Universal Health

[Neomalthusian]

That's the current situation.

exactly, and that's a part of the problem.

Perhaps not, but it's a lot more expensive that simply going to a clinic or a private MD.

Actually I don't think that's evident either. Last I read we have by far the world's most expensive outpatient clinic care, leaps above the #2 country, which last I checked was Sweden. So just entitling everyone to outpatient isn't necessarily any sort of cost-saver. It's inherently problematic that people misuse emergency services, e.g. substance abusers and homeless malingering to find temporary shelter.

If it works in Japan, it can work here. I'm pretty sure Japan isn't the only one.

They're one of the only ones that come to mind with a literal rate book for services, and Japan is 10x more densely populated than the US, where in addition to metro area hospitals and clinics we have critical access facilities and clinics scattered across the country in every bum**** nowhere town (I live in one such town). These smaller clinics couldn't survive a standard fee structure, so they'd close and accessibility would decline, travel related costs of care would ramp up, etc.

My HMO doesn't think so. They're really big on preventative care. Anyway, if a physical can identify a problem that can be fixed with a pill before it requires surgery, that's a pretty good savings.

That all varies widely on the epidemiology and treatment outcomes of the particular condition. If incidence is one in a hundred million and early detection saves $1 million per patient and the test costs $1,000, do the math. Saying preventive care saves money is like saying investing in commodities makes you rich fast. Not necessarily true, not necessarily false.

We already ration care. There is no such thing as unlimited care.

I think it's a stretch to say real rationing occurs, unless you care to explain further.

 

[Neomalthusian]

Yes.. the healthcare system costs more than the entire federal budget. WE have an aging baby boomer population, we have more comorbidities.. we are living longer, we demand more healthcare technology... we have been all over that. AND that money we spend on healthcare? IT STAYS IN OUR ECONOMY. Wages for hospital workers.. contractors building more clinics, more technological advancements (which is one of our exports by the way).. Salaries for nurses.

All that spending goes RIGHT BACK INTO THE ECONOMY. and goes right back into a lot of people in the economy not just a few.

Sure but it doesn't truly produce anything. It's not the harvesting or processing of a natural resource into a more refined or useful thing. It's basic human body maintenance -- extremely expensive maintenance. A mind-bogglingly large expense to maintain the status quo.

To say it's all well and good because it's "going back into the economy" kind of ties into the Keynesian hypothetical of burying money in abandoned coal mines for people to dig back up. If the immense government outlays on health are justified as being good for the economy by simple virtue of the fact it gives people something to do, then we might as well have government put a shovel in the hands of every unemployed person and pay them from the printing press to dig random holes. After all, it's just money going into the economy right?

Okay.. exactly HOW to you expect to achieve such a huge reduction in healthcare spending.. and what effect do you think such an effect will have on the economy that constitutes 18% of GDP

The US government spends almost as much public money on health care as the already-universalized countries do per capita. And then on top of that, we spend almost that much of our private dollars on it. I understand reducing our per capita expenditures on health would mean less money going into the pockets of health care industry workers, but it also means more money that people can spend on everything other than health care. Things that enable them to live more prosperous self-sufficient lives, grow their businesses, and so forth.

 

[Dittohead not!]

Actually I don't think that's evident either. Last I read we have by far the world's most expensive outpatient clinic care, leaps above the #2 country, which last I checked was Sweden. So just entitling everyone to outpatient isn't necessarily any sort of cost-saver. It's inherently problematic that people misuse emergency services, e.g. substance abusers and homeless malingering to find temporary shelter.



They're one of the only ones that come to mind with a literal rate book for services, and Japan is 10x more densely populated than the US, where in addition to metro area hospitals and clinics we have critical access facilities and clinics scattered across the country in every bum**** nowhere town (I live in one such town). These smaller clinics couldn't survive a standard fee structure, so they'd close and accessibility would decline, travel related costs of care would ramp up, etc.



That all varies widely on the epidemiology and treatment outcomes of the particular condition. If incidence is one in a hundred million and early detection saves $1 million per patient and the test costs $1,000, do the math. Saying preventive care saves money is like saying investing in commodities makes you rich fast. Not necessarily true, not necessarily false.



I think it's a stretch to say real rationing occurs, unless you care to explain further.

I got to wondering about that ER cost, so I looked it up:

$1,233
Uninsured patients face additional charges for things like x-rays, shots, lab tests or casting a broken bone. As a result, the costs for their care can be much higher. Average emergency room costs vary wildly based on treatment, but a 2013 National Institute of Health study put the median cost at $1,233.

If a doctor's visit costs that much, then we're in even more trouble than I thought.

And, when an uninsured person who can't afford the 12 hundred bucks shows up at the emergency room needing a lengthy hospital stay and physical therapy after, do they get all they need, or is their care rationed?

Of course there is a limit to what preventative care is cost effective, but such things as keeping immunizations up to date, having an annual physical, and talking to patients about diet, exercise, and smoking saves more than its costs.

 

[jaeger19]

Sure but it doesn't truly produce anything. It's not the harvesting or processing of a natural resource into a more refined or useful thing. It's basic human body maintenance -- extremely expensive maintenance. A mind-bogglingly large expense to maintain the status quo.

To say it's all well and good because it's "going back into the economy" kind of ties into the Keynesian hypothetical of burying money in abandoned coal mines for people to dig back up. If the immense government outlays on health are justified as being good for the economy by simple virtue of the fact it gives people something to do, then we might as well have government put a shovel in the hands of every unemployed person and pay them from the printing press to dig random holes. After all, it's just money going into the economy right?



The US government spends almost as much public money on health care as the already-universalized countries do per capita. And then on top of that, we spend almost that much of our private dollars on it. I understand reducing our per capita expenditures on health would mean less money going into the pockets of health care industry workers, but it also means more money that people can spend on everything other than health care. Things that enable them to live more prosperous self-sufficient lives, grow their businesses, and so forth.

that's nuts.. "it doesn't produce anything". :doh

IT produces healthy functioning workers. Cripes man.. are you nuts. What do you think happens to an economy where a large portion of the population is unhealthy and incapable of production? What do you think happens to production when you have to take workers out of the work force to take care of unhealthy parents? Cripes man its why corporations pay for health insurance policies in the first place.. because healthy workers are more productive..

Cripes.. you can't even dig random holes if your workers are dying of ebola.

The US government spends almost as much public money on health care as the already-universalized countries do per capita. And then on top of that, we spend almost that much of our private dollars on it. I understand reducing our per capita expenditures on health would mean less money going into the pockets of health care industry workers, but it also means more money that people can spend on everything other than health care. Things that enable them to live more prosperous self-sufficient lives, grow their businesses, and so forth

Right.. everything other than healthcare.. which means goods from china, food from mexico.. and all sorts of other products that DON"T help people grow their businesses and live more prosperous self sufficient lives. Not only does that money go back into healthcare industry workers... who by the way are producing HEALTHY people.. (who then can expand their businesses, and live more prosperous self sufficient lives. for example my patient that has returned to running his ag corporation after crashing his airplane.) .. that money ALSO helps prop up wages in other industries.. Which gives people more money to spend etc.

Maybe you want a third world economy.. but I don't. You don't know what you are talking about.

 

[jaeger19]

I got to wondering about that ER cost, so I looked it up:



If a doctor's visit costs that much, then we're in even more trouble than I thought.

And, when an uninsured person who can't afford the 12 hundred bucks shows up at the emergency room needing a lengthy hospital stay and physical therapy after, do they get all they need, or is their care rationed?

Of course there is a limit to what preventative care is cost effective, but such things as keeping immunizations up to date, having an annual physical, and talking to patients about diet, exercise, and smoking saves more than its costs.

Often when an uninsured patient shows up at the emergency room and needing a lengthy hospital stay.. and physical therapy.. they get more than they need. And that's because lower levels of care.. like SNF's won't take an uninsured patient.. in fact.. many of them won't take a Medicaid patient. so the patient stays in the hospital longer than necessary at a great expense. And they typically get a lot of care because the hospital is desperately trying to get them better enough to "GO HOME".

Preventative care is more than giving healthy people physicals. Preventative care as you alluded to is really catching people that have problems EARLY and treating them before they are a huge expense. And preventative medicine defined as that.. (which is what it is).. is extremely effective.

Preventative medicine defined as giving healthy people CT scans to check for lung disease.. is of course ineffective since its HEALTHY PEOPLE.

(the only real reason I think that the discussion ever really gets to whether preventative medicine is "effective" is because there is pushes from people in the industry and thus politicians.. to pay for unneeded tests. And testing someone that has no symptoms, history and is low risk is not cost effective. )

 

[Dittohead not!]

1. Often when an uninsured patient shows up at the emergency room and needing a lengthy hospital stay.. and physical therapy.. they get more than they need. And that's because lower levels of care.. like SNF's won't take an uninsured patient.. in fact.. many of them won't take a Medicaid patient. so the patient stays in the hospital longer than necessary at a great expense. And they typically get a lot of care because the hospital is desperately trying to get them better enough to "GO HOME".

2. Preventative care is more than giving healthy people physicals. Preventative care as you alluded to is really catching people that have problems EARLY and treating them before they are a huge expense. And preventative medicine defined as that.. (which is what it is).. is extremely effective.

3. Preventative medicine defined as giving healthy people CT scans to check for lung disease.. is of course ineffective since its HEALTHY PEOPLE.

(the only real reason I think that the discussion ever really gets to whether preventative medicine is "effective" is because there is pushes from people in the industry and thus politicians.. to pay for unneeded tests. And testing someone that has no symptoms, history and is low risk is not cost effective. )

Finally, I think we agree.
1. Exactly, and that's one of many factors that are ramping up the cost of medical care.
2. That's what I meant by "preventative care," that and keeping immunizations up to date.
3. Now what you're describing is unnecessary care, which is sometimes done because the insurance company/government will pay for it and not because it's beneficial to the patient, yet another factor ramping up the cost.

 

[jaeger19]

Finally, I think we agree.
1. Exactly, and that's one of many factors that are ramping up the cost of medical care.
2. That's what I meant by "preventative care," that and keeping immunizations up to date.
3. Now what you're describing is unnecessary care, which is sometimes done because the insurance company/government will pay for it and not because it's beneficial to the patient, yet another factor ramping up the cost.

1. Yes
2. Yes. Its annoying hearing from others that preventative care doesn't work. And then then they put "CT scans on healthy individuals".. real shocker there. But a person with a chronic cough. fatigue., 65 plus getting a chest x ray and discovering pneumonia before he ends up on a vent in the critical care unit.. . Yes that saves money

3. there is a caveat here which is that reimbursement flows from the insurance company or government and sometimes the asinine system almost require "abuse" to get paid. I recall when Obama talked about saving "millions" in fraud and abuse in the medicare system. Well that fraud and abuse was providers like myself that had billed months before on the "old" billing system (which was the correct one at the time of billing) but now they were processing claims on the "new system and since they were behind in their processing.. old bills now came back with denials for "fraud and abuse".

Of course there are unscrupulous providers networks out there. However, this problem is not unigue to the American system. Overbilling, and fraud are rampant in government single payer systems. In some ways.. more so since its that disparity of billing different insurances that trips providers up as well as the patients having to pay some part of a bill. In countries where its all one government system.. the unscrupulous providers sometimes have an easier time with fraud.

 

[Neomalthusian]

that's nuts.. "it doesn't produce anything". :doh

IT produces healthy functioning workers.

No it really doesn't. There are plenty of available workers and that isn't thanks to the health care system for "producing" them.

In a previous post you took the angle that our excess spending on health ends up in the economy. Well of course it does, but that basically attempts to rationalize any excessive expenditure.

Cripes man.. are you nuts. What do you think happens to an economy where a large portion of the population is unhealthy and incapable of production?

I have no clue, pretty sosure that's never happened before. Countries don't experience economic decline because of insufficient labor supply as a result of not being healthy enough to work.

What do you think happens to production when you have to take workers out of the work force to take care of unhealthy parents?

False dilemma.

Cripes man its why corporations pay for health insurance policies in the first place.. because healthy workers are more productive..

That really truly isn't why.

Cripes.. you can't even dig random holes if your workers are dying of ebola.

An even more ridiculous false dilemma. You're giving infinitely more credit to our health care system for the supply of labor.

Right.. everything other than healthcare.. which means goods from china, food from mexico.. and all sorts of other products that DON"T help people grow their businesses and live more prosperous self sufficient lives.

Your claim is that if we didn't spend excessively on health, we'd spend only in ways that benefit foreigners? Quite a bizarre thing to think.

Not only does that money go back into healthcare industry workers... who by the way are producing HEALTHY people..

No they're not. They're helping to maintain unhealthy people at an extreme cost, some of whom don't even work. Health is great, but it isn't so critically fundamental to economics as you're suggesting.

(who then can expand their businesses, and live more prosperous self sufficient lives. for example my patient that has returned to running his ag corporation after crashing his airplane.) .. that money ALSO helps prop up wages in other industries.. Which gives people more money to spend etc.

Maybe you want a third world economy.. but I don't. You don't know what you are talking about.

You're placing health care at the core and of economic activity and prosperity, vastly over-inflating the sector's importance, and only after revealing you work in health care does it make a bit more sense why one would suggest such strange things.

If I have a bad transmission in my pickup, replacing it makes it run better and do more for me, true. But if instead of costing $2,000 to replace it, it costs $10,000, or $20,000, or $80,000, that's not good for me or for the economy generally. Your argument would be like a mechanic piping up at this point and saying "but but, those $80,000 transmission swap-outs are money spent in the economy, creates jobs for mechanics and part makers, and it makes your truck run better!!!" Misses the point just a little, right? That's just a sugar-coat rationalization applied by someone who personally benefits from tons of money being dedicated to his overgrown sector, who feels threatened by the idea that we need to be spending less of our national resources on this.

 

[Dittohead not!]

1. Yes
2. Yes. Its annoying hearing from others that preventative care doesn't work. And then then they put "CT scans on healthy individuals".. real shocker there. But a person with a chronic cough. fatigue., 65 plus getting a chest x ray and discovering pneumonia before he ends up on a vent in the critical care unit.. . Yes that saves money

3. there is a caveat here which is that reimbursement flows from the insurance company or government and sometimes the asinine system almost require "abuse" to get paid. I recall when Obama talked about saving "millions" in fraud and abuse in the medicare system. Well that fraud and abuse was providers like myself that had billed months before on the "old" billing system (which was the correct one at the time of billing) but now they were processing claims on the "new system and since they were behind in their processing.. old bills now came back with denials for "fraud and abuse".

Of course there are unscrupulous providers networks out there. However, this problem is not unigue to the American system. Overbilling, and fraud are rampant in government single payer systems. In some ways.. more so since its that disparity of billing different insurances that trips providers up as well as the patients having to pay some part of a bill. In countries where its all one government system.. the unscrupulous providers sometimes have an easier time with fraud.

Ordering unnecessary tests might be fraud in some instances. In others, it's more of a CYA. Doctor, did you order a (insert expensive medical test here)?
No, it wasn't indicated.
And yet, had this (expensive test) been performed, my client might have been diagnosed sooner and may have survived, is that not true?
No, not in my professional judgement.
Oh well (thinking, not saying this out loud) that's OK. I can hire an "expert" whose professional judgement is different.

 

[jaeger19]

No it really doesn't. There are plenty of available workers and that isn't thanks to the health care system for "producing" them.

Now we know you are nuts.. of course it does.. healthcare system has improved lifespans and has improved the health and productivity of persons within those lifespans. There a plenty of workers because we don't get periodic plagues that ravage through communities (courtesy of healthcare).

In a previous post you took the angle that our excess spending on health ends up in the economy.

Nope.. I pointed out that its not excessive spending. Its result of supply and demand. More people needing healthcare and needing more advanced healthcare.. AND it does go back into the economy.

Countries don't experience economic decline because of insufficient labor supply as a result of not being healthy enough to work.

Absolutely they do.

Abstract

The thematic thrust of this paper examines health as a fundamental determinant of economicgrowth and development. The paper focuses its discourse mainly on the economies of countrieswith medium and low human development (henceforth referred to as Developing Countries DVCs ). Health will be discussed at the macroeconomics level as public health. Health is acausative factor not only of individual income, education and demographic trends, but also of a country’s aggregate level of economic growth. Since development is a consequence of good health, even the poorest developing countries should make it a priority to invest in their healthsector. Unfortunately, health has been poorly invested upon by countries with low humandevelopment, and the health sector still remains largely untapped and continues to suffer neglect. This has further slowed down the industrialization of DVCs.

\
THE ROLE OF HEALTH IN ECONOMIC GROWTH AND DEVELOPMENT. | Rume Ogbobine - Academia.edu

False dilemma.

Very true dilemma.

The number of U.S. workers who are caring for one or both of their parents has tripled in the past 15 years. According to one recent study, there are nearly 10 million adult children over 50 years old responsible for an aging parent, and companies are losing upward of $17 billion a year due to absenteeism and other factors relating to caregiving.

Health is great, but it isn't so critically fundamental to economics as you're suggesting.

Actually.. any economist worth a at least a lick understands that health is absolutely critical to economics.

You're placing health care at the core and of economic activity and prosperity, vastly over-inflating the sector's importance, and only after revealing you work in health care does it make a bit more sense why one would suggest such strange things.

That's because you can't be productive when you are dead of a heart attack, or have malaria, or have a myriad of other diseases, infections, and injuries all which hamper productivity. The single most important factor in any economy is health.

Yes.. being in healthcare one understands exactly why its so important. When people are sick.. it puts ALL their productivity on hold.. not just at work.. but caring for children, for parents.. for all sorts of activities especially the ability to be educated..

 

[jaeger19]

If I have a bad transmission in my pickup, replacing it makes it run better and do more for me, true. But if instead of costing $2,000 to replace it, it costs $10,000, or $20,000, or $80,000, that's not good for me or for the economy generally

If it means that in the course of a lifetime of your truck.. that the return is 200,000 dollars then its good for both you and the economy. Healthcare has that effect as it effects people over their whole lifespans.. and directly increases their productivity and indirectly increases other peoples productivity.

Just facts.

The wealth-health gradient characterizes all age groups in Table 1. Thus, it is not only a middle- or late-life phenomena, but appears for some as their labor force activity begins and emerges for others as their economic resources and health increasingly interact over their lives. The second and third columns of Table 1 indicate that changes in wealth are also correlated with initial health. Those whose 1984 reported health was worse not only had much lower baseline wealth, but they experienced considerably smaller absolute wealth growth over the ensuing 10 years. Among those 35–44 years old in excellent health in 1984, median wealth grew by almost $100,000 while it increased by less than $10,000 for similarly aged people whose 1984 health was fair or poor.

Changes in health status over time, not shown in Table 1, are also associated with changes in wealth. Consider those in very good health in 1984 who had a median wealth of $66,300. If their health remained ‘very good’ by 1994, median wealth in 1994 was $100,000. If their 1994 health was ‘excellent’, median wealth was $121,000 while if their health declined to ‘fair’ or ‘poor’, median 1994 wealth was only $31,000.

]

Healthy Bodies and Thick Wallets: The Dual Relation Between Health and Economic Status

Further Evidence on the Economic Effects of Poor Health on JSTOR

 

[jaeger19]

Ordering unnecessary tests might be fraud in some instances. In others, it's more of a CYA. Doctor, did you order a (insert expensive medical test here)?
No, it wasn't indicated.
And yet, had this (expensive test) been performed, my client might have been diagnosed sooner and may have survived, is that not true?
No, not in my professional judgement.
Oh well (thinking, not saying this out loud) that's OK. I can hire an "expert" whose professional judgement is different.

Yep there is some truth to this.. however. its not as much CYA as you think (depends on field.. I will admit). It also depends on the expectation of the patient. We here in the united states put great value on the getting the best test. the most out of our healthcare insurance. And sometimes providers cave in because patients demand them. You would be surprised at the number of patients that ask me why other providers didn't order more tests, etc. ITs a fast and easy way to keep the customer happy.. and happy customers tell their friends to come in.

there is great talk about lawsuits.. and they SUCK x 26... but whats worse? Is getting badmouthed in the community because a customer didn't think you were thorough enough ordering tests. THAT hurts your business.

 

[Neomalthusian]

Now we know you are nuts.. of course it does.. healthcare system has improved lifespans and has improved the health and productivity of persons within those lifespans.

And that's fantastic but it doesn't mean workers are produced by the health care system.

There a plenty of workers because we don't get periodic plagues that ravage through communities (courtesy of healthcare).

Plague prevention isn't a big reason why we overspend so dramatically on health care.

Nope.. I pointed out that its not excessive spending. Its result of supply and demand. More people needing healthcare and needing more advanced healthcare.. AND it does go back into the economy.

Demand is extremely inelastic because our regulations entitle people to medical care but we don't finance it with the efficiency we should finance public goods. And again the "going back into the economy" thing doesn't mean anything. So if we start spend 200% of GDP on health, you're still pleased as a peach? Just because the health care sector employs Americans doesn't mean we will promote the general welfare by consuming all our resources to be professional patients who have no money left over to buy anything else for ourselves. The overgrowth and overspending in the health care sector has crowded out wages and hampered demand. We have a mess and it seems as though you're basically saying "well I work in health care so I say no, there's no mess."

Actually.. any economist worth a at least a lick understands that health is absolutely critical to economics.

That's because you can't be productive when you are dead of a heart attack, or have malaria, or have a myriad of other diseases, infections, and injuries all which hamper productivity. The single most important factor in any economy is health.[/quote]

Do you think I'm arguing there should be no more medical care in the US or something?

 

[Manc Skipper]

 

[tech30528]

Here is a thought. Let's have health care work for the best interest of the patient rather than the drug companies. It would be cheaper and maybe I can stop watching my friends die from cancer poisoned and burned from radiation. Maybe, you know, CURE some **** instead of treating it for profit and killing the patient.

 

[jaeger19]

And that's fantastic but it doesn't mean workers are produced by the health care system.

Sure it does. Cripes man.. do you know how many babies would die if it were not for our medical system? Whats sad is that our healthcare system is SO GOOD.. that it has allowed you to take having good health for granted. That's why you put so little value on the healthcare system.. because you don't realize just what happens without a good healthcare system.

Plague prevention isn't a big reason why we overspend so dramatically on health care

Well for one we don't "overspend". But yes.. plague prevention is part of our expense. As is the demand for good healthcare.. which is what drives our expense.

Demand is extremely inelastic because our regulations entitle people to medical care but we don't finance it with the efficiency we should finance public goods.

Bullcrap. Demand is demand because when people get sick.. they need healthcare. That's it. Same as food. Or water. etc.

And again the "going back into the economy" thing doesn't mean anything. So if we start spend 200% of GDP on health, you're still pleased as a peach?

It means everthing. You don't seem to get that if we spend more in the US.. that increases GDP. If we spend more on GDP.. then GDP will go UP. Its the nature of how we calculate GDP.

Just because the health care sector employs Americans doesn't mean we will promote the general welfare by consuming all our resources to be professional patients who have no money left over to buy anything else for ourselves

Wrong.. because americans can't be "professional patients"... people are not walking into my facilities saying "I feel like having a kidney transplant today"... Oh no.. no problem with my current kidney's.. I just feel like a kidney transplant today". EVEN if the have the money for it and want it.. we can't give it to them because it would violate our regulations.
Now.. if someone wants to buy a house they don't need and can't afford.. well they can. And guys like you that have no understanding of economics, say.. HEY THATS AWESOME.. if fuels the economy.. isn't that great.. and then the economy crashes. :doh

The overgrowth and overspending in the health care sector has crowded out wages and hampered demand

First there is not the overgrowth and overspending (I will make the caveat that in some regions there has been overgrowth like two hospital systems fighting) But in general growth has been a direct result of the number of baby boomers aging.. the increase in our population in general and people living longer. THAT is true demand and that's fueled the growth of our systems.. and its fueled the spending as well.
It most certainly hasn't ""crowded out wages".. heck it props up wages. The healthcare system in most communities is a prime employer and pays good wages.. and that competition for more workers, and higher pay has INCREASED wages. Take out the healthcare sytems in most communities and you will see a dramatic DECREASE in the local economy.. not an increase.

PARTICULARLY.. since many systems are non profit.. which means that money isn't being siphoned out of the community and to out of area shareholder.
Sorry sir.. but your premise is dead wrong and doesn't fit in with reality.

We have a mess and it seems as though you're basically saying "well I work in health care so I say no, there's no mess."

NO.. I am stating reality. the reality is that we have a lot of demand for healthcare with a larger population, who is aging, living longer, and who also has lots of immigrants from third world countries that will need more healthcare because they didn't get healthcare as children. THATS the main reason that spending on healthcare has increased. Not some mythical boogeyman.

Now.. are there problems? Most certainly.. having people uninsured or underinsured and seeing them in the emergency room when they have pneumonia and end up on a vent is very inefficient rather than seeing them in the clinic when they just have bronchitis and need and antibiotic.

But the reality is that we don't have tremendous problems with our healthcare system... we have a mess with our insurance system that has a virtual monopoly.. in fact its exempt from anti trust laws. An insurance system that doesn't have to compete across state lines, that is being subsidied by the government and that rather than having to compete to provide millions of individuals insurance. Only has to compete to provide a few large companies insurance.
THATS where we have a mess. ..

 

[jaeger19]

Here is a thought. Let's have health care work for the best interest of the patient rather than the drug companies. It would be cheaper and maybe I can stop watching my friends die from cancer poisoned and burned from radiation. Maybe, you know, CURE some **** instead of treating it for profit and killing the patient.

Sorry to hear about your friends. Survival of cancer continues to improve and the American system is one of the best in the world when it comes to cancer survival rates. .

 

[jaeger19]

It is shared by the community in the US.

 

[Dittohead not!]

It is shared by the community in the US.

Yes, to a degree it is.

About half of medical spending is by the federal government.
Most of the rest falls on the shoulders of the employers.
and both of them pick up the tab for the indigent and uninsured, or at least some of it.

At least now, people who choose to risk being uninsured do have to pay a tax to defray the cost of treating them when they come to the emergency room.

 

[jaeger19]

Yes, to a degree it is.

About half of medical spending is by the federal government.
Most of the rest falls on the shoulders of the employers.
and both of them pick up the tab for the indigent and uninsured, or at least some of it.

At least now, people who choose to risk being uninsured do have to pay a tax to defray the cost of treating them when they come to the emergency room.

Yep.. and that's how insurance works. I had this argument with someone who "doesn't want to pay for abortion".. you know the whole.. I don't want to pay for it.

I pointed out to him that there is no money in an account at the insurance company with his name on it.. that is only used for him. The insurance company takes the money that they collect from him in premium and they use it to pay out other claims when they come in.. so his money is most certainly paying for abortions.. just as my money (since we both have Blue Cross) is paying for his healthcare.

Its how insurance works. The question is whether we want a government that gets stymied over planned parenthood and has shown itself to be fiscally irresponsible and socially irresponsible the power over our healthcare. I suggest its a bad idea.. the two worst programs are generally the VA and Medicaid... and the most likely result would be a Medicaid like system.

Medicare only works because you pay your whole life into it and only take out when you are retired. Apply that system to everyone and it goes tits up in a couple of years.. and would devolve into a Medicaid like system. Just now I fought with Medicaid. We are trying to get a patient who just had a redo of a torn rotator cuff therapy. Well they already used "30 days" of therapy. So now they won;t cover it and when we pointed out that they just had a redo after tearing their shoulder again (first surgery was not done in our facilties) they said.. "well you can appeal and we have 30 days to get back to you. She is probably going to have adhesive capsulitis by that time.

And yet we think that if we hand over it all to the government its going to be roses and unicorns. Yet the evidence of how stupid the government can be is all around us.

 

[Dittohead not!]

Yep.. and that's how insurance works. I had this argument with someone who "doesn't want to pay for abortion".. you know the whole.. I don't want to pay for it.

I pointed out to him that there is no money in an account at the insurance company with his name on it.. that is only used for him. The insurance company takes the money that they collect from him in premium and they use it to pay out other claims when they come in.. so his money is most certainly paying for abortions.. just as my money (since we both have Blue Cross) is paying for his healthcare.

Its how insurance works. The question is whether we want a government that gets stymied over planned parenthood and has shown itself to be fiscally irresponsible and socially irresponsible the power over our healthcare. I suggest its a bad idea.. the two worst programs are generally the VA and Medicaid... and the most likely result would be a Medicaid like system.

Medicare only works because you pay your whole life into it and only take out when you are retired. Apply that system to everyone and it goes tits up in a couple of years.. and would devolve into a Medicaid like system. Just now I fought with Medicaid. We are trying to get a patient who just had a redo of a torn rotator cuff therapy. Well they already used "30 days" of therapy. So now they won;t cover it and when we pointed out that they just had a redo after tearing their shoulder again (first surgery was not done in our facilties) they said.. "well you can appeal and we have 30 days to get back to you. She is probably going to have adhesive capsulitis by that time.

And yet we think that if we hand over it all to the government its going to be roses and unicorns. Yet the evidence of how stupid the government can be is all around us.

You seem to think that a universal Medicare program would be unaffordable. Maybe I've misinterpreted that, but that's what I get out of it going "tits up" after a couple of years.

And yet, every nation that has such a program pays less than we do in the USA.

 

[Neomalthusian]

You seem to think that a universal Medicare program would be unaffordable. Maybe I've misinterpreted that, but that's what I get out of it going "tits up" after a couple of years.

And yet, every nation that has such a program pays less than we do in the USA.

The affordability of a national Medicare model would rely on government finding the means and the will to pay significantly less for a similar amount of health care. There are obvious downsides to that too, i.e. the sector would get a haircut and quality and/or quantity of care would likely decline. Otherwise a similar amount is spent on health but it's all public and minimal private dollars, which is just a large indirect transfer of burden to future taxpayers.

On the other hand, what we're doing now isn't exactly working.

 

[Dittohead not!]

The affordability of a national Medicare model would rely on government finding the means and the will to pay significantly less for a similar amount of health care. There are obvious downsides to that too, i.e. the sector would get a haircut and quality and/or quantity of care would likely decline. Otherwise a similar amount is spent on health but it's all public and minimal private dollars, which is just a large indirect transfer of burden to future taxpayers.

On the other hand, what we're doing now isn't exactly working.

What we're doing now is unsustainable over the long term, and that's for sure.
Would the health care sector get a "haircut", or would the insurance industry take the hit? It seems to me that, if doctors really are making out so much better in the USA, we'd have plenty of doctors here. It doesn't appear to be working that way, and why not? Maybe doctoring isn't quite so attractive as it could be. Maybe the way to make it in medicine today is to be good at business, and not necessarily at medicine. I'm on the outside looking in, of course, so I'm not sure, but that's the way it looks from my point of view.

Would health care be scaled down, not as effective, if we were to have a universal system and pay less for it? The life expectancy in other modern nations seems to say that their less expensive universal health care systems are at least as effective as ours is.

But, maybe not. Maybe the problem with our health care system is that Americans are just too fat and lazy. If that's so, then heaven help us.

 

[jaeger19]

You seem to think that a universal Medicare program would be unaffordable. Maybe I've misinterpreted that, but that's what I get out of it going "tits up" after a couple of years.

And yet, every nation that has such a program pays less than we do in the USA.

Yep.. and you erroneously assume that's due to the difference in their system versus ours. As I have pointed out its more due to differences in demographics, ways healthcare costs are calculated etc. Its a problem that people don't really understand the numbers.

Lets take Goshin's examples: he will love to point out that the US pays so much more for healthcare than every other country.. and yet our lifespan is almost exactly the same. SEE.. he says.. we suck compare to them and its our system.

But here is the thing.. look at the figures and you will see that Great Britain.. and South Korea.. have 1. relatively the same lifespan and 2. The SAME system of healthcare (universal government healthcare).. and yet Great Britain pays close to THREE TIMES what south Korea pays?

how do you explain THAT difference even thought they have the same lifespans, and same system of healthcare? Well its obvious that other factors MATTER MORE when it comes to the cost rather than the system. if the main factor in healthcare expense was the type of system.. the Great Britain and South Korea should be equal in costs.. but they are not.. and it means that other factors matter more.

So the assumption that we are going to get this great savings by emulating other countries is not based on reality.

Now.. on to Medicare.

Medicare is far and away a better insurance than what other countries public systems insurance are. ( a notable exception is France.. but France is currently having quite a bit of trouble financially as we have discussed). Our Medicare is so good that our rich LIKE IT.. where in many other countries.. the wealthy avoid the public system and step outside it when they want better care.

Medicare has no restrictions on physicians, no protocols for treatment, no pre authorization, no restrictions on specialists or when you can see one.. no real rationing of care. The vast majority of other countries do.. it is in some measure how they get the savings that they do. If you call it really savings. The elderly lady here falls and breaks a hip and she gets a total hip and therapy and rehab in an attempt to get her to full function.. and back to home.
In Sweden.. she may get a hip pinning and sent home with therapy twice a week and her family will get a stipend to stay at home with her or they may be able to retire early on the system..or she will be eligible to go to a public care center.
In general.. medicare is not a good example of the care you would get in other countries on the public system
Medicaid.. would be a better example of what a public system would be like.. not medicare.

Medicare works because its a unique animal. People pay their whole working lives but DON"T take from medicare. Medicare doesn't have to pay out until you reach 65. And that's why medicare has stayed solvent. You have people working for two years.. and then getting in a car accident and Medicare having to pay out for them.. you will see Medicare go bankrupt in a couple of years. It already is in trouble simply because of the baby boomers. (it ran surpluses up until 2005-2006. So that's what will pay for care for decades even though running a deficit in each year for the next two decades).

 

[jaeger19]

What we're doing now is unsustainable over the long term, and that's for sure.
Would the health care sector get a "haircut", or would the insurance industry take the hit? It seems to me that, if doctors really are making out so much better in the USA, we'd have plenty of doctors here. It doesn't appear to be working that way, and why not? Maybe doctoring isn't quite so attractive as it could be. Maybe the way to make it in medicine today is to be good at business, and not necessarily at medicine. I'm on the outside looking in, of course, so I'm not sure, but that's the way it looks from my point of view.

Would health care be scaled down, not as effective, if we were to have a universal system and pay less for it? The life expectancy in other modern nations seems to say that their less expensive universal health care systems are at least as effective as ours is.

But, maybe not. Maybe the problem with our health care system is that Americans are just too fat and lazy. If that's so, then heaven help us.

Except what you are talking about.. the cost of healthcare.. is giving the health sector a haircut.. the insurance industry loves this.. and by the way.. its what the healthcare industry has been getting as reimbursement drops... yet as reimbursement to physicians drop.. the insurance industry makes more money than ever.

Are americans too fat and lazy? Fat yes.. lazy no... we work more than most other countries.. longer hours.. longer work weeks, take less vacation, and work longer until effective retirement. Which by the way adds to our healthcare costs. Oh and it probably does add to our obesity since we spend less time recreating,, and eat poorly because of working through lunch hours (who the heck gets a lunch "hour" anymore?)