-range/), let's say $1400/year but the government will probably pay 30% of it
* Government is single-buyer for medications (http://en.wikipedia.org/wiki/Pharmaceutical_Benefits_Scheme): either sell cheap to them, or fuck off
* medical imaging and assorted stuff is often private, but prices are regulated (after all, the government probably ends up paying)
* Hospitals can be private or public, and are run by each state, presumably by money given by the feds.

F*** My Aunt Rita
February 28 2013, 02:04:04 AM
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/


When you follow the money, you see the choices we’ve made, knowingly or unknowingly.

Over the past few decades, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we’ve squeezed the doctors who don’t own their own clinics, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. And of course, we’ve squeezed everyone outside the system who gets stuck with the bills.

We’ve created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract.

And we’ve allowed those on the island and their lobbyists and allies to control the debate, diverting us from what Gerard Anderson, a health care economist at the Johns Hopkins Bloomberg School of Public Health, says is the obvious and only issue: “All the prices are too damn high.”

Long article but worth it.

Pacefalm
February 28 2013, 07:56:34 AM
Easy and cheap access to healthcare is imho a sign of living in a developed country. How Americans can live comfortably knowing they are but one illness away from bankrupcy boggles my mind.

Lallante
February 28 2013, 08:47:16 AM
Easy and cheap access to healthcare is imho a sign of living in a developed country. How Americans can live comfortably knowing they are but one illness away from bankrupcy boggles my mind.

They pretty much dont. They either live in fear or else apply an individual version of american exceptionalism ("It wont happen to me, I'm different"). Even people with good insurance are a chronic illness away from bankruptcy

Alistair
February 28 2013, 04:36:25 PM
It all comes down to this question: Is healthcare a human right, and if so, to what degree?

If it is a human right, the question is moot, all people (citizen or non-citizen) deserve healthcare regardless of cost or delivery system specifics.

If it's not a human right, then it's a whole different discussion.

Debating system is putting the cart ahead of the horse. The debate (in the U.S.) is (or should be) the position of healthcare as a human right or not, and THEN about the best way to fulfill that human right if it is one.

Victoria Steckersaurus
February 28 2013, 05:22:22 PM
Even if the conclusion is that it isn’t a human right, the fact that we have the most inefficient, overpriced, anti-competitive, capitalism-gone-wrong system in the developed world means that there’s a HUGE room for improvement without wasting time debating philosophy.

Healthcare used to simply be affordable. We wouldn’t be arguing whether it was a “right” if it was again.

Actually, that’s not true, we would be arguing whether it’s a right, but the economic cost of saying that it is wouldn’t be so prohibitive as to sway the debate. In fact, we might even conclude that it isn’t a right, but it’s something we can provide for the poor at a reasonable cost to help lift them out of poverty.

Alistair
February 28 2013, 05:50:24 PM
...without wasting time debating philosophy.

With respect Victoria, we are just forum posters. We have no effect on anything on the grand scale. All we can do IS "debate philosophy".

Until you know what the system is required to do and why, you cannot design the best possible system.


Healthcare used to simply be affordable.

It also used to be almost completely ineffective. Cost has risen as technology and pharmicology has risen (albeit perhaps not appropriately so, I agree), as well as industrialization of healthcare insurance has come to the fore.

Back when healthcare was affordable, you might see your local sawbones once every few years, and maybe, once in a while, be seen at a local hospital. Now, you're seen many times more often, by a suite of doctors and specialists, with advanced technology, and a warehuse full of pharmicopia, all run by a massive industry with massive overhead, salaries, and yes, profit. Two different worlds.


but the economic cost of saying that it is wouldn’t be so prohibitive as to sway the debate.

The debate over it's status as a Right is vital. If it is a right, cost to provide and personal responsabillity (for example) cannot be the primary motivation of the discussion. If it is not a right, then multiple other aspects can have a place as part of the discussion/debate.

As with the Gun debate, it is my view that Americans consistently take the wrong tact in the modern era. If you do not want gun ownership to be a right, and you do want healthcare to be a right (both very common beliefs in the U.S., specificly on the U.S. left), there is a mechanic to amend the Consitution to do so and make it so. We did it many times before.

I strongly support that being the route taken to enshrine (or remove) these issues, thus clarifying the issue, so we can get past the basic debates we get permanently stuck on (rights vs. States role in taking away/regulating those rights) and on to the more vital and meaningful real world debate of specific delivery system design to best provide/protect those rights.

Keorythe
February 28 2013, 10:08:19 PM
The debate over it's status as a Right is vital. If it is a right, cost to provide and personal responsabillity (for example) cannot be the primary motivation of the discussion. If it is not a right, then multiple other aspects can have a place as part of the discussion/debate.

Is there any other service out there that is a "human right"? Not really. Even food isn't a right. It always has been and always will be a privilege. The only argument is how to make that privilege affordable and what steps we're willing to take.


As with the Gun debate, it is my view that Americans consistently take the wrong tact in the modern era. If you do not want gun ownership to be a right, and you do want healthcare to be a right (both very common beliefs in the U.S., specificly on the U.S. left), there is a mechanic to amend the Consitution to do so and make it so. We did it many times before.

Not even on the same level. The gun debate is about the US Constitution guaranteeing that an individual can have the ability to own an item. There is nothing that changes pricing or availability. And there have been many cases on both federal and State levels where high taxes or other punitive monetary challenges have been put in place to prevent people from being able to purchase them. There is nothing that is preventing people from having access to healthcare as there is guns. Cost only makes it prohibitive.

Zeekar
February 28 2013, 10:15:20 PM
It all comes down to this question: Is healthcare a human right, and if so, to what degree?

If it is a human right, the question is moot, all people (citizen or non-citizen) deserve healthcare regardless of cost or delivery system specifics.

If it's not a human right, then it's a whole different discussion.

Debating system is putting the cart ahead of the horse. The debate (in the U.S.) is (or should be) the position of healthcare as a human right or not, and THEN about the best way to fulfill that human right if it is one.

You could debate that if your (USA) system would be competitive , but its not so its retarded not to change it in any case.

Straight Hustlin
February 28 2013, 10:36:50 PM
One thing that really needs to be examined in US healthcare is the relationships between pharmaceutical corporations and insurance companies. It raises a serious eyebrow when a insurance company will cover upwards of $400k a year of chemo-therapy but not shit like grief counselling, or alternative medicine like enzyme theraphy which cost a tiny fraction of that. We're all currently going through the affects of what happened when they let savings & loans banks intermingle with investment banks, so I feel this is something important to address, lest your perscribed medications & treatments are determined more by which pharmaceutical corps are invested in your health insurance provider, then your ailment.

Sacul
March 1 2013, 01:25:05 AM
Easy and cheap access to healthcare is imho a sign of living in a developed country. How Americans can live comfortably knowing they are but one illness away from bankrupcy boggles my mind.

They pretty much dont. They either live in fear or else apply an individual version of american exceptionalism ("It wont happen to me, I'm different"). Even people with good insurance are a chronic illness away from bankruptcy

Sad state indeeed. In the USA 60% of all personal bankrupcy cases are due to medical bills. Absolutely mental in socialist Holland.

Synapse
March 1 2013, 03:44:45 AM
Even if the conclusion is that it isn’t a human right, the fact that we have the most inefficient, overpriced, anti-competitive, capitalism-gone-wrong system in the developed world means that there’s a HUGE room for improvement without wasting time debating philosophy.

Healthcare used to simply be affordable. We wouldn’t be arguing whether it was a “right” if it was again.

Actually, that’s not true, we would be arguing whether it’s a right, but the economic cost of saying that it is wouldn’t be so prohibitive as to sway the debate. In fact, we might even conclude that it isn’t a right, but it’s something we can provide for the poor at a reasonable cost to help lift them out of poverty.

This absolutely.

The fact that is costs us ridiculous piles of money to provide the same services provided by other countries should be independent of the universality of that care. An X ray should not cost less because it happens to take place in sweeden.

Can anyone link some actual data as to comparative costs of atomic operations like "chest xray" in various countries?

I've been told previously that the cost of the American system was basically paying for extreme care for the bottom 20% who had never had any preventive care and then spent the final months or years of their lives as taxpayer funded cyborgs. Yes that's wildly overstated but you get the idea.

If FMAR and Victoria are right....If the problem is actually just that we get overcharged for everything, then it's (as we Americans like to say) a very different ballgame.

Synapse
March 1 2013, 03:50:52 AM
In reply to sponk in the other thread:



How much is US health insurance cost anyway?

Seems to be like $10,000 a year. I combined the worker and company average 2009 premiums mentioned here:
http://en.wikipedia.org/wiki/Health_insurance_costs_in_the_United_States#Pre-existing_conditions

Jesus f christ. For us it's an extra 1.5% income tax for public + $15/week for private cover.

I've heard 20% of one's income referenced as "low" when buying non-employer healthcare plans.

Sponk
March 1 2013, 04:56:44 AM
Can anyone link some actual data as to comparative costs of atomic operations like "chest xray" in various countries?

Australia: $60.10 (http://www.bobinoz.com/blog/2784/the-australian-health-service-getting-an-x-ray/), of which $40.10 is reimbursable by the government.

USA: $70, but really $250 (http://www.akrongeneral.org/portal/page/portal/AGMC_PAGEGROUP/Price_guide/PRICE_GUIDE8), with a chance of spiralling (http://blog.remakehealth.com/blog_Healthcare_Consumers-0/bid/8507/How-much-does-an-X-ray-cost) into over a thousand.

Aea
March 1 2013, 05:26:01 AM
The true cost of medical services is a major farce in America because of the lofty relationship between insurance providers and health care providers. Providers will set one cost, insurance companies will pay a small fraction and they call it good. If you don't have insurance you're usually stuck with 100% of the inflated cost, or none of it (because it is just too expensive to pay for).

My Chest CT scan "cost" $8700 but it only "cost" me $250 (on top of existing insurance premiums), the insurance company paid out another $1000, and it probably cost the hospital ~$250. Clusterfuck.

F*** My Aunt Rita
March 1 2013, 06:13:08 AM
The true cost of medical services is a major farce in America because of the lofty relationship between insurance providers and health care providers. Providers will set one cost, insurance companies will pay a small fraction and they call it good. If you don't have insurance you're usually stuck with 100% of the inflated cost, or none of it (because it is just too expensive to pay for).

My Chest CT scan "cost" $8700 but it only "cost" me $250 (on top of existing insurance premiums), the insurance company paid out another $1000, and it probably cost the hospital ~$250. Clusterfuck.

Just remember that personnel costs were a fraction of that.

Kanv
March 1 2013, 06:36:08 AM
The debate over it's status as a Right is vital. If it is a right, cost to provide and personal responsabillity (for example) cannot be the primary motivation of the discussion. If it is not a right, then multiple other aspects can have a place as part of the discussion/debate.

Is there any other service out there that is a "human right"? Not really. Even food isn't a right. It always has been and always will be a privilege. The only argument is how to make that privilege affordable and what steps we're willing to take.


As with the Gun debate, it is my view that Americans consistently take the wrong tact in the modern era. If you do not want gun ownership to be a right, and you do want healthcare to be a right (both very common beliefs in the U.S., specificly on the U.S. left), there is a mechanic to amend the Consitution to do so and make it so. We did it many times before.

Not even on the same level. The gun debate is about the US Constitution guaranteeing that an individual can have the ability to own an item. There is nothing that changes pricing or availability. And there have been many cases on both federal and State levels where high taxes or other punitive monetary challenges have been put in place to prevent people from being able to purchase them. There is nothing that is preventing people from having access to healthcare as there is guns. Cost only makes it prohibitive.
The constitution can be altered, but it takes the societal values to accept it.

Therefore it's about American social values rather than an old document.

F*** My Aunt Rita
March 1 2013, 06:51:39 AM
The constitution can be altered, but it takes the societal values to accept it.

Therefore it's about American social values rather than an old document.

It's already a right. No one is debating that except the crazies. With the PPACA and previous laws we have a system for determining who pays. Now we need to make sure we are getting value for that money.

Keorythe
March 1 2013, 07:19:07 AM
The constitution can be altered, but it takes the societal values to accept it.

Therefore it's about American social values rather than an old document.

The "old document" is the basis for most rights in the US. Social values change from decade to decade, rights do not.


It's already a right. No one is debating that except the crazies.

Again, confusing rights with privileges/entitlements. The only rights associated with health care are those that prevent laws or individuals from intentionally preventing access. Obamacare didn't instill any rights, only regulatory changes.

I agree 100% with Aea about the relationship between insurance and provider/drug companies. The OP's article went into this describing the chargemaster issues. Is price fixing the answer? Maybe technology and drug development license regulations need to be reviewed

Rakshasa The Cat
March 1 2013, 07:43:25 AM
The "old document" is the basis for most rights in the US. Social values change from decade to decade, rights do not.

Some 3/5 persons would no doubt like to have a word on that statement.

Lallante
March 1 2013, 11:04:41 AM
I consider that access to healthcare should be a right, not a privilege. Rights are (in my opinion) posited, so its up for individual jurisdictions to grant that right to its people.

Living in fear of being bankrupted by getting ill through no fault of your own is ridiculous. Illness and disability is unpleasant enough without the added stress of the cost to worry about.

Many countries around the world have demonstrated that single-payer free at the point of delivery or similar systems can work, can be efficient and can provide a high level of care cost effectively. The burden on taxpayers is not infrequently far less than the cost of health insurance would be individually in the US.

It therefore stands to reason that a national universal healthcare system is a moral imperative.

metacannibal
March 1 2013, 01:08:22 PM
It therefore stands to reason that a national universal healthcare system is a moral imperative.


This. Add good and clean water to that. Apart from a moral perspective, it is also cheaper to have a conscience where people go to doctors and get treatment without worry since medical cost rise exponentialy the later the treatment starts.

Alistair
March 1 2013, 01:44:50 PM
It therefore stands to reason that a national universal healthcare system is a moral imperative.

In my opinion, I think you'd find most Americans, even on the right, agree.......when discussing the poor, the disabled, veterans, etc.

The disagreement, in my experience, is the concept of paying for able-bodied people who should (as the argument goes) be working and paying for this service themselves.

Many Americans do not see it as a moral imperative to provide free healthcare for the able bodied non-poor, anymore than they see it as a moral imperative to provide food stamps, free housing, free cellphones, free cars, etc, etc, etc.

Food and housing are two key items on that list, given that life cannot survive without food and water, or without shelter from the elements. There is no percieved moral imperative in the United States that we should have a national system of food distribution, or a national system of housing, even if it may be cheaper when taken as a whole, or more fair (as some define it) when taken as a whole, or more effective when taken as a whole. We provide aid in aquiring both to those in need, i.e. the poor (with the expectation they'll try and work their way out of it) and the disabled/retired/veterans/etc. on a more permanent basis. We also provide aid in healthcare to those same groups in the same way.

It's a fundamental viewpoint difference between a meaningful portion of U.S. voters, and how Europe et al. feels. There is a distinction made between what moral imperative exists and to whom that imperitive applies. Put simply, a majority (thus far) of American taxpayers and voters do not believe they should be required to pay for basic needs if the person is able-bodied beyond the short-term aid offered specificly to those living below the poverty line.

Please note (before someone gets all spergy and ad hom. again) that I'm not taking a side on the issue here, I am relaying the position and issues that bar a Universal System in the United States, based on my experience discussing and debating the issue with other "regular" Americans, right and left.

Victoria Steckersaurus
March 1 2013, 01:53:08 PM
Indeed. A good chunk of our country still believes that the poor should simply get jobs and stop being poor, ignoring the fact that so much of our system is rigged to keep this from ever happening. Effective marginal tax rates exceeding 100% are great for discouraging people from wanting to earn more money.

And the unaffordability of healthcare is part of that system that keeps them poor. TBH, we'd probably be better off helping pay for it with the hopes that they could then get out of the poverty trap and start earning enough money to pay meaningful taxes. But that logic applies to a lot of things, like paying for better schools and kids programs, etc.

Alistair
March 1 2013, 02:19:15 PM
Indeed. A good chunk of our country still believes that the poor should simply get jobs and stop being poor, ignoring the fact that so much of our system is rigged to keep this from ever happening. Effective marginal tax rates exceeding 100% are great for discouraging people from wanting to earn more money.

And the unaffordability of healthcare is part of that system that keeps them poor. TBH, we'd probably be better off helping pay for it with the hopes that they could then get out of the poverty trap and start earning enough money to pay meaningful taxes. But that logic applies to a lot of things, like paying for better schools and kids programs, etc.

How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

50% perhaps? 75%?

It is VERY easy to say "we should help". It is far harder for many to actually do it, when they see their paycheck get cut, and can no longer live their own life in the comfort they have come to expect, and feel they've earned with their labor.

It's very easy to say "do these things, and it'll be cheaper!", except when one looks at how the U.S. Federal Govt. operates fiscally, it is never, ever cheaper. The Feds never spend less, they always spend more. There is no reason to have faith that, if implemented, a Universal healthcare system in the U.S. will result in any lowered burden to taxpayers, quite the contrary. The fact that it is cheaper elsewhere does not mean it will be cheaper here.

In my own view, I'd be far more supportive of this aim IF alongside it's creation, we took a cold hard look at what our Government is currently spending it's money on, and cut the ever loving fuck out quite a large portion of it. Including defense and foreign interventionism. Especially defense as it related to places like Europe, Japan and Korea and the middle east.

Reallocate existing federal revenues from these wastes, and put them to expanding/building an efficient national Federal Healthcare option (at least to start) citizens can choose, and fund real science to start the shift from oil-based to green-energy-based, and to rebuild our own infrastructure of roads, bridges, rail, mass transit, internet, etc.

As a finance guy, I have absolute faith we can have so much of what we want.....with the money we taxpayers already pay in. But some VERY sacred cows will ahve to be butchered in the process.

Victoria Steckersaurus
March 1 2013, 02:48:27 PM
How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

50% perhaps? 75%?

It is VERY easy to say "we should help". It is far harder for many to actually do it, when they see their paycheck get cut, and can no longer live their own life in the comfort they have come to expect, and feel they've earned with their labor.



Are you trying to argue that implementing a decent healthcare system would increase costs? Because you'd be wrong. Period. Our current system inflates costs massively, and the savings from putting in something effective (Israel is a good model) would be enough that we could provide decent healthcare for the poor and still be coming out ahead.

I think the piece you're missing is that your insurance already comes out of your paycheck - you just don't see it. If you have employer-backed health insurance, your employer is paying a large amount of money for your insurance. So yes, taxes would probably need to go up for a government run system, but the cost savings to your employer is going to massively outweigh your increased taxes. Hopefully you're working for a company with a soul and they raise your salary by a reasonable amount as a result.

The only argument against it boils down to "The poor don't deserve the help, therefore I'll pay more money for my broken system that doesn't help them than implement one that saves both of us money."

It's like after school and community programs for at-risk youth. People say they don't want to pay for them, without realizing that they are actually a massive savings because of the reduced rate of incarceration. So you choose not to pay for the program because you don't think they deserve the help (or your budget is simply tight), and instead you pay even more money to keep them in prison.

Cool09
March 1 2013, 03:14:45 PM
Allistair did you read the posts earlier in this thread that showed that the US spends MORE of its GDP, MORE per capita per year on healthcare than any other country in the world?

Those darn liberal hippies with universal healthcare are spending LESS than you are. Also they are far healthier and live longer.

My point is that if the US moved to an efficient (lol) universal healthcare system it would save costs while vastly improving the quality of life of the whole population. It's not some tradoff like you describe, where the rich must help the poor by paying extra.

Lallante
March 1 2013, 03:26:27 PM
It therefore stands to reason that a national universal healthcare system is a moral imperative.

In my opinion, I think you'd find most Americans, even on the right, agree.......when discussing the poor, the disabled, veterans, etc.

The disagreement, in my experience, is the concept of paying for able-bodied people who should (as the argument goes) be working and paying for this service themselves.If you need healthcare, you by definition are not "able bodied".




Many Americans do not see it as a moral imperative to provide free healthcare for the able bodied non-poor, anymore than they see it as a moral imperative to provide food stamps, free housing, free cellphones, free cars, etc, etc, etc.
Right, which is why fuck america tbh.


Food and housing are two key items on that list, given that life cannot survive without food and water, or without shelter from the elements. There is no percieved moral imperative in the United States that we should have a national system of food distribution, or a national system of housing, even if it may be cheaper when taken as a whole, or more fair (as some define it) when taken as a whole, or more effective when taken as a whole.
right, which is why the USA is a terrible place. The whole "if you cant afford it, die" attitude is horribly wrong and the fact that its mainstream is terrifying.


It's a fundamental viewpoint difference between a meaningful portion of U.S. voters, and how Europe et al. feels. There is a distinction made between what moral imperative exists and to whom that imperitive applies. Put simply, a majority (thus far) of American taxpayers and voters do not believe they should be required to pay for basic needs if the person is able-bodied beyond the short-term aid offered specificly to those living below the poverty line.

I agree. I'd rather live in a world where people help you up when you fall rather than counting to 5 and then standing on your head.

Alistair
March 1 2013, 03:37:22 PM
Are you trying to argue.....

I'm not trying to argue. Given that you've just demonized every possible opponent or objection as coming exclusively from someone who hates poor people and is too stupid to understand their own budgets vs. tax budens. I don't see much room for argueing with you.

Suffice it to say, you have far more faith in the abillity of the U.S. Federal Govt. to operate an efficent cost-effective, spending-appropriate, equivalent-to-current-quality single-payor Universal Healthcare system than many Americans do, you have more faith that such a system will translate from Israel-sized to U.S.-sized without considerable problems and additional costs or adverse economic impacts, and you have far more faith that the result wouldn't be either either raised levels of Federal debt and/ or increased taxation to fund it all.

These are the concerns (in part) you'll need to overcome to get such a system passed into Law in the United States. Even if the concerns are all based in stupidity and ignorence and hatred of poor people, they will still need overcome.


Right, which is why fuck america tbh.

right, which is why the USA is a terrible place.

Ok.

Lallante
March 1 2013, 03:38:08 PM
Are you trying to argue.....

I'm not trying to argue. Given that you've just demonized every possible opponent or objection as coming exclusively from someone who hates poor people and is too stupid to understand their own budgets vs. tax budens. I don't see much room for argueing with you.

Suffice it to say, you have far more faith in the abillity of the U.S. Federal Govt. to operate an efficent cost-effective, spending-appropriate, equivalent-to-current-quality single-payor Universal Healthcare system than many Americans do, you have more faith that such a system will translate from Israel-sized to U.S.-sized without considerable problems and additional costs or adverse economic impacts, and you have far more faith that the result wouldn't be either either raised levels of Federal debt and/ or increased taxation to fund it all.

These are the concerns (in part) you'll need to overcome to get such a system passed into Law in the United States. Even if the concerns are all based in stupidity and ignorence and hatred of poor people, they will still need overcome.

Why not state run, federally mandated minimum standard schemes paid for by a federal grant distributed by population?

Alistair
March 1 2013, 03:49:37 PM
Are you trying to argue.....

I'm not trying to argue. Given that you've just demonized every possible opponent or objection as coming exclusively from someone who hates poor people and is too stupid to understand their own budgets vs. tax budens. I don't see much room for argueing with you.

Suffice it to say, you have far more faith in the abillity of the U.S. Federal Govt. to operate an efficent cost-effective, spending-appropriate, equivalent-to-current-quality single-payor Universal Healthcare system than many Americans do, you have more faith that such a system will translate from Israel-sized to U.S.-sized without considerable problems and additional costs or adverse economic impacts, and you have far more faith that the result wouldn't be either either raised levels of Federal debt and/ or increased taxation to fund it all.

These are the concerns (in part) you'll need to overcome to get such a system passed into Law in the United States. Even if the concerns are all based in stupidity and ignorence and hatred of poor people, they will still need overcome.

Why not state run, federally mandated minimum standard schemes paid for by a federal grant distributed by population?

Given how existing Federal healthcare programs work, this is very likely the way any such system would be implemented. State run, funded partially via Federal subsidy (i.e. grant) with some form of state match requirements, with Federally imposed standards.

Population basis would certainly be a part of the calculation for funding, but only a part, other factors would be included as well I'd venture.

Victoria Steckersaurus
March 1 2013, 04:03:57 PM
Are you trying to argue.....

I'm not trying to argue. Given that you've just demonized every possible opponent or objection as coming exclusively from someone who hates poor people and is too stupid to understand their own budgets vs. tax budens. I don't see much room for argueing with you.

Suffice it to say, you have far more faith in the abillity of the U.S. Federal Govt. to operate an efficent cost-effective, spending-appropriate, equivalent-to-current-quality single-payor Universal Healthcare system than many Americans do, you have more faith that such a system will translate from Israel-sized to U.S.-sized without considerable problems and additional costs or adverse economic impacts, and you have far more faith that the result wouldn't be either either raised levels of Federal debt and/ or increased taxation to fund it all.

These are the concerns (in part) you'll need to overcome to get such a system passed into Law in the United States. Even if the concerns are all based in stupidity and ignorence and hatred of poor people, they will still need overcome.


If you start with a statement like this:


How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

50% perhaps? 75%?

It looks like you're trying to argue. Just FYI.

And actually, I don't think every objection comes from people who (in lesser terms) hate the poor - although politicians have done an excellent job of encouraging it. Most objections come from people who are ignorant - specifically, ignorant of how much money their employer wastes on their insurance. Because they don't tell us.

Do I think the Israeli system will scale perfectly from a country their size to ours? Probably not. But our current system spends 18% GDP on mediocre to poor healthcare, and theirs spends 8% on very good healthcare. That's such a massive gulf it's absurd.

And of course taxes are going to go up, I mentioned that in my post. But compared to the amount we currently waste on private insurance companies, the tax increase should be less than the savings.

Does the Federal Gov. waste money? Sure. Do we have some bloated programs that need to be cut? Absolutely. Most of that is due to congressmen doing their best to bring federal money back to their states to help get themselves elected again. Is there a risk that healthcare could end up the same way? Certainly. But most every country that has universal healthcare has implemented ways to keep costs in line. I don't think it's impossible.


And even if the FedGov does continue to waste money, it would still likely be less than the amount we currently overpay for healthcare. They have some form of oversight, which private insurance has successfully removed from the system.

Alistair
March 1 2013, 04:17:53 PM
If you start with a statement like this:


How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

50% perhaps? 75%?

It looks like you're trying to argue. Just FYI.

It's fair to ask what level of overall taxation you're personally comfortable with accepting to achieve the aims your promote, is it not?


Do I think the Israeli system will scale perfectly from a country their size to ours? Probably not. But our current system spends 18% GDP on mediocre to poor healthcare, and theirs spends 8% on very good healthcare. That's such a massive gulf it's absurd.

So, your position (if I understand it) is that we're going to add full coverage to something like ~100,000,000 new people (non- and underinsured currently) reaching 100% coverage, at a superior level of service to that enjoyed by the average privately insured person, with the same level of technology and pharmacopia access, the same level of investment in advancement, and we're going to save ~10% of our GDP doing it.

And it's going to be run by the Federal Govt. and administered by the 50 States (following on Lall's quite astute point above).

I have trouble believing that.

So lets be objective. Can you provide an example of any other servidce that the Federal Government does that was taken away from the private sector competition where the Govt. service was a marked increase in service, at a marked descrease in costs, to the previous private version?

As I am sure you understand, if you can promise me we can cover everyone, at current levels of service or better, and my paycheck will be bigger each week net take-home (higher taxes but no insurance costs), it would be a very difficult issue to oppose except from an ultra-libertarian individualist position (whcih is in truth a very small minority, most voters still vote out of personal self-interest above all else).

The hurdle is showing that this is actually how it would work. Proof of concept here in the U.S. Do we have an example that could be used to prove it?

Lallante
March 1 2013, 04:22:51 PM
In answer to your question I'm happy to pay 50% overall in taxation. Potentially more if the additional tax comes from spending on luxuries.

An example of nationalisation that caused an improvement in services is Railtrack in the UK, which was pseudo nationalised (it was liquidated and its assets were given to its government backed successor, Network Rail). Network Rail is safer and better run than Railtrack (though not without its own problems).

The US doesnt nationalise because its so right-wing.

Alistair
March 1 2013, 04:37:14 PM
An example of nationalisation that caused an improvement in services is Railtrack in the UK, which was pseudo nationalised (it was liquidated and its assets were given to its government backed successor, Network Rail). Network Rail is safer and better run than Railtrack (though not without its own problems).

The US doesnt nationalise because its so right-wing.

An interesting example, as the U.S. nationalized it's long-distance passenger rail services, in the form of Amtrak, in the 1970's. In this case, however, it's a difficult example to use as proof-of-case, as passenger rail in the United States has never been a profitable venture (unlike healthcare), and never will be.

The private freight-rail companies were quite eager to dump their service requirements on the Federal Govt. Service did not improve (but it was generally maintained) and costs have risen substantially from before the mid-70's nationalization to after.

I will agree with the last, the U.S. in general (very general) belives in private-for-profit ownership of industries, not collectivised nationalization of industries. Something I believe is changing and will continue to change over time.

Hast
March 1 2013, 04:37:37 PM
So, your position (if I understand it) is that we're going to add full coverage to something like ~100,000,000 new people (non- and underinsured currently) reaching 100% coverage, at a superior level of service to that enjoyed by the average privately insured person, with the same level of technology and pharmacopia access, the same level of investment in advancement, and we're going to save ~10% of our GDP doing it.

And it's going to be run by the Federal Govt. and administered by the 50 States (following on Lall's quite astute point above).

I have trouble believing that.


You could probably save that by just implementing a bit system for government as single purchaser of medicine tbh. And no, that does not mean less choice for consumers, in fact a system where patients asks the doctor for specific brands of drugs is frankly retarded.




So lets be objective. Can you provide an example of any other servidce that the Federal Government does that was taken away from the private sector competition where the Govt. service was a marked increase in service, at a marked descrease in costs, to the previous private version?

As I am sure you understand, if you can promise me we can cover everyone, at current levels of service or better, and my paycheck will be bigger each week net take-home (higher taxes but no insurance costs), it would be a very difficult issue to oppose except from an ultra-libertarian individualist position (whcih is in truth a very small minority, most voters still vote out of personal self-interest above all else).

The hurdle is showing that this is actually how it would work. Proof of concept here in the U.S. Do we have an example that could be used to prove it?

This is not us being objective FYI.

And the rest of the western world is a brilliant proof of concept.

Sent from my Nexus 7 using Tapatalk HD

Straight Hustlin
March 1 2013, 05:02:53 PM
The affordable health care act is a pretty intresting thing, and there is soo much mis-information surrounding it. If you were to ask what the primary purpose of the legislation was, most people would tell you its either to provide healthcare to those who cannot afford it, or to bring down said costs. Both would be wrong. The goal of the affordable health care act is the abolition of "pre-existing" conditions. This is certainly a goal that is worth pursuing as having a lapse in health insurance should not prevent you from being able to get it affordably ever again.

This is why there is the requirement for everyone to have health insurance, as if you were not required to from the get go, people would abuse the system and only purchase healthcare when the need arose. Its to make it as fair as possible for both the insurance companies & the people. This way everyone has health coverage, and skin in the game from the get go, and insurance companies do not have to suffer massive losses from people who would only purchase health care when they needed it, and stop it as soon as no longer do. Its not fair to expect an insurance company to shell out 100's of thousands of dollars for cancer treatment, when the person only acquired it only after they were diagnosed, and cancelled it as soon as treatments were done & they were given a clean bill of health.

I also think its worth mentioning that, atleast IMO, part of the huge rises in healthcare has been that people go to the hospitals now adays for things that do not neccesitate it. When I was growing up, if you went to the hospital, it was an emergency, something was broken, or someone was in bad shape and need immediate medical attention. Now adays people take their kids to the emergency room for colds, minor infections, or many other things that simply do not represent a medical emergency, and would be the type of thing you would see your GP about. I understand that when it comes to your kids everything is serious & that people want the best care possible for them, but alot of people need a fucking reality check. For an example of how messed up this shit is; A few weeks ago my friend took her 7 year old son to the hospital because his throat was sore, he has strept throat. This is something that in no way shape or form requires a hospital visit. Its one thing if your getting recuring strept as that can be a sign of appendix or immune problems, but an isolated case of it is not a medical emergency. Do you want to know why she went to the hospital? Because she cancelled her health private insurance policy because most hospitals in NJ will provide free healthcare to individuals under 26 y/o with no health insurance. She currently has no incentive to carry health insurance because she can game the system. And this is far from rare occurance. Any american can likely tell you stories of sitting in a waiting room with people legitamately needing medical care & they are having to wait for because so many people with inane, non-emergency issues got there before them. And by law the hospital cannot turn them away, even if its just little timmy broke his pinky toe.

Keorythe
March 1 2013, 07:04:56 PM
Given how existing Federal healthcare programs work, this is very likely the way any such system would be implemented. State run, funded partially via Federal subsidy (i.e. grant) with some form of state match requirements, with Federally imposed standards.

Population basis would certainly be a part of the calculation for funding, but only a part, other factors would be included as well I'd venture.

Needs to be mandatory spending if this happens. The federal government has a long track record of making mandatory programs where States match federal funds. But federal funding cuts off after a few years and the State governments are stuck with the program which they can't control and can't remove.

What you're describing is a healthcare exchange sort of like the ones in Obamacare but with the roles reversed. And just like previous federal implemented programs, this is funded by the State but the State really has no control over it. The likelihood of subsidies being yanked in the future are pretty high and this is a REALLY expensive program. This scares the crap out of a number of States since they tried this long before and failed due to cherry picking and a market only within the State itself.

EU countries get the luxury of lower prices through price controlling. We could do the same here in the US but you could just see the lawyers prepping for the future Supreme Court battles. We could institute regulations about pricing, drug licensing, and other items to reduce costs. Again, read the OP article. Yes, it's fucking long but it's a darn good read. The major issue of pricing is the key here. If it were normalized and if there was some real competition between companies rather than the stranglehold they have over patents then prices would drop like a rock.

Gotta run, Blue Cross meeting for my company insurance in an hour. Ironic isn't it? Wondering if I should skip the dental plan.

Alistair
March 1 2013, 07:09:17 PM
Given how existing Federal healthcare programs work, this is very likely the way any such system would be implemented. State run, funded partially via Federal subsidy (i.e. grant) with some form of state match requirements, with Federally imposed standards.

Population basis would certainly be a part of the calculation for funding, but only a part, other factors would be included as well I'd venture.

Needs to be mandatory spending if this happens. The federal government has a long track record of making mandatory programs where States match federal funds. But federal funding cuts off after a few years and the State governments are stuck with the program which they can't control and can't remove.

What you're describing is a healthcare exchange sort of like the ones in Obamacare but with the roles reversed. And just like previous federal implemented programs, this is funded by the State but the State really has no control over it. The likelihood of subsidies being yanked in the future are pretty high and this is a REALLY expensive program. This scares the crap out of a number of States since they tried this long before and failed due to cherry picking and a market only within the State itself.

EU countries get the luxury of lower prices through price controlling. We could do the same here in the US but you could just see the lawyers prepping for the future Supreme Court battles. We could institute regulations about pricing, drug licensing, and other items to reduce costs. Again, read the OP article. Yes, it's fucking long but it's a darn good read. The major issue of pricing is the key here. If it were normalized and if there was some real competition between companies rather than the stranglehold they have over patents then prices would drop like a rock.

Gotta run, Blue Cross meeting for my company insurance in an hour. Ironic isn't it? Wondering if I should skip the dental plan.

Aye, good post.
And as one who recently had all four wisdom teeth yanked......don't skip the dental.

Victoria Steckersaurus
March 1 2013, 07:54:46 PM
If you start with a statement like this:


How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

50% perhaps? 75%?

It looks like you're trying to argue. Just FYI.

It's fair to ask what level of overall taxation you're personally comfortable with accepting to achieve the aims your promote, is it not?


Do I think the Israeli system will scale perfectly from a country their size to ours? Probably not. But our current system spends 18% GDP on mediocre to poor healthcare, and theirs spends 8% on very good healthcare. That's such a massive gulf it's absurd.

So, your position (if I understand it) is that we're going to add full coverage to something like ~100,000,000 new people (non- and underinsured currently) reaching 100% coverage, at a superior level of service to that enjoyed by the average privately insured person, with the same level of technology and pharmacopia access, the same level of investment in advancement, and we're going to save ~10% of our GDP doing it.

And it's going to be run by the Federal Govt. and administered by the 50 States (following on Lall's quite astute point above).

I have trouble believing that.

So lets be objective. Can you provide an example of any other servidce that the Federal Government does that was taken away from the private sector competition where the Govt. service was a marked increase in service, at a marked descrease in costs, to the previous private version?

As I am sure you understand, if you can promise me we can cover everyone, at current levels of service or better, and my paycheck will be bigger each week net take-home (higher taxes but no insurance costs), it would be a very difficult issue to oppose except from an ultra-libertarian individualist position (whcih is in truth a very small minority, most voters still vote out of personal self-interest above all else).

The hurdle is showing that this is actually how it would work. Proof of concept here in the U.S. Do we have an example that could be used to prove it?

You need to do a better job reading, please. I didn't say we were going to get down to 8%, I said right up front that it wouldn't scale perfectly. But the gulf is so large that I believe we would see significant savings.

And see, those ~100m people without insurance? We already pay for them. Either they are covered by medicare, or we pay for them when they end up in emergency rooms (which can't refuse them service) because they couldn't get the vastly less expensive preventative care (which can refuse them service if they can't pay). So it's entirely possible that we won't see a large cost rise from them. We may even see savings from that.

I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.

You keep comparing it to the private sector, but in this instance, the private sector is the one that is horrifically ineffient and overpriced. By hiding pricing from both the people making decisions and the people paying (you and your employer, respectively), they've been able to steadily jack prices through the roof while eliminating competition. Even the (sometimes questionable) oversight that the government is subject to will prohibit such a degree of waste.

So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.

Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.

Alistair
March 1 2013, 08:14:57 PM
I didn't say we were going to get down to 8%, I said right up front that it wouldn't scale perfectly. But the gulf is so large that I believe we would see significant savings.


And see, those ~100m people without insurance? We already pay for them. So it's entirely possible that we won't see a large cost rise from them. We may even see savings from that.


So we'll save, say, 5% to 6% of GDP in spending on Healthcare then? General Ballpark figures.


I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.

http://www.gao.gov/products/GAO-11-409T would seem, at first glance, to disagree with that claim.

Googling "GAO medicare waste" makes for interesting reading. This for example: http://www.gao.gov/products/GAO-12-966


So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.

Happily, the medical industry does not get a vote on election day.

If the facts are so clearly in favor of such a system, as you and other say they are, it shouldn't be that hard to convince a majority of voters of how clearly in their own best interests such a choice is. Perhaps for a start, you may wish to stop calling them poor hated stupid people....thats generally a turnoff right from the start.

Next, repeat ad neasuem "Everyone covered, bigger paychecks for all". Then show examples.

Then (and this is the important part) when the Law passes finally.....you sure better have been right.;)


Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.

Another serious topic, for another (seperate) serious thread.

Synapse
March 1 2013, 09:14:36 PM
I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.

http://www.gao.gov/products/GAO-11-409T would seem, at first glance, to disagree with that claim.

Googling "GAO medicare waste" makes for interesting reading. This for example: http://www.gao.gov/products/GAO-12-966

Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.
In short I agree it's bad, but I don't see how we're special.

Edit: I guess another way to put it is, governments are frequently wasteful, but would they be "300% to 1000% above cost" wasteful? Because that's what our current system seems to be giving us with $250 bills for $50 operations.

Even if government runs this setup at 100% waste above cost we'd be looking at 50-70% savings.




So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.

Happily, the medical industry does not get a vote on election day.

If the facts are so clearly in favor of such a system, as you and other say they are, it shouldn't be that hard to convince a majority of voters of how clearly in their own best interests such a choice is. Perhaps for a start, you may wish to stop calling them poor hated stupid people....thats generally a turnoff right from the start.

Next, repeat ad neasuem "Everyone covered, bigger paychecks for all". Then show examples.

Then (and this is the important part) when the Law passes finally.....you sure better have been right.;)

Sadly, the healthcare industry gets a vote every other day of the year instead. We had numbers posted earlier showing they spend more lobbying than military contractors and investment banks combined.

As for the posted strategy...I have no clue why we don't do this. I've been waiting to see it for a long time and have seen no evidence it couldnt be done just like that ("Everyone covered, lower costs"). My only hypothesis why this doesn't happen is that it's a politically suicidal option given the healthcare lobbying above.




Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.

Another serious topic, for another (seperate) serious thread.

Yes let's not discuss gullibility in America here. It could fill several threads.

Straight Hustlin
March 1 2013, 09:23:56 PM
TBH just passing regulation banning the practice of "evergreening" medication would likely be enough to drastically bring down the cost of medication & increase compition between pharma-corps.

If you aren't familiar with what evergreening means, its the practice of a pharmaceutical company slightly altering the medication, usually the inactive ingrediants, as a way of extending the patents life time. If we were to introduce legislation that upon changing it, the company would recieve an entirely new patent for the altered medication, and that the previous makeup would have its patent voided, it would make companies vastly reconsider if the slight alterations are worth having the previous form of the drug made generic as they would have to compete against it. So it would push them to only alter the make-up when it actually offers tangible benefits to the consumer.

Keorythe
March 2 2013, 01:29:21 AM
Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

In short I agree it's bad, but I don't see how we're special.

Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.

Hast
March 2 2013, 11:16:57 AM
Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

In short I agree it's bad, but I don't see how we're special.

Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.

Well, right now it seems that the US has done exactly that, then opted for the Albanian system. So I fail to see how that would be a worse situation then todays. And I'm pretty sure that the UK would be perfectly fine with the Swedish system and vice versa. And the same with the Dutch and Italian. (Italian is second rated after the French FYI according to the CIA World Factbook). The fact is that there are more similarities then there are differences in these systems, with the main focus being the patient, and not the wallet of the medical industry.

Synapse
March 2 2013, 11:20:38 AM
Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

In short I agree it's bad, but I don't see how we're special.

Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.

Even assuming your argument is correct that it doesn't scale (something not entirely settled). There's no reason it has to be a federally run system. Pretty unlikely that it would be anything greater than a federally mandated and supported set of systems, as we have discussed. So that point seems kind of moot.

Furthermore, you're offering a false choice. It's not about whether the dutch would be happy with how the italians do it, its about whether either one would take the american system. (they wouldnt.)

The dutch might not be fine with how the italians do it. But californians or dakotans would BOTH be happier with how either the dutch or the italians do it, compared to what they have now.
Any US state would be so much better off that the comparative differences would just be washed out by improvements.

Toxic
March 4 2013, 11:22:22 AM
How the rest of the world sees the american healthcare discussion:

http://satwcomic.com/art/600x1084xthe-end-of-america.jpg.pagespeed.ic.yEozhbtzq_.jpg

Lallante
March 5 2013, 12:17:55 PM
the problem, you see, is that USA is too awesome for healthcare

Hast
March 5 2013, 02:18:04 PM
I have yet to hear a convincing argument against universal health care that does not fall flat on its face when faced with reality and economics. Most of the arguments against seems to be based on disprovable myths and misguided ideologies.

And personally I must say that I prefer to get something back for the money I pay in taxes. And since I do I gladly pay them.

elmicker
March 5 2013, 02:27:03 PM
Let's move the focus a bit

http://www.bbc.co.uk/news/health-21654536

Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.

Hast
March 5 2013, 02:52:51 PM
I think the problem lies a bit deeper then that. A lot of it is probably culturally based. If you can get people to eat healthier and exercise it will probably do more for public health then restricting tobacco sales. But as long as people don't move and eat low quality food, not just because it is cheap, but also because it requires no effort to prepare, you won't see much in the way of an improvement to general health.

Must say that I'm generally for a tax on sugar and maybe even unhealthy food additives.

Alistair
March 5 2013, 04:15:49 PM
It should be pointed out that the U.S. does have something of a test-bed for a light-version of Universal Healthcare, in the form of the State of Mass. Albeit in the form of individual mandate + Social Welfare benefit, not a true Universal Single-Payer system.

http://en.wikipedia.org/wiki/Massachusetts_universal_healthcare

Makes for interesting reading.

Synapse
March 6 2013, 04:21:04 AM
Move-on.org keeps sending me mails saying they want my money to help fight against Obama putting ANY CUTS up for negotiation in medicare, social security, or Medicaid.

My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?

Am I right that MoveOn is fighting a reactionary "don't touch my benefits" battle to the detriment of our national finances, or is Obama offering up the only lifeline left to America's poor in an attempt to meet the extreme right in the middle?

...or is it both?

Sponk
March 6 2013, 04:49:52 AM
Am I right that MoveOn is fighting a reactionary "don't touch my benefits" battle to the detriment of our national finances, or is Obama offering up the only lifeline left to America's poor in an attempt to meet the extreme right in the middle?

A bit of both, but more the second than the first. It has happened so often that it's cliched now:

1. The GOP says "let's meet in the middle"
2. Obama moves a step closer.
3. GOP moves a step further away.
4. Goto step 1

The last plan I saw to fix sequester was still firmly slanted towards everything the GOP wants, except a few bones thrown to Dem electorates with a large military presence, so I can understand the concern that moveon has.

F*** My Aunt Rita
March 6 2013, 04:52:45 AM
My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?

Where are you getting these numbers?

Lallante
March 6 2013, 03:08:36 PM
Let's move the focus a bit

http://www.bbc.co.uk/news/health-21654536

Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.

If you look at the statistics its clearly due to ciggarettes, alcohol and junk food, rather than health service.

I think yes, the government should tax unhealthy products.

cheeba
March 6 2013, 03:53:08 PM
Let's move the focus a bit

http://www.bbc.co.uk/news/health-21654536

Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.

If you look at the statistics its clearly due to ciggarettes, alcohol and junk food, rather than health service.

I think yes, the government should tax unhealthy products.

But doesnt the UK already have the highest taxation rates on booze + cigs out of any european country?

(but im all for a tax on soda!)

Synapse
March 6 2013, 04:55:53 PM
My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?

Where are you getting these numbers?

Honestly this is just coming from the gestalt of all I've heard on the subject over years from various sources, however this seems a representative sample below. I was wrong about 30-40 years, it was 75 years.

The prodigious level of spending makes health care important, but it is the fearsome growth of health care costs that has put health care reform on the national agenda. Medicare spending has grown 2.4 percentage points per year faster than GDP over the past 30 years, more than tripling as a share of GDP since 1960. If costs continue to grow at current rates relative to GDP, then Medicare alone will account for 8 percent of GDP by 2030, 14 percent by 2050, and 31 percent by the end of the 75-year budget projection window. This would imply that Medicare would be more than 50 percent larger than the current size of the entire federal budget. While these numbers are absurdly large, a similar projection would forecast total health care spending to account for an impossible 99 percent of GDP by 2082 (Congressional Budget Office, 2007).

(bolding mine)
Source: http://www.ncbi.nlm.nih.gov/books/NBK52815/

Moreover, the point is not how much that they will grow, but that the near term trajectory even through the next 15 years (~2030) is also an untenable amount of healthcare spending.

Lallante
March 6 2013, 06:27:40 PM
But doesnt the UK already have the highest taxation rates on booze + cigs out of any european country?

(but im all for a tax on soda!)

Literally nowhere near.

Lallante
March 6 2013, 06:30:19 PM
My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?

Where are you getting these numbers?

Honestly this is just coming from the gestalt of all I've heard on the subject over years from various sources, however this seems a representative sample below. I was wrong about 30-40 years, it was 75 years.

The prodigious level of spending makes health care important, but it is the fearsome growth of health care costs that has put health care reform on the national agenda. Medicare spending has grown 2.4 percentage points per year faster than GDP over the past 30 years, more than tripling as a share of GDP since 1960. If costs continue to grow at current rates relative to GDP, then Medicare alone will account for 8 percent of GDP by 2030, 14 percent by 2050, and 31 percent by the end of the 75-year budget projection window. This would imply that Medicare would be more than 50 percent larger than the current size of the entire federal budget. While these numbers are absurdly large, a similar projection would forecast total health care spending to account for an impossible 99 percent of GDP by 2082 (Congressional Budget Office, 2007).

(bolding mine)
Source: http://www.ncbi.nlm.nih.gov/books/NBK52815/

Moreover, the point is not how much that they will grow, but that the near term trajectory even through the next 15 years (~2030) is also an untenable amount of healthcare spending.

Thats completely misleading - they are talking about CURRENT budget but 75 years in the FUTURE medicare value (INCLUDING inflation).

The current budget, adjusted ONLY for inflation (at 4%) and not growth, would be approximately 15x larger than it is now by that time.

Synapse
March 6 2013, 07:34:23 PM
Not understanding your point, unless its that "comparing somethign inflated after 75 years to the current budget not inflated 75 years is silly" in which case I get you.

However the ratio to GDP still sounds like it's going to be way more money than we can afford.

Sponk
March 6 2013, 11:06:28 PM
I think it's fair to say that extrapolating rising health care costs out to T+75 years is not particularly accurate.

However, it does demonstrate that the current increase in health care costs are worrying, especially since Medicare spending probably increases a lot less than private health care prices do.

Rakshasa The Cat
March 10 2013, 06:17:21 PM
I think it's fair to say that extrapolating rising health care costs out to T+75 years is not particularly accurate.

However, it does demonstrate that the current increase in health care costs are worrying, especially since Medicare spending probably increases a lot less than private health care prices do.

This reminds me of a presentation one of the chinese girls in my class gave on a US health insurance company. This was here in Japan, so they were really not that aware of the whole social consciousness thing.

She presented the amazing profit margin of the insurance company, almost 60%, and when it was time for questions I commented on this and asked her if she realized the significance of such a high margin. Blank stares and I might as well have been asking the wall.

IMO, Americans are closer to the Chinese than they'll ever admit.

Victoria Steckersaurus
March 10 2013, 09:14:49 PM
IIRC, one of the provisions of Obamacare actually places a cap on the profitability of insurance companies which may in fact push some of them out of business. I personally see this as a good thing.

Please note that I may have that wrong, I'm remembering something second or third hand.

Toxic
March 12 2013, 02:57:30 PM
IIRC, one of the provisions of Obamacare actually places a cap on the profitability of insurance companies which may in fact push some of them out of business. I personally see this as a good thing.

Please note that I may have that wrong, I'm remembering something second or third hand.

How can a cap on profit push someone out of business? They are still making money.

Alistair
March 12 2013, 03:00:42 PM
IIRC, one of the provisions of Obamacare actually places a cap on the profitability of insurance companies which may in fact push some of them out of business. I personally see this as a good thing.

Please note that I may have that wrong, I'm remembering something second or third hand.

How can a cap on profit push someone out of business? They are still making money.

It can't.

For example, Kaiser Permanente (an HMO) is a not-for-profit health insurer of some note and has, to my knowledge, always been non-profit. They seem to get along just fine.

Synapse
March 12 2013, 07:11:19 PM
IIRC, one of the provisions of Obamacare actually places a cap on the profitability of insurance companies which may in fact push some of them out of business. I personally see this as a good thing.

Please note that I may have that wrong, I'm remembering something second or third hand.

How can a cap on profit push someone out of business? They are still making money.

It can't.

For example, Kaiser Permanente (an HMO) is a not-for-profit health insurer of some note and has, to my knowledge, always been non-profit. They seem to get along just fine.

A cap on earnings can. It would be a simple mistake to mix the two, and much more politically likely to cap earnings than profit.

Capping profit just means the company reinvests everything until it reaches the capped amount and then keeps that. Kinda silly idea unless you want to just force reinvestment of those high costs into the HMO that is benefitting from them, without changing the costs themselves.

Victoria Steckersaurus
March 13 2013, 06:45:43 PM
That might have been it. Perhaps it was a cap on how much their revenue [what they take from your employer] can exceed their payments [what they pay for your healthcare], because some of the numbers are ridiculous.

On the other hand, re: capping profits, you could in theory close down certain business because investors will take their money somewhere they can get a better return on investment. But you're right, I was working from memory and probably got that wrong.

Sponk
April 6 2013, 10:03:48 AM
fyi

http://i.imgur.com/MOFOrhN.jpg

Keorythe
April 6 2013, 10:12:01 AM
fyi

http://i.imgur.com/MOFOrhN.jpg


That red box seems kind of redundant and could have been written better.

Sponk
April 6 2013, 10:17:23 AM
That red box seems kind of redundant and could have been written better.

Not everyone is gud at reeding inglish vov

F*** My Aunt Rita
April 6 2013, 02:05:40 PM
One thing I learned recently is that in Australia next of kin don't have the final word when it comes to patient care decisions.

Your 80 year old granpappy has severe dementia and won't live much longer without aggressive care applied. In America, if the family directed all means necessary physicians have to comply. Australia, physicians take the families input but ol granpappy ain't getting an ICU bed and half a million dollars in useless care.

Aea
April 7 2013, 01:07:22 AM
One thing I learned recently is that in Australia next of kin don't have the final word when it comes to patient care decisions.

Your 80 year old granpappy has severe dementia and won't live much longer without aggressive care applied. In America, if the family directed all means necessary physicians have to comply. Australia, physicians take the families input but ol granpappy ain't getting an ICU bed and half a million dollars in useless care.

This is a very common problem in the US and does lead to extremely high costs for EOLC. This may be a good article to peruse http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html

Additionally, the "cap on profit" is mis-represented. The actual limitation is that a maximum of 15-20% of insurance premiums can be spent on administrative costs. This is a good first step, but hardly a panacea. Insurance costs are high since the underlying cost is high, this isn't to say that insurance companies don't have incredibly questionable business practices, but they do pay out the majority of the dollars they take in towards health care providers.

Also, it bears mentioning that non-profit has nearly no bearing in the medical world. A hospital may be non-profit but yet pay executives millions of dollars a year in compensation. Just because the underlying entity doesn't make a profit doesn't mean that individuals aren't making outrageous amounts of money in other ways.

Rakshasa The Cat
April 7 2013, 07:22:16 PM
One thing I learned recently is that in Australia next of kin don't have the final word when it comes to patient care decisions.

Your 80 year old granpappy has severe dementia and won't live much longer without aggressive care applied. In America, if the family directed all means necessary physicians have to comply. Australia, physicians take the families input but ol granpappy ain't getting an ICU bed and half a million dollars in useless care.

Death panels are rather funny, as if the grieving family has more experience with how to best plan for the last trip in life.

Lallante
April 8 2013, 02:07:19 PM
One thing I learned recently is that in Australia next of kin don't have the final word when it comes to patient care decisions.

Your 80 year old granpappy has severe dementia and won't live much longer without aggressive care applied. In America, if the family directed all means necessary physicians have to comply. Australia, physicians take the families input but ol granpappy ain't getting an ICU bed and half a million dollars in useless care.

Death panels are rather funny, as if the grieving family has more experience with how to best plan for the last trip in life.

Anyone using the expression "death panel" is automatically wrong, and retarded.

Synapse
April 8 2013, 04:56:01 PM
That red box seems kind of redundant and could have been written better.

Not everyone is gud at reeding inglish vov

I'm sure an industry with some competition would have found a better way to word it! </joke time>

Rakshasa The Cat
April 9 2013, 10:01:14 AM
Death panels are rather funny, as if the grieving family has more experience with how to best plan for the last trip in life.

Anyone using the expression "death panel" is automatically wrong, and retarded.

I see you also used the expression "death panel", so you're retarded too.

Edit: And wrong... which leads to a rather interesting logical argument.

SAI Peregrinus
April 9 2013, 08:37:06 PM
Right now the insurance companies have "claims adjusters" who decide if you die.
With a single payer system the government has them.

The Republicans are smart enough to know that the government can't be trusted with such things. The Democrats are smart enough to know that the insurance companies can't be trusted with such things.

And really, no system will get it right every time. If your policy is to keep everyone alive as long as possible you'll have a lot of incredibly miserable people. CPR doesn't save that many lives, and those it does it breaks the ribs and causes significant suffering. In an already weakened person it tends to simply delay death by adding a few weeks of agony. So "try to save everyone, even if we have to torture some old people" clearly isn't the morally correct choice. But "have the possibly demented or otherwise unresponsive patient make the choice" can't work, and all the other choices have either conflicts of interest or uninformed parties likely to make poor decisions.

So we have to quantify the harm done and the costs, and find an optimal minimum.

Rakshasa The Cat
April 13 2013, 08:51:26 AM
With a single payer system the government has them.

Assuming you consider the doctors that make those decisions in single payer countries as 'government'.

Lallante
April 17 2013, 02:12:02 PM
With a single payer system the government has them.

Assuming you consider the doctors that make those decisions in single payer countries as 'government'.

lol

Rakshasa The Cat
April 18 2013, 10:17:57 AM
With a single payer system the government has them.

Assuming you consider the doctors that make those decisions in single payer countries as 'government'.

lol

Sorry you live in a dysfunctional society.

Lallante
April 18 2013, 11:57:40 AM
With a single payer system the government has them.

Assuming you consider the doctors that make those decisions in single payer countries as 'government'.

lol

Sorry you live in a dysfunctional society.

No I was agreeing with you. Its dumb to call the doctors making the healthcare assessments "the government".

Alistair
April 18 2013, 02:34:38 PM
With a single payer system the government has them.

Assuming you consider the doctors that make those decisions in single payer countries as 'government'.

Assuming every Doctor makes every treatment decision without any consideration of what the Government suggests, requires, pays for or the like?

In a single-pay system, if the Government pays the costs, and the Government sets the pay and reimbursed treatment/medication rules, then yes, the Doctor is carrying out the Governments policy when making his decisions (i.e. his decisions can only be within the realm of Govt. supportered and reimbursed choices), unless they are willing to break said policy, not be repaid for it, and do something other than what the Government reqs say he should.

Examples of this abound today in relation to the current Medicare Reimbursement system here in the U.S.


Right now the insurance companies have "claims adjusters" who decide if you die.
With a single payer system the government has them.

The Republicans are smart enough to know that the government can't be trusted with such things. The Democrats are smart enough to know that the insurance companies can't be trusted with such things.

Aye, very well said.

Rakshasa The Cat
April 18 2013, 06:56:02 PM
Assuming every Doctor makes every treatment decision without any consideration of what the Government suggests, requires, pays for or the like?

In a single-pay system, if the Government pays the costs, and the Government sets the pay and reimbursed treatment/medication rules, then yes, the Doctor is carrying out the Governments policy when making his decisions (i.e. his decisions can only be within the realm of Govt. supportered and reimbursed choices), unless they are willing to break said policy, not be repaid for it, and do something other than what the Government reqs say he should.

Examples of this abound today in relation to the current Medicare Reimbursement system here in the U.S.

Sorry to hear you live in such a horrible country.

Where I come from the ones that make those decisions on priorities and prioritized treatments are all doctors. Sure they'll come to the conclusion that it's not worth spending hundreds of thousands of dollars to keep a terminally ill patient alive on a bed in agony for a few more months, cause the resources can better be spent helping hundreds of people live a better life... Is that so horrible?

Alistair
April 18 2013, 07:19:27 PM
Is that so horrible?

Not for me to decide. That what we have society for, to determine what is or is not moral for any given period in time. When to stop treating a loved one is obviously a touchy decision for some, something (frankly) not everyone is comfortable leaving to a doctor who is primarily motivated by what the Government tells him is policy, and will thus refund him for performing.

What I'll say is I have reservation about the creation of a single-pay Govt. controlled system that everyone if required to be a part of.

It's a small step from that to "well, since we (the State) pay for your healthcare, we get a say in what you're allowed to eat, drink, do, etc. a la New York's Soda Size ban, smoking bans or Pot laws, etc.". Folks who think that wouldn't happen in the State are, IMO, being willfully naive, or simply support such withdrawal of personal liberty as for the greater good.

And as was so well said earlier, I trust neither a Corporation, nor Government, to be in control of my Healthcare availabillity or treatment decision making. And I would not agree that a single-pay system controlled by Government would not directly, and strongly, effect the treatments and services that would/could be offered, or that social engineering/social "justice" bais would not at some point be injected into the process in the U.S. as well. We'll cover an unlimited amount of abortions for someone whose never paid a dime into the system, but we'll cut Grandpops treatment because he's terminal, despite the fact he paid in for 65 years...I have trouble supporting a system that wouldn;t just allow that, but encourage it.

The idea that Government is any more accountable to the individual or any more moral or rightious overall is quite laughable in the face of history IMO. Nobody kills people like Governments do, and no one is less accountable for having done so throughout history.

Unlike the State, I can sue a Corporation if they breach their contract with me. With the State, there is no contract and no fighting their decisions....what they say (and are willing to pay for) is it.

Anyway, I know how horribly unpopular most of what I just wrote is, so.....whatever. Negrep away.

Aea
April 19 2013, 01:00:25 AM
Yet, Medicare is basically everything that you're arguing against and yet is an effective system used by tens of millions of people.

Rakshasa The Cat
April 21 2013, 08:44:27 PM
Is that so horrible?

Not for me to decide. That what we have society for, to determine what is or is not moral for any given period in time. When to stop treating a loved one is obviously a touchy decision for some, something (frankly) not everyone is comfortable leaving to a doctor who is primarily motivated by what the Government tells him is policy, and will thus refund him for performing.

What I'll say is I have reservation about the creation of a single-pay Govt. controlled system that everyone if required to be a part of.

That's why you Americans get the broken fucked up system you deserve.

The whole "doctor who is primarily motivated by what the Government tells him" part is so damn typical of how you guys approach complex subjects. The world is not black and white, people are not 'isms, and government is not an evil overlord trying to get you, it's a collection of people who might or might not want to take advantage of you.

The doctors?... I'm sure they are all lizardmen who went into medical school in order to suck the federal dick... or tit... what ever it was.

Tarminic
April 22 2013, 04:32:12 PM
While either option is a gross oversimplification, I'd rather have a doctor motivated by government policy than one motivated by the the profit margins of an insurance company.

Rakshasa The Cat
April 22 2013, 10:09:14 PM
While either option is a gross oversimplification, I'd rather have a doctor motivated by government policy than one motivated by the the profit margins of an insurance company.

Your kittens can heal any disease except for full retard.

F*** My Aunt Rita
April 25 2013, 10:23:31 PM
http://www.youtube.com/watch?v=-MqC6ga034U

(Part 1 of 6)

http://www.businessinsider.com/inside-indias-no-frills-hospitals-where-heart-surgery-costs-just-800-2013-4


What if hospitals were run like a mix of Wal-Mart and a low-cost airline? The result might be something like the chain of "no-frills" Narayana Hrudayalaya clinics in southern India.

Using pre-fabricated buildings, stripping out air-conditioning and even training visitors to help with post-operative care, the group believes it can cut the cost of heart surgery to an astonishing 800 dollars.

"Today healthcare has got phenomenal services to offer. Almost every disease can be cured and if you can't cure patients, you can give them meaningful life," says company founder Devi Shetty, one of the world's most famous heart surgeons.

"But what percentage of the people of this planet can afford it? A hundred years after the first heart surgery, less than 10 percent of the world's population can," he told AFP from his office in hi-tech hub Bangalore.

Lallante
May 9 2013, 08:58:30 AM
Stolen from the daythread

http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html?utm_hp_ref=email_share

HOLY FUCK. Just when you thought you understood the scope of how fucked up the US healthcare system is....


I don't really understand why "capitalism" is still seen as an acceptable solution to problems where "market efficiency" means literally forcing people to pay as much as possible to stay alive.

Rudolf Miller
May 9 2013, 10:18:04 AM
I have seen this mysterious 'chargemaster' and I can tell you, it makes no fucking sense.

Do remember this though, hospitals are not the enemy. They operate on a less than 5% profit margin or worse. Insurance companies/device manufacturers and drug companies all have margins north of 20%.

Not saying the current system is worth defending, just pointing out that others need to be taken down a notch first.

F*** My Aunt Rita
May 10 2013, 10:12:38 PM
I don't really understand why "capitalism" is still seen as an acceptable solution to problems where "market efficiency" means literally forcing people to pay as much as possible to stay alive.

Have to remember that providers may charge whatever they want but that doesn't mean they're paid that amount. It can be pretty byzantine trying to parse it out but the difference between what is billed and what is paid can be staggering. For me the most interesting bit is the avg payment difference between two identical teaching hospitals in the same region.

Ronald Reagan/UCLA
http://onebit.us/x/u/AuntRita/NQ1gvfameL.jpg

Keck/USC
http://onebit.us/x/u/AuntRita/4Hat37ziv9.jpg

metacannibal
May 16 2013, 08:09:59 AM
That's why you Americans get the broken fucked up system you deserve.

The whole "doctor who is primarily motivated by what the Government tells him" part is so damn typical of how you guys approach complex subjects. The world is not black and white, people are not 'isms, and government is not an evil overlord trying to get you, it's a collection of people who might or might not want to take advantage of you.

The doctors?... I'm sure they are all lizardmen who went into medical school in order to suck the federal dick... or tit... what ever it was.

+1 to your posting plus:

I would still put the motivation for most people working as healthcare professionals at inherently wanting to help people and lessen suffering, if it pays well even better. I generally believe that if nurses, doctors et al get an environment to do their job in the interest of the patient, they would do so.
What however will not work is hoping that doctors will work in the interest of the patient if they get incentivized by the system to be rewarded more in a specific procedure, i.e. the hospital gives a target quota for bonus for operations, then hell yes, if the choice is between conventional, proven therapy or operation, both equally proven and suited, then yes, the 10x more expensive operation will be done.

Well being of patient, high quality of work, improvement of health overall and then cost cutting should be the things that are incentivized, not making money for the clinic, the medical companies or the doctor himself at the expense of the patient(only in the interest of the patient).
Once you nail that down you have a rather affordable system with all around healthcare and alot of happy and healthy people. And in that category, most 1st world countries are lightyears ahead of the US.

Calgus
May 24 2013, 03:19:53 PM
Not for me to decide. That what we have society for, to determine what is or is not moral for any given period in time. When to stop treating a loved one is obviously a touchy decision for some, something (frankly) not everyone is comfortable leaving to a doctor who is primarily motivated by what the Government tells him is policy, and will thus refund him for performing.

What I'll say is I have reservation about the creation of a single-pay Govt. controlled system that everyone if required to be a part of.

It's a small step from that to "well, since we (the State) pay for your healthcare, we get a say in what you're allowed to eat, drink, do, etc. a la New York's Soda Size ban, smoking bans or Pot laws, etc.". Folks who think that wouldn't happen in the State are, IMO, being willfully naive, or simply support such withdrawal of personal liberty as for the greater good.

And as was so well said earlier, I trust neither a Corporation, nor Government, to be in control of my Healthcare availabillity or treatment decision making. And I would not agree that a single-pay system controlled by Government would not directly, and strongly, effect the treatments and services that would/could be offered, or that social engineering/social "justice" bais would not at some point be injected into the process in the U.S. as well. We'll cover an unlimited amount of abortions for someone whose never paid a dime into the system, but we'll cut Grandpops treatment because he's terminal, despite the fact he paid in for 65 years...I have trouble supporting a system that wouldn;t just allow that, but encourage it.

The idea that Government is any more accountable to the individual or any more moral or rightious overall is quite laughable in the face of history IMO. Nobody kills people like Governments do, and no one is less accountable for having done so throughout history.

Unlike the State, I can sue a Corporation if they breach their contract with me. With the State, there is no contract and no fighting their decisions....what they say (and are willing to pay for) is it.

Anyway, I know how horribly unpopular most of what I just wrote is, so.....whatever. Negrep away.


Just had to pop in for a second.

As someone who has audited the State Health system over here in Oz, I have dealt with a lot of doctors, nurses and hospital administrators over the last few years. I can safely say I have never encountered a case where a patient's medical treatment was at all affected by government policy. A doctor or nurse has never not performed a particular treatment they feel is best for their patient due to some government policy. Hell, I doubt many nurses or doctors even know how much it costs the government to perform surgery X, it is not in their job description, they're there to heal.

Even during periods of budget cuts the onus has been put on administrators to keep wages level steady or put a halt to capital projects such as new hospital buildings or expansions of existing hospitals. This may reduce service quality due to longer queues, but you can be assured of never having your actual treatment influenced.

Personally I'd trust my doctor a lot more if he didn't have thousands of dollars worth of jetskis influencing his decision on how to treat me.

Hast
May 24 2013, 04:47:40 PM
Not for me to decide. That what we have society for, to determine what is or is not moral for any given period in time. When to stop treating a loved one is obviously a touchy decision for some, something (frankly) not everyone is comfortable leaving to a doctor who is primarily motivated by what the Government tells him is policy, and will thus refund him for performing.

What I'll say is I have reservation about the creation of a single-pay Govt. controlled system that everyone if required to be a part of.

It's a small step from that to "well, since we (the State) pay for your healthcare, we get a say in what you're allowed to eat, drink, do, etc. a la New York's Soda Size ban, smoking bans or Pot laws, etc.". Folks who think that wouldn't happen in the State are, IMO, being willfully naive, or simply support such withdrawal of personal liberty as for the greater good.

And as was so well said earlier, I trust neither a Corporation, nor Government, to be in control of my Healthcare availabillity or treatment decision making. And I would not agree that a single-pay system controlled by Government would not directly, and strongly, effect the treatments and services that would/could be offered, or that social engineering/social "justice" bais would not at some point be injected into the process in the U.S. as well. We'll cover an unlimited amount of abortions for someone whose never paid a dime into the system, but we'll cut Grandpops treatment because he's terminal, despite the fact he paid in for 65 years...I have trouble supporting a system that wouldn;t just allow that, but encourage it.

The idea that Government is any more accountable to the individual or any more moral or rightious overall is quite laughable in the face of history IMO. Nobody kills people like Governments do, and no one is less accountable for having done so throughout history.

Unlike the State, I can sue a Corporation if they breach their contract with me. With the State, there is no contract and no fighting their decisions....what they say (and are willing to pay for) is it.

Anyway, I know how horribly unpopular most of what I just wrote is, so.....whatever. Negrep away.


Just had to pop in for a second.

As someone who has audited the State Health system over here in Oz, I have dealt with a lot of doctors, nurses and hospital administrators over the last few years. I can safely say I have never encountered a case where a patient's medical treatment was at all affected by government policy. A doctor or nurse has never not performed a particular treatment they feel is best for their patient due to some government policy. Hell, I doubt many nurses or doctors even know how much it costs the government to perform surgery X, it is not in their job description, they're there to heal.

Even during periods of budget cuts the onus has been put on administrators to keep wages level steady or put a halt to capital projects such as new hospital buildings or expansions of existing hospitals. This may reduce service quality due to longer queues, but you can be assured of never having your actual treatment influenced.

Personally I'd trust my doctor a lot more if he didn't have thousands of dollars worth of jetskis influencing his decision on how to treat me.

Pretty much this.

It really takes a lot of logical disconnect when you think that a corporation where profit is the #1 goal will care for you better then a doctor paid by the government.

Rakshasa The Cat
May 25 2013, 04:19:16 PM
Pretty much this.

It really takes a lot of logical disconnect when you think that a corporation where profit is the #1 goal will care for you better then a doctor paid by the government.

This reminds me of a story not long ago in Norway (a country that spans quite a distance longitudinally) where someone far north had a (deadly) medical condition that didn't allow for the long time required by land transport nor could she be without the support of a specially fitted ambulance.

Solution? The military provided the air transport, they just drove the whole ambulance in and flew down to Oslo.

I'm sure this would have been covered by the insurance companies if Norway wasn't such a socialist hellhole.

Aea
May 25 2013, 10:54:03 PM
In related news, the rise of Healthcare Costs in America continues.

http://www.forbes.com/sites/danmunro/2013/05/22/annual-healthcare-costs-surpasses-22000/

Victoria Steckersaurus
May 29 2013, 01:25:58 PM
So the insurance companies participating in the California exchange have announced their rates. The result: Much much better than expected (http://www.forbes.com/sites/rickungar/2013/05/24/unexpected-health-insurance-rate-shock-california-obamacare-insurance-exchange-announces-premium-rates/).

Short version: Critics warned that making healthy, young people support the old and sick would lead to outrageously high premiums. Supporters said that insurance companies competing for market share would push down prices. Supporters were right – even more so than they expected to me.

Keorythe
May 29 2013, 04:22:05 PM
Much better than expected is fine but it's also a bit misleading. Costs still went up, just not as much as predicted is what they're saying.


The average premium for individual plans sold through EHealthInsurance in California last year was $177 a month. Covered California said the average premium for the three lowest Silver plans statewide was $321 a month, albeit for more comprehensive benefits.

Overall, state officials said they can't estimate yet how much rates will rise on average. Blue Shield of California, one of the winning bidders in the exchange, said its existing individual policyholders would pay about 13% more, on average, for coverage in the state marketplace.

These rates "came in below what people legitimately expected them to be," said Paul Markovich, Blue Shield's chief executive.

Comparing the proposed rates for next year with current premiums is difficult, officials and experts agree, because the healthcare law mandates next year's plans to offer richer benefits and to limit consumers' out-of-pocket expenses.

So you're looking at a 13% - 50% increase depending on your previous plan. The entire article points out some of the risks and benefits of what may happen in the future.

http://articles.latimes.com/2013/may/23/business/la-fi-calif-health-rates-20130524

Rudolf Miller
May 29 2013, 06:04:19 PM
Gotta remember the new unspent premiums rule may undo some of these costs. I imagine to a large extent that premiums were based on many actuaries worst case scenarios.

Pacefalm
May 29 2013, 10:22:19 PM
Much better than expected is fine but it's also a bit misleading. Costs still went up, just not as much as predicted is what they're saying.


The average premium for individual plans sold through EHealthInsurance in California last year was $177 a month. Covered California said the average premium for the three lowest Silver plans statewide was $321 a month, albeit for more comprehensive benefits.

Overall, state officials said they can't estimate yet how much rates will rise on average. Blue Shield of California, one of the winning bidders in the exchange, said its existing individual policyholders would pay about 13% more, on average, for coverage in the state marketplace.

These rates "came in below what people legitimately expected them to be," said Paul Markovich, Blue Shield's chief executive.

Comparing the proposed rates for next year with current premiums is difficult, officials and experts agree, because the healthcare law mandates next year's plans to offer richer benefits and to limit consumers' out-of-pocket expenses.

So you're looking at a 13% - 50% increase depending on your previous plan. The entire article points out some of the risks and benefits of what may happen in the future.

http://articles.latimes.com/2013/may/23/business/la-fi-calif-health-rates-20130524

While correct, you forget that citizens will get additional subsidies based on their income that further reduce the cost of the premiums. For example, if you live around double the poverty line, the cost is only in the order of $100 /mo.

Aea
June 1 2013, 10:16:33 PM
Much better than expected is fine but it's also a bit misleading. Costs still went up, just not as much as predicted is what they're saying.


The average premium for individual plans sold through EHealthInsurance in California last year was $177 a month. Covered California said the average premium for the three lowest Silver plans statewide was $321 a month, albeit for more comprehensive benefits.

Overall, state officials said they can't estimate yet how much rates will rise on average. Blue Shield of California, one of the winning bidders in the exchange, said its existing individual policyholders would pay about 13% more, on average, for coverage in the state marketplace.

These rates "came in below what people legitimately expected them to be," said Paul Markovich, Blue Shield's chief executive.

Comparing the proposed rates for next year with current premiums is difficult, officials and experts agree, because the healthcare law mandates next year's plans to offer richer benefits and to limit consumers' out-of-pocket expenses.

So you're looking at a 13% - 50% increase depending on your previous plan. The entire article points out some of the risks and benefits of what may happen in the future.

http://articles.latimes.com/2013/may/23/business/la-fi-calif-health-rates-20130524

While correct, you forget that citizens will get additional subsidies based on their income that further reduce the cost of the premiums. For example, if you live around double the poverty line, the cost is only in the order of $100 /mo.

Bah, I saw that same article on Forbes and it was disingenuous to the extreme. You're comparing plans that have no obligation to cover you on a single reseller vs. a comprehensive plan where coverage will be offered. What about the average cost of all individual insurance plans in 2012? I feel the author just cherry-picked the number here. Oh wait, he then mentions it, 13% according to an insurance provider. That's really not that bad at all, especially if the coverage is universally offered and more comprehensive.

F*** My Aunt Rita
June 2 2013, 08:41:15 AM
Bah, I saw that same article on Forbes and it was disingenuous to the extreme. You're comparing plans that have no obligation to cover you on a single reseller vs. a comprehensive plan where coverage will be offered. What about the average cost of all individual insurance plans in 2012? I feel the author just cherry-picked the number here. Oh wait, he then mentions it, 13% according to an insurance provider. That's really not that bad at all, especially if the coverage is universally offered and more comprehensive.

It's apples to oranges. No one pays quoted rates and the pricing schemes before reflected a market that basically excluded everyone but the healthy and wealthy. So on the individual market people were underpaying because insurers spent a couple decades dumping all the expensive people. Now that they can't discriminate like that anymore people will actually be paying the real price.

F*** My Aunt Rita
August 4 2013, 11:09:31 PM
http://www.nrmp.org/data/main.png

Not trying to do a picdumpandrun but god damn, didn't know the difference between applicants and pgy1 slots was so large. And PPACA wasn't gonna add that much more money to CMS for more slots. Then again the job market for physicians has changed a lot from just 20 years ago. Don't recall where I saw it, but the mean retirement age for US MD's is ~67. Then up to 1/3 rejoin the job market within 2 years.

Lallante
August 4 2013, 11:31:21 PM
No, I have no idea what the fuck he is talking about either, sorry.

Rakshasa The Cat
August 5 2013, 12:46:19 PM
He has graphs, must be something important.

Zeekar
August 5 2013, 12:55:16 PM
PGY-1 are postgrad year 1 students and are the ones who do residency / internship. The graph is showing 15k difference between available positions and the number of them.

Lallante
August 5 2013, 12:56:46 PM
PGY-1 are postgrad year 1 students and are the ones who do residency / internship. The graph is showing 15k difference between available positions and the number of them.

Thanks but that doesn't change the fact that a 5 sentance post with 4 seperate unexplained acronyms is terribad.

Zeekar
August 5 2013, 01:08:01 PM
Thats why I offered a longer explanation.

Lallante
August 5 2013, 04:03:44 PM
Thats why I offered a longer explanation.

Congrats you are a better poster than FMAR based on a post-sample size of 2

QuackBot
August 5 2013, 04:23:41 PM
Gotta remember the new unspent premiums rule may undo some of these costs. I imagine to a large extent that premiums were based on many actuaries worst case scenarios.
Also, you're failing out of case western?

Zeekar
August 5 2013, 05:10:05 PM
Thats why I offered a longer explanation.

Congrats you are a better poster than FMAR based on a post-sample size of 2

Whats the issue here? Do you need a longer more detailed explanation that I offered? Or are you just being retarded again?

Lallante
August 5 2013, 05:13:28 PM
Thats why I offered a longer explanation.

Congrats you are a better poster than FMAR based on a post-sample size of 2

Whats the issue here? Do you need a longer more detailed explanation that I offered? Or are you just being retarded again?

No sorry, thanks for your explanation. I'm criticising FMAR not you.