Kasich Steps up to the Plate (1 Viewer)

[jaeger19]

What Helix is so wisely if obliquely observing here is that while it may be true that total healthcare cost may be reduced simply by an across the board $salary reduction of all healthcare workers,
there's more than one way to reduce healthcare costs.

Procedural efficiency and reduction of needless duplication can lower healthcare costs without affecting salary.

And paradoxically, adding benefits can actually LOWER total healthcare costs.
An obvious example of that is home healthcare for seniors and the infirm.

While it surely is an added expense, it can be a substantially smaller addition than such common alternatives as moving the patient to a nursing home.

The sanity check is that not only is it hypothetically possible to have healthcare outcomes that are as good or better; but at lower cost.
It reportedly exists in such places as Norway, and Denmark.

Yeah wrong. You need to listen to what Greenbeard is saying. Healthcare is LABOR INTENSIVE. that's the major cost.. if you are "reducing duplication, and increasing procedural efficiency".. its by using less help, using cheaper help, etc.. or not using labor at all. that cuts salaries.

Homecare is cheaper because there are less people involved and those people are some of the lowest paid healthcare workers.

As far as healthcare outcomes? it depends on what outcome measures you use.

When it comes to functional outcomes.. the US tends to rank higher when controlled for comorbidities..

But functional outcomes are rarely used as a measure. That's one of the failings of Obamacare. It uses hospital re admissions as its only outcome measure of the quality of care at home. Not whether that total hip or knee has better rom, that patient walking without assistive devices, or returning to prior level of function.

 

[sear]

"I'm not arguing against making the health care industry more efficient." Gb #223

I'd have guessed what you were arguing for included it.

"I'm advocating for going in with a clear-eyed understanding of what that means in a labor intensive industry like health care." Gb #223

And you're still right.
My counterpoint was that you've described something that needn't necessarily require impoverishing our healthcare labor force.

"You cite home health care as an example of finding cost efficiencies. You're right! But ..." Gb

I was w/ you until then.

"why are you right? Because home health workers are low wage workers largely left behind by the labor movement." Gb

In some cases probably so.

But there are other reasons.

To move a patient from residence to institutional housing shifts the total cost burden to the healthcare bucket.
If the patient can live in their own home, they may be paying their own:
- phone bill
- commercial electric bill
- taxes
- fuel bill (though may be on government assistance)
- food bill
- etc.

I suspect even if the service provided the patient was provided by the same person, for the exact same pay, the home healthcare option would still be the much better bargain; even though you may be right about a salary differential. Whether that salary gap will narrow, I don't know.

"Obviously it's cheaper to get folks cared for by low wage workers than higher paid workers elsewhere.Gb #223

Fair enough.
But I hope I've persuaded you with my above comment there's more to it, perhaps substantially more to it than that.

 

[jaeger19]

At some point TAXPAYERS are the ones being injured . Medicaid is costing $ 40,000,000 per hour and the number of abled-bodied enrolling is rising . There are NO checks and balances and NO accountability . Government should NOT be in the healthcare business !

Yeah.. and that's just wrong. There are definite checks and balances and accountability in the Medicaid system. In some cases to many checks.. which makes some things more costly.

 

[sear]

PS

"Yeah wrong." j1 #226

Excellent & thank you.
Please quote my errant words concisely *, and then post your correction.

"You need to listen to what Greenbeard is saying. Healthcare is LABOR INTENSIVE." j1

I never disputed it. To the contrary, I thought I'd corroborated it. I'd be amused if you'd quote my words which you perceive to disagree.

"that's the major cost.." j1

It's a major cost. But as a percentage that may actually be on the decrease.
Why?
A few centuries ago, before local and general anesthesia, X-ray, MRI, ECG, Penicillin, etc., medicine, and surgery in particular could be quite grim. Don't read historic accounts of Civil War battlefield amputations on a full stomach.
Point being in the 18th Century a doctor was a guy with a pliers for extracting bullets, and a stethoscope for cracking combination safes.
In the 3rd Millennium pharmaceuticals alone can cost more for one month dose than an entire lifetime might have cost a few centuries earlier.

I'm not an expert on it. And labor-intensive though healthcare SURELY is, I suspect that % of the total healthcare bill may be shrinking for many patients, if not for the industry as a whole.

"if you are "reducing duplication, and increasing procedural efficiency".. its by using less help, using cheaper help, etc.. " j1

Potentially.
Perhaps usually.
I suspect there are exceptions.

"or not using labor at all. that cuts salaries." j1

Again, potentially. But not necessarily.

It can cut jobs, eliminate jobs; without any reduction in salary of those that retain their employment.
Mine is not blanket disagreement w/ you.
But I suspect real world may be a tad more complex than what you represent it to be.

"Homecare is cheaper because there are less people involved and those people are some of the lowest paid healthcare workers." j1

I won't challenge your salary disparity assertion, though I don't recall anyone posting authoritative statistics (BLS?) in this thread to confirm it.

"As far as healthcare outcomes? it depends on what outcome measures you use." j1

Obviously.

I'd settle for the industry standards for now; and if there's need to change it; so be it.

"When it comes to functional outcomes.. the US tends to rank higher when controlled for comorbidities.." j1

I'm not sure what you mean by that.
You mean when a patient has and is treated for more than one disease? They differentiate for each?

* You've quoted 5 paragraphs of mine. It's difficult to know which assertion you deem "wrong". Again, thanks.
And thank you for your service.

 

[jaeger19]

I'd have guessed what you were arguing for included it.

And you're still right.
My counterpoint was that you've described something that needn't necessarily require impoverishing our healthcare labor force.

I was w/ you until then.

In some cases probably so.

But there are other reasons.

To move a patient from residence to institutional housing shifts the total cost burden to the healthcare bucket.
If the patient can live in their own home, they may be paying their own:
- phone bill
- commercial electric bill
- taxes
- fuel bill (though may be on government assistance)
- food bill
- etc.

I suspect even if the service provided the patient was provided by the same person, for the exact same pay, the home healthcare option would still be the much better bargain; even though you may be right about a salary differential. Whether that salary gap will narrow, I don't know.

Fair enough.
But I hope I've persuaded you with my above comment there's more to it, perhaps substantially more to it than that.

Just to point out though.. that you are not talking about reducing healthcare costs.

Secondly,, its questionable that in a housing situation that patient is paying for their own phone bill, commercial electric bill etc.

If they qualify for long term care under Medicaid.. they also qualify for EBT, housing assistance, so on and so forth.

 

[jaeger19]

PS

I never disputed it. To the contrary, I thought I'd corroborated it. I'd be amused if you'd quote my words which you perceive to disagree.

okay:

Procedural efficiency and reduction of needless duplication can lower healthcare costs without affecting salary.[/QUOTE

And I explained that in a labor intensive environment.. reducing needless duplication and increasing efficiency.. generally means increasing efficiency and reduction in LABOR.. since its a labor intensive field. Increasing efficiency and reduction in labor leads to decreases in wage and salary.

It's a major cost. But as a percentage that may actually be on the decrease.
Why?

the why is because of decreasing reimbursement. Since the late 1990's healthcare has been seeing reduced reimbursement. Its started with the balanced budget act and has gone on since then. Obamacare has several provisions that lowered reimbursement for providers. Its why you aren't being seen by the Doctor but by a PA. Its why now one of the local orthopods have his patients seen after surgery by an "extender".. which is an athletic trainer.. probably at much less salary than a PA.

Those changes are already occurring with the reduction of reimbursement per procedure and per patient. and then you tell me that reducing those reimbursement to the level that they have in Europe won't have an economic effect on wages and salaries in a community?

Please.

It can cut jobs, eliminate jobs; without any reduction in salary of those that retain their employment.

Cutting those jobs means decreases in the wages in a community. More out of work workers equals less wage pressure on the rest. I was listening to NPR.. and it was awesome to actually hear for once this argument being explained. The discussion was on the reduction of Medicaid and its effect on communities especially in the rural Midwest where healthcare was a major employer. In one community.. a healthcare system made up 2000 employees. It was the single biggest employer.. the next being a plant with 400 people.

A reduction in Medicaid made the likelihood of a reduction of 600 workers minimum to that healthcare system employer. Unemployment in the region is already 7.4%. What do you think throwing another 600 out of work housekeepers, billing people, laundry personal, security people, nurses, x ray techs, office workers etc.. is going to do the wages of those other 400 people? You think its going to make it easier for those 400 in a plant to ask for a wage hike when the employer has ANOTHER 600 people to choose from?

I won't challenge your salary disparity assertion, though I don't recall anyone posting authoritative statistics (BLS?) in this thread to confirm it.

I see that Greenbeard did.

I'm not sure what you mean by that.
You mean when a patient has and is treated for more than one disease? They differentiate for each?

Sort of.. its so that you are comparing apples to apples when comparing function.

So lets say you have a patient with a total knee that's 65, and otherwise healthy..

Then you have a patient that has a total knee that's 65 but also has diabetes, is clinically obese, and has back pain with sciatica.

If you compare the two, obviously the person that's healthy but has no other comorbidities (things wrong with them) is going to improve in function faster, and probably end up with a better overall functional outcome.

The reason that you have to control for co morbidities when comparing different populations of people.. say Europe and American is so you compare apples to apples.

So if you are comparing a total knees in Sweden.. with the outcome of total knees in the US.. you are valid.

There are differences in population demographics, and in selection criteria for say total knee that need to be accounted for.

 

[sear]

"Just to point out though.. that you are not talking about reducing healthcare costs." j1 #230

If by "you" you mean me (sear), if I address process, that doesn't necessarily mean I've rejected the overall objective.

My recent comments, even if indirect, were intended with that as the objective.

But if you'd like to go further with it:
we are on the cusp of an A.I. and robot revolution.

I don't know if you know. But the IBM computer that beat Ken Jennings on Jeopardy has (semi?)-retired from TV quiz shows, and has been working full-time on human healthcare research.
My information is a few months old, but iirc the report I read indicated Watson (a very powerful computer) can practice diagnostic medicine as well or better than human MD's.
And it's all still in the research phase.
Imagine what it would be like if they put Watson on the Internet, diagnosing dozens of patients across the nation or around the world each minute.

Robots?
If they're not already doing so, they may be taking blood-pressure, temperature, heart-rate, and other "vital" readings, and may someday do basic phlebotomy; not just blood draws, but perhaps basic analysis, providing lab results so the doctor can discuss them with the patient all in the same office visit.

"Secondly,, its questionable that in a housing situation that patient is paying for their own phone bill, commercial electric bill etc."

I'm sure it varies enormously, from perhaps near $100% to near $zero% at the other end of the spectrum.
Even if my example wasn't flawless, the underlying point remains valid.

"If they qualify for long term care under Medicaid.. they also qualify for EBT, housing assistance, so on and so forth."

Whatever you say.
But even if so, that doesn't mean the costs of residing in either, must by edict of god have the same exact cost to the haypenny.
In some cases one may be cheaper. In other cases the other may be cheaper.
What the aggregate national differential is, I wouldn't know. But the answer would need to exclude healthcare provider salary to be useful to addressing this detail.

"I love dancing skeletons. If I ever become a super-villain I am gunna have a hollowed out volcano in which I'm gunna live. And I'm gunna have an army of robot skeletons to take over the world. So if that ever happens you'll know it was me.
And you'll say, "I thought he was kiddin'."
I'm not kiddin'!" Craig Ferguson 09/01/13

 

[jaeger19]

If by "you" you mean me (sear), if I address process, that doesn't necessarily mean I've rejected the overall objective.

My recent comments, even if indirect, were intended with that as the objective.

But if you'd like to go further with it:
we are on the cusp of an A.I. and robot revolution.

I don't know if you know. But the IBM computer that beat Ken Jennings on Jeopardy has (semi?)-retired from TV quiz shows, and has been working full-time on human healthcare research.
My information is a few months old, but iirc the report I read indicated Watson (a very powerful computer) can practice diagnostic medicine as well or better than human MD's.
And it's all still in the research phase.
Imagine what it would be like if they put Watson on the Internet, diagnosing dozens of patients across the nation or around the world each minute.

Robots?
If they're not already doing so, they may be taking blood-pressure, temperature, heart-rate, and other "vital" readings, and may someday do basic phlebotomy; not just blood draws, but perhaps basic analysis, providing lab results so the doctor can discuss them with the patient all in the same office visit.

Yeah.. that's not what you were talking about. Robots and AI are a nice Segway to divert from the fact that we were talking about the effect on going to single payer savings like they have in other countries and what effect that has on salaries of people.

I'm sure it varies enormously, from perhaps near $100% to near $zero% at the other end of the spectrum.
Even if my example wasn't flawless, the underlying point remains valid.

Actually no it doesn't remain valid. but it does bring up another issue regarding other countries and healthcare expenses and how they are calculated.

So a patient here undergoes a surgery for a fractured hip in the us. a 65 year old male who was working. In the US he goes from the hospital to a rehab.. and gets 2 weeks of intense therapy 2-3 hours a day.. returns home, gets another 2 weeks of home health and then gets another 4 weeks of rehab in an outpatient facility. that patient fully recovers, is independent walking all over and returns to work. Just using a number.. his medical cost is 130,000 dollars

Now a patient undergoes a surgery for a fractured hip in Europe. A 65 year old male who was working. He stays a big longer in the hospital maybe 2 more days.. then goes directly home. He gets some home health and therapy. Then he is discharged. Now.. he doesn';t return to the same functional level as the man in the US; He is not able to return to work. He still uses a cane. Can't walk out in the community very well.. and is largely home bound.

His medical cost is 68,000 dollars.

BUT.. he is now retired on the European system.. so that cost adds up to the European country. As he gets older, the system pays his daughter to stop working and take care of her dad at home.

So the reality is that the ancillary costs due to the fractured hip and the lower care he received added up to way more than the upfront cost of that healthcare in the US... BUT it doesn;t get added to the cost of healthcare in that European country.. it gets added to their other safety net costs.. of which they provide better safety nets.

And that cost is not captured because functional outcome is not used as a measure... their age at death is used as a measure.

 

[sear]

"It's a major cost. But as a percentage that may actually be on the decrease.
Why?" s

"the why is because of decreasing reimbursement." j1 #231

I'll concede your point. But yours is a different point than mine.

"Reimburse" means to repay. It's NOT about administering healthcare at patient level. It's about $payment.

My irrefutable point is substantially more fundamental than that.
In the 18th Century patients weren't billed for X-rays, pharmaceuticals (ground-up eagle claws doesn't count) or dialysis because they didn't exist.
Each new medical innovation expands the suite of things for which a patient's healthcare FUNDER may have to pay.
And we may logically deduce that it is a certitude that, starting the comparison when there were no medical instruments; in an era when healthcare was 100% a doctor or nurse's effort, that the doctor & nurse split 100% of the payment.
And as these non-human healthcare elements proliferate, it's logical to assume they are reducing that former 100% payment share the doctor and nurse got.
Reimbursement plays no direct role in it; EVEN IF REDUCED COMPENSATION REDUCES OR ELIMINATES SOME MEDICAL SERVICES.

"It can cut jobs, eliminate jobs; without any reduction in salary of those that retain their employment." s

"Cutting those jobs means decreases in the wages in a community. More out of work workers equals less wage pressure on the rest. I was listening to NPR.. and it was awesome to actually hear for once this argument being explained. The discussion was on the reduction of Medicaid and its effect on communities especially in the rural Midwest where healthcare was a major employer. In one community.. a healthcare system made up 2000 employees. It was the single biggest employer.. the next being a plant with 400 people." j1

I'm glad you agree with me.

"A reduction in Medicaid made the likelihood of a reduction of 600 workers minimum to that healthcare system employer. Unemployment in the region is already 7.4%. What do you think throwing another 600 out of work housekeepers, billing people, laundry personal, security people, nurses, x ray techs, office workers etc.. is going to do the wages of those other 400 people? You think its going to make it easier for those 400 in a plant to ask for a wage hike when the employer has ANOTHER 600 people to choose from?" j1

You make a valid point. I'm just bewildered about what relevance it has.

"The reason that you have to control for co morbidities when comparing different populations of people.. say Europe and American is so you compare apples to apples." j1

Obviously.
I just wasn't sure if that was what you meant.

"There are differences in population demographics, and in selection criteria for say total knee that need to be accounted for." j1 #231

Unquestionably.
At some level of distinction, no two cases are the same, not even among identical twins.

But your diabetic fatso knee is an excellent example.
I would hope that in large population comparisons, the statistical noise more or less cancels in most cases.

 

[sear]

"Yeah.. that's not what you were talking about. Robots and AI are a nice Segway to divert from the fact that we were talking about the effect on going to single payer savings like they have in other countries and what effect that has on salaries of people." j1 #233

That's probably what YOU had in mind.
I've been quite candid about what I've been addressing.

"Actually no it doesn't remain valid." j1

Yours is simple contradiction, not refutation. And my point couldn't possibly be refuted, as it was an elegantly simple melding of irrefutable logic, and simple arithmetic corroboration. We'll have to agree to disagree on it. The salary slice of the total healthcare funding pie is beyond all doubt on a shrinking trend.

"So a patient here undergoes a surgery for a fractured hip in the us. a 65 year old male who was working. In the US he goes from the hospital to a rehab.. and gets 2 weeks of intense therapy 2-3 hours a day.. returns home, gets another 2 weeks of home health and then gets another 4 weeks of rehab in an outpatient facility. that patient fully recovers, is independent walking all over and returns to work. Just using a number.. his medical cost is 130,000 dollars

Now a patient undergoes a surgery for a fractured hip in Europe. A 65 year old male who was working. He stays a big longer in the hospital maybe 2 more days.. then goes directly home. He gets some home health and therapy. Then he is discharged. Now.. he doesn';t return to the same functional level as the man in the US; He is not able to return to work. He still uses a cane. Can't walk out in the community very well.. and is largely home bound.

His medical cost is 68,000 dollars.

BUT.. he is now retired on the European system.. so that cost adds up to the European country. As he gets older, the system pays his daughter to stop working and take care of her dad at home.

So the reality is that the ancillary costs due to the fractured hip and the lower care he received added up to way more than the upfront cost of that healthcare in the US... BUT it doesn;t get added to the cost of healthcare in that European country.. it gets added to their other safety net costs.. of which they provide better safety nets.

And that cost is not captured because functional outcome is not used as a measure... their age at death is used as a measure." j1

Excellent example.

That's part of what I had in mind in my earlier reference to "bucket".

 

[jaeger19]

I'll concede your point. But yours is a different point than mine.

"Reimburse" means to repay. It's NOT about administering healthcare at patient level. It's about $payment.

My irrefutable point is substantially more fundamental than that.
In the 18th Century patients weren't billed for X-rays, pharmaceuticals (ground-up eagle claws doesn't count) or dialysis because they didn't exist.
Each new medical innovation expands the suite of things for which a patient's healthcare FUNDER may have to pay.
And we may logically deduce that it is a certitude that, starting the comparison when there were no medical instruments; in an era when healthcare was 100% a doctor or nurse's effort, that the doctor & nurse split 100% of the payment.
And as these non-human healthcare elements proliferate, it's logical to assume they are reducing that former 100% payment share the doctor and nurse got.
Reimbursement plays no direct role in it; EVEN IF REDUCED COMPENSATION REDUCES OR ELIMINATES SOME MEDICAL SERVICES.

I'm glad you agree with me.

You make a valid point. I'm just bewildered about what relevance it has.

.

I think you may be bewildered because I am dealing with the real world and todays world and you have gotten off into discussions of the 18th century. and even your point there is not correct. Because as technology has increased.. the demand for people who can operate that technology and use that technology also increases.. which increases demand and salaries for those people.

I would hope that in large population comparisons, the statistical noise more or less cancels in most cases.

interestingly it doesn't when comparing the US to other countries. We have certain demographics such as obesity, that are outliers in the world.

 

[jaeger19]

That's probably what YOU had in mind.
I've been quite candid about what I've been addressing.

Yours is simple contradiction, not refutation. And my point couldn't possibly be refuted, as it was an elegantly simple melding of irrefutable logic, and simple arithmetic corroboration. We'll have to agree to disagree on it. The salary slice of the total healthcare funding pie is beyond all doubt on a shrinking trend.

Excellent example.

That's part of what I had in mind in my earlier reference to "bucket".

Actually it is refutable because as technology has increased.. the salary has had to increase for people to operate said technology and the number of staff have increased. You have x rays now.. and x ray techs... etc. .

 

[sear]

"I think you may be bewildered because I am dealing with the real world and todays world and you have gotten off into discussions of the 18th century." j1

Right.
Everyone knows the 18th Century wasn't real.

"as technology has increased.. the demand for people who can operate that technology and use that technology also increases.. which increases demand and salaries for those people." j1

Unquestionably 100% correct; but equally irrelevant. Because regardless of inflation by whatever means, the issue I was addressing is "$payment."

Whether that's thruppence, or $94,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000.27 it's completely immaterial.
No matter how big or how small the treatment $payment TOTAL is, no one can ever take more than 100% OF IT.
Doctors used to get 100%, but no longer. I expect that trend to continue as innovation in drug, machine, A.I., and robots continues.

"interestingly it doesn't when comparing the US to other countries. We have certain demographics such as obesity, that are outliers in the world." j1

Precisely as I thought, and asserted.
Your error is in misrepresenting obesity; an EXCEEDINGLY significant morbidity potentially more serious than the alleged comorbidity, as "noise".

For a cardiac patient on Coumadin, morbid obesity is hardly noise. It's a significant health issue which AS YOU POINT OUT absolutely MUST be considered to obtain valid comparison.

BUT !!

A family history of mild dermatitis might well qualify as noise, assuming there's no documented link between that and heart disease.
There may be a connection, in 0.00002% of cases, in the U.S.

BUT !!

In Germany there may be a 0.00002% connection of similar detrimental severity of male pattern baldness and heart disease. In this example, the "noise" (issues with no widely recognized significant causal link) would then roughly cancel.

 

[Helix]

As a practical and political matter, you're going to have to do a lot better than this rhetorical question if you want to go down this road. As I already mentioned, health systems are the economic anchor of many communities and, in a number of cases, entire states. Ushering in a wave of layoffs and pay cuts because we've decided there's too much economic activity tied up in that sector and we want to abruptly rightsize it (using an arguably arbitrary international comparison as a yardstick for what ought to be) isn't likely to go over well.

while it would be nice to keep all of the higher paying jobs in the private health insurance industry, i don't see a way to make that sustainable. the system is going to collapse under its own weight if we don't rethink it. in other first world countries, you can still make a decent living in the health care industry, and a lot fewer people are going broke because they got hurt or sick.

 

[Helix]

And that's simply not the real world. Others will not fill the demand if there is no adequate profit to be made. Doesn't matter just how much people want it.. if they don't have the means to pay for it. .

your argument, then, is that if America had a system which more closely resembled the entire rest of the first world, innovation would cease or slow to a crawl? i don't agree.

 

[Abbazorkzog]

I'd support him over Trump, but unfortunately a Kasich Presidency probably wouldn't be good and would probably in all actuality suck balls.

 

[jaeger19]

Right.
Everyone knows the 18th Century wasn't real.
.

And everyone knows that the 18th century medicine is relevant to todays world. :doh

No matter how big or how small the treatment $payment TOTAL is, no one can ever take more than 100% OF IT.

Which is irrelevant to this discussion.

If you are talking the cost of healthcare. 10% of 940000000000000000000000000000000000000000 dollars.. means a lot more..

than 100% of 1000 dollars

Precisely as I thought, and asserted.
Your error is in misrepresenting obesity; an EXCEEDINGLY significant morbidity potentially more serious than the alleged comorbidity, as "noise".

Your error is in claiming I misrepresented obesity,

A family history of mild dermatitis might well qualify as noise, assuming there's no documented link between that and heart disease

its not about "cancelling out".. mild dermatitis is not a significant comorbidity when dealing with say a total knee.

Listen.. you need to just stop your rambling. I notice you do this when you don't have a valid argument to make and you are trying to extricate yourself from a debate you have lost.

 

[jaeger19]

your argument, then, is that if America had a system which more closely resembled the entire rest of the first world, innovation would cease or slow to a crawl? i don't agree.

Cease entirely? no.. Slow to a crawl? Perhaps..

Innovation would continue in those areas in which there is enough volume that would justify the cost economically.

Innovation would cease or slow to a crawl in those areas in which the cost of the development was not justified by the reimbursement.. usually because the volume was so low (since single payer pays significantly less.. you have to make it on volume).

AS I said.. innovation on a disease the kills 1000 people a year.. would probably halt.

Innovation on say acne, or high blood pressure, would probably continue.

 

[jaeger19]

while it would be nice to keep all of the higher paying jobs in the private health insurance industry, i don't see a way to make that sustainable. the system is going to collapse under its own weight if we don't rethink it. in other first world countries, you can still make a decent living in the health care industry, and a lot fewer people are going broke because they got hurt or sick.

Actually in these systems the same number of people go broke because they got hurt or sick. Studies comparing similar economic times between Canada and the US show that bankruptcies were identical despite Canada having a single payer system.

Secondly.. there is no reason to think that its not sustainable. why is it not sustainable?

 

[sear]

"And everyone knows that the 18th century medicine is relevant to todays world." j1

Undeniably true, in a contrast between olden and modern. It's a span of time relevant to our nation, as the U.S. was Founded in the 18th Century.
And no contrast can be conducted with only one datum point.

"Which is irrelevant to this discussion.

If you are talking the cost of healthcare. 10% of 940000000000000000000000000000000000000000 dollars.. means a lot more..

than 100% of 1000 dollars"

I understand. You're simply utterly incapable of distinguishing sums from ratios. No problem. I can lead a whore to Walter, BUT !! ...

"mild dermatitis is not a significant comorbidity when dealing with say a total knee." j1

My point precisely. Glad I'm able to gradually turn you to my point of view, one fact at a time. Glad you now agree with me, though not sure what took you so long.

 

[jaeger19]

Undeniably true, in a contrast between olden and modern. It's a span of time relevant to our nation, as the U.S. was Founded in the 18th Century.
And no contrast can be conducted with only one datum point.

.

Funny.. I 'll remember that when there are calls for us to go back to 18th Century medicine. You should run out and go contact your senator and Congressman and explain to them why they should research 18th century medicine so that they can come up with a good plan for 2017.

I understand. You're simply utterly incapable of distinguishing sums from ratios. No problem. I can lead a whore to Walter, BUT !! ...

Oh.. no.. the point is I DO understand what a ratio is.

That's why I know that when we are talking about costs, and medicine... 10% of 9400000000000000000 dollars... is a LOT MORE MONEY..

than 100% of 1000 dollars....

My point precisely. Glad I'm able to gradually turn you to my point of view, one fact at a time. Glad you now agree with me, though not sure what took you so long.

Ahhhh.. the old classic how to get out of a debate you are losing gambit. ITs really a classic on this debate forum.

Make up a position that I don't hold and NEVER EVER HELD. Disagree with that position

Then when its pointed out that I never held that position... declare victory!...

nice try..

 

[Helix]

Cease entirely? no.. Slow to a crawl? Perhaps..

Innovation would continue in those areas in which there is enough volume that would justify the cost economically.

Innovation would cease or slow to a crawl in those areas in which the cost of the development was not justified by the reimbursement.. usually because the volume was so low (since single payer pays significantly less.. you have to make it on volume).

AS I said.. innovation on a disease the kills 1000 people a year.. would probably halt.

Innovation on say acne, or high blood pressure, would probably continue.

i'm willing to risk forward and give other solutions a try.

 

[Unitedwestand13]

i'm willing to risk forward and give other solutions a try.

Price controls?

 

[Helix]

Actually in these systems the same number of people go broke because they got hurt or sick. Studies comparing similar economic times between Canada and the US show that bankruptcies were identical despite Canada having a single payer system.

Secondly.. there is no reason to think that its not sustainable. why is it not sustainable?

consider me skeptical.

either way,

 

[Helix]

Price controls?

i support a single payer system for basic care. that payer would have significant negotiating leverage to push down prices.