How to argue for universal health care

[danielpalos]

...solving simple poverty should potentiate a solution for access to healthcare.

 

[jaeger19]

notice how a liberal loves go substance free and avoid debate? what does that teach you?

You must be liberal.

Have a nice day James;.. it will probably take you a full day to figure out what I just wrote. (okay.. maybe longer... but... I am giving you the benefit of the doubt).

 

[danielpalos]

equal protection of the law is in our Constitutions and still isn't that easy.

 

[Waddy]

When we were working my wife and I were covered by an excellent union health plan. It basically paid for everything, including drugs, dental and eye care. Now we are on Medicare, paying a premium, but have an excellent free tie-in program from the union.

Basic Medicare doesn't pay all that well, the doctors hate it, and it leaves a LOT for the individual to pay. Now I have a $20 co-pay for each office visit. Thank God for the tie-in plan.

I used to get an annual physical. The doctor checked everything, and ran very comprehensive blood work. I asked him to check for lead since I did a lot of remodels on older homes. No problem. Now I get a "Wellness" check. Not exactly a physical. And he can only run blood tests depending on my "symptoms". So neither the "Wellness Check" nor the blood test is as comprehensive as before. Anything additional I would have to pay out of pocket.

If I get a colonoscopy Medicare allows one per 240 months. If the colonoscopy is clear, no polyps, Medicare pays. If they find and remove any polyps in the process, things change. Now Medicare pays only 80% of the TOTAL procedure. Once again, thank God for the tie-in.

And Medicare already runs deep in the red. Taxpayers and borrowing keep it afloat.

The tie-in also pays for all our prescriptions, our eye care and our dental.

Medicare is better than no insurance at all, but it can still leave people with quite a bill. So how's it gonna work when we get rid of everything else (Medicaid and VA) when we go to Medicare For All?

 

[James972]

So how's it gonna work when we get rid of everything else (Medicaid and VA) when we go to Medicare For All?

it depends on implementation. Hopefully all prices will have to be published and public, and people will shop wisely for price and quality. If that happens prices can come down about 89%. It will be in effect Republican capitalist health care. Do you understand?

 

[Waddy]

it depends on implementation. Hopefully all prices will have to be published and public, and people will shop wisely for price and quality. If that happens prices can come down about 89%. It will be in effect Republican capitalist health care. Do you understand?

So you're saying if people have skin in the game they will shop around. Who'd a thunk it? However, since Medicare pays the same extremely low rate to all doctors in the region, what's there to shop?

 

[James972]

So you're saying if people have skin in the game they will shop around. Who'd a thunk it? However, since Medicare pays the same extremely low rate to all doctors in the region, what's there to shop?

that's a problem but hopefully Republicans will let providers charge anything they want thus forcing them to compete on basis of price and quality like other real world businesses.

 

[Waddy]

that's a problem but hopefully Republicans will let providers charge anything they want thus forcing them to compete on basis of price and quality like other real world businesses.

My doctor doesn't take new Medicare patients. But he treats us because we were patients many years before we went on Medicare. He says the reimbursements through Medicare are so low he can't pay the bills on it. Now, he does have a nice office in a good part of town. rent ain't cheap. So I don't know how doctors could be "competitive" when they would all be stuck at the lowest price already.

 

[James972]

So I don't know how doctors could be "competitive" when they would all be stuck at the lowest price already.

there is competitive and there is competitive. In most of the world they deliver same care for 30% of our price. We don't innovate until we have to. Make sense??

Who would have thought we could make a HD Blu ray player for $100 when they started at $10,000. It takes decades of international competition.

 

[Waddy]

there is competitive and there is competitive. In most of the world they deliver same care for 30% of our price. We don't innovate until we have to. Make sense??

Who would have thought we could make a HD Blu ray player for $100 when they started at $10,000. It takes decades of international competition.

I dunno; sometimes it's comparing apples to oranges. Some countries pay for medical training, and equipment like MRI machines, and it isn't charged off on the health care accounts. So I'd need to see the details. Accounting practices vary widely.

In this country I would compare costs to Lasik procedures. Lasic eye correction used to cost thousands, and mostly because it wasn't covered by insurance , dropped to the mere hundreds of dollars because of competition. How exactly would you make MFA a competitive system?

 

[James972]

I dunno; sometimes it's comparing apples to oranges. Some countries pay for medical training, and equipment like MRI machines, and it isn't charged off on the health care accounts. So I'd need to see the details. Accounting practices vary widely.

In this country I would compare costs to Lasik procedures. Lasic eye correction used to cost thousands, and mostly because it wasn't covered by insurance , dropped to the mere hundreds of dollars because of competition. How exactly would you make MFA a competitive system?

mfa?????????????

 

[Waddy]

mfa?????????????

Medicare For All is the new proposal for universal health care. I'm just wondering how you would make it competitive? The reimbursement rate is already below most doctor's costs.

 

[Drawdown]

Medicare For All is the new proposal for universal health care. I'm just wondering how you would make it competitive? The reimbursement rate is already below most doctor's costs.

You can't until the government goes about buying up all the for profit healthcare systems, starting with the 1 hospital areas. Once that is complete competitive becomes irrelevant.

 

[Waddy]

You can't until the government goes about buying up all the for profit healthcare systems, starting with the 1 hospital areas. Once that is complete competitive becomes irrelevant.

Once the government owns it all, what's the incentive to control costs?

 

[Drawdown]

Once the government owns it all, what's the incentive to control costs?

lower pay of workers contains costs. That is how the european countries do it. Surgeon pay is more in line with what our upper skill nursing pay is in the US currently.

The reality is we don't need MFA. Having a more robust cost-sharing for the uninsured would be enough. The hospitalization rate for the uninsured has been about the same 4-5% range for quite awhile. Obamacare only dropped it on average by about a percent it looks like • Persons with hospital stays in past year by insurance status U.S. 2017 | Statista

 

[Waddy]

Drawdown;

lower pay of workers contains costs. That is how the european countries do it. Surgeon pay is more in line with what our upper skill nursing pay is in the US currently.

The reality is we don't need MFA. Having a more robust cost-sharing for the uninsured would be enough. The hospitalization rate for the uninsured has been about the same 4-5% range for quite awhile. Obamacare only dropped it on average by about a percent it looks like

So the answer is to pay surgeons what we pay nurses? Who will pay off those student loans? Do you have any idea how many years of training and residence, and specialty, it takes before a surgeon makes ANY money?

A report some years back said that a person going to work for UPS right out of high school would have higher lifetime earnings than a doctor in general practice, after including the costs of medical training.

I've had the same general practitioner for 30 years. We're good friends. I once asked him how much he cleared being a doctor. He said, now, about $150K per year. But the first ten years he didn't clear that, having to set up an office, buy equipment and such. He's now 67 years old and doing OK he feels. Do you know why very few doctors hang out their own shingle these days? Because it costs too much, so they join a group practice. That's also why few of them will go to a rural area to set up a practice; got to pay off those loans and up-front costs to set up an office.

I just don't get where people think doctors are all millionaires. A very few do very well, but most don't.

 

[jaeger19]

it depends on implementation. Hopefully all prices will have to be published and public, and people will shop wisely for price and quality. If that happens prices can come down about 89%. It will be in effect Republican capitalist health care. Do you understand?

BWAAAAHHHH... "shop for price and quality".

Sure.. when you can't breath because the pain from your myocardial infarction is so bad you can't catch your breath... be sure that you shop around wisely James.

 

[jaeger19]

My doctor doesn't take new Medicare patients. But he treats us because we were patients many years before we went on Medicare. He says the reimbursements through Medicare are so low he can't pay the bills on it. Now, he does have a nice office in a good part of town. rent ain't cheap. So I don't know how doctors could be "competitive" when they would all be stuck at the lowest price already.

Bingo. PEople just don't get that the prices we charge.. are pretty much meaningless.. its what insurances.. like medicare will pay.

What would happen if we went to a plan like medicare for all with the CURRENT reimbursement.. (and to get the savings they plan.. they would have to go lower)..

Well..it would mean that a lot of facilities would have to close. The only way to make it with such low reimbursement would be to consolidate care (to be more efficient)..and to reduce the number of providers and facilities.

The other way.. is to be comprehensive facility so that you can control the flow of patients and thus the referrals and create your own reimbursement. In other words.. try to overutilize services.

 

[jaeger19]

I dunno; sometimes it's comparing apples to oranges. Some countries pay for medical training, and equipment like MRI machines, and it isn't charged off on the health care accounts. So I'd need to see the details. Accounting practices vary widely.

In this country I would compare costs to Lasik procedures. Lasic eye correction used to cost thousands, and mostly because it wasn't covered by insurance , dropped to the mere hundreds of dollars because of competition. How exactly would you make MFA a competitive system?

Here is the think with Lasik though.

What people don't understand is that in healthcare.. unlike other industries... you have to have equipment available.. that YOU DO NOT USE. Imagine a company that had to keep a third of their equipment ready to run at a moments notice.. but rarely did.

They would have to up their prices on those things that they did manufacture or provide.. in order to pay for that cost.

That's medical providers. So the hospital say charges and gets more for an MRI than the local freestanding MRI facility... because the hospital has to shift costs to the MRI.. to pay for the three ventilators it has available if people need it... but its not being used.

The freestanding MRI.. doesn't have that cost.

The same withi Lasik facilities. Lasik could go respond to "market forces".. better because it was not propping up other interventions and procedures.

 

[aociswundumho]

BWAAAAHHHH... "shop for price and quality".

Sure.. when you can't breath because the pain from your myocardial infarction is so bad you can't catch your breath... be sure that you shop around wisely James.

Emergency care is about 1% of all healthcare spending, so I guess by your own reasoning people could shop based on price and quality for the other 99%.

Oh, and people do shop based on price even in emergency situations:

Uber, Lyft and the Urgency of Saving Money on Ambulances - The New York Times

 

[jaeger19]

Emergency care is about 1% of all healthcare spending, so I guess by your own reasoning people could shop based on price and quality for the other 99%.

Oh, and people do shop based on price even in emergency situations:

Uber, Lyft and the Urgency of Saving Money on Ambulances - The New York Times

Yeah.. that's because when you go in with your MI.. the emergency care that's billed is the emergency room. THEN you are admitted to the hospital.. and then you have your bypass surgery or stent.. etc procedure.. and then recover in the hospital, then perhaps cardiac rehab...…

Or you could be the fellow that collapsed outside our ER with a rupture of an abdominal aortic aneurysm. He went to emergency.. then surgery.. then spent the next 3 months in the hospital. I guarantee you.. the only cost was not "emergency services".

And folks like him...just 5%or so account for more than 50% of medical spending.

Besides the fact that price as I have stated is largely meaningless.. and Quality? Try to figure out whats quality in the medical field. Hah... Most patients have no idea what quality of medical care is or how to measure it. Its just a fact.

 

[James972]

Medicare For All is the new proposal for universal health care. I'm just wondering how you would make it competitive? The reimbursement rate is already below most doctor's costs.

its already somewhat competitive because of co-pays. If Republicans ran it they could easy switch it to capitalism by raising co pays and mandating published prices. We estimate it would reduce prices by about 70% and improve care.

 

[James972]

You can't until the government goes about buying up all the for profit healthcare systems, starting with the 1 hospital areas. Once that is complete competitive becomes irrelevant.

not really. if people are spending their own money it becomes more competitive. Published prices would be huge, as would be allowing interstate competition.

 

[James972]

Once the government owns it all, what's the incentive to control costs?

depends how they manage it

 

[James972]

lower pay of workers contains costs.

yes but how low? Only the free market can decide. Equipment is huge too. MRI can rage from $200 to $2500. Competition is the only way to contain costs and save each American about $7000 a year.