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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 30th January 2017, 09:55 AM   #401
ponderingturtle
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Originally Posted by xjx388 View Post
It's not free. You pay for it in taxes and in cuts to other areas where the government might spend money: infrastructure, defense, etc. Let's not pretend that other developed nations are utopias. They have problems in other areas than health care and even health care isn't the perfect model. I believe we can do better.
Not in terms of healthcare, the same percentage of GDP goes to cover the entire population as we cover with only medicare and medicaid. So hitting those levels of efficiency in the system as a whole would not require cuts in other areas.
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Old 30th January 2017, 09:56 AM   #402
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Originally Posted by xjx388 View Post
Roads: You benefit from roads even if you don't personally drive. Without them, you couldn't get supplies to your home. Roads are essential for modern life and, as part of infrastructure is one of the primary roles of the government.

Schools: I'm with you on that. I think education should be privatized. Eliminate the property tax levies for school and let people spend that money for their own kid's education as they see fit. Government should have as little to do with education as possible because they aren't particularly good at it.
But we need to do something to disenfranchise the uneducated serfdom classes that such systems create.
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Old 30th January 2017, 10:37 AM   #403
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Originally Posted by ponderingturtle View Post
Yep the ideal customer is healthy until they suddenly drop dead. Like how smoking lowers health care costs and so really insurance companies should be encouraging their customers to smoke.
Originally Posted by Minoosh View Post
In a way that's the ideal life. Though a brief illness is sometimes desirable.
Yes indeed, that would be a life well lived. Imagine if you lived a long healthy life, needed very little medical care and then just one day died in your sleep of old age. I hope that's the way I go. If we all could live like that, we would spend so much less on health care. Isn't that the goal? Health care should be something you don't need to use very often. But that's not the way it works. We continue to live unhealthy lives and develop debilitating chronic diseases that require wheelchairs, multiple medications, pacemakers, amputations, oxygen tanks, etc. That leads to much lower quality of life and a long, slow, painful, expensive death.

So, while I realize that ponderingturtle was trying to be ironic, he/she's actually right on the nose.
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Old 30th January 2017, 10:57 AM   #404
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Here's what health insurance has meant to one family, and what losing it could mean to everyone like her:
http://www.slate.com/articles/busine..._repealed.html

Last edited by Bob001; 30th January 2017 at 12:00 PM. Reason: to fix bad link
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Old 30th January 2017, 11:07 AM   #405
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Originally Posted by Minoosh View Post
This link provides the relevant data. It's got nothing to do with whether prevention is cheaper than a cure. Other developed countries have universal health care, spend far less on health care and have better outcomes. It's flat-out cheaper to just take care of everybody. The data is with me.
That article doesn't really cover what you are discussing. It isn't about whether or not universal treatment is cheaper than universal prevention; it's about the plain fact that other countries spend much less than the US for healthcare than we do. The million dollar question is: Why? The article attempts to explain:

Quote:
A 2013 report from the Institute of Medicine reviewed the literature about the health disadvantages of Americans relative to residents of other high-income countries. It found the U.S. performed poorly on several important determinants of health.14 More than a third of adults in the U.S. were obese in 2012, a rate that was about 15 percent higher than the next-highest country, New Zealand. The U.S. had one of the lowest smoking rates in 2013, but one of the highest rates of tobacco consumption in the 1960s and 1970s. This earlier period of heavy tobacco use may still be contributing to relatively worse health outcomes among older U.S. adults.15 Other potential contributors to the United States’ health disadvantage include the large number of uninsured, as well as differences in lifestyle, environment, and rates of accidents and violence.
The article also lists a table showing that 68% of Americans have 2 or more chronic diseases and 35.3% are obese, which are both higher than any other compared country by a significant margin. Obesity and Chronic disease are both primarily caused by lifestyle factors. The article also points out that the US has more adverse effects from diabetes, which is directly driven by patient non-compliance to medical treatment; we see it every day in our clinic -patients who have Medicare, are prescribed insulin and other meds but don't change their lifestyle. The disease just keeps killing them despite the efforts of our doctors to get them to adhere to the treatment protocol. I think the data is clearly with me: The US's problem with lifestyle related disease is the big driver of the US's healthcare spending.



Quote:
How 'bout one from Column A, two from Column B?

Are they, though? Can you provide data? Also, what about my questions re: genetics? Why is it OK to ignore genetic components in obesity, alcoholism, cancer and heart disease?
I'm not saying to ignore genetic components. I'll let this article (relating to obesity but mirrors other research for other diseases) from Harvard School of Public Health sum up for me:

Quote:
What’s increasingly clear from these early findings is that genetic factors identified so far make only a small contribution to obesity risk-and that our genes are not our destiny: Many people who carry these so-called “obesity genes” do not become overweight, and healthy lifestyles can counteract these genetic effects.
Quote:
And so how much of a person's cancer treatment should be covered if they have also abused alcohol? Does that apply to all cancers, or just certain ones? Do they get a credit if they got sober before they got cancer? Etc.
No need to get so detailed. Obese smokers who abuse drugs and/or alcohol should just pay more for their healthcare/insurance than people who are fit, active, don't smoke and don't abuse alcohol and drugs. Simple.

Quote:
Look: "Nothing we can do" is pretty cheap. Lung cancer used to be pretty cheap! And, blaming people for pigging out, it's just not that simple. People seek solace where they can find it, and in the U.S. that often means grease, sugar, salt and starch. Most of us get sick and all of us die. I don't see the utility of blaming the patients.
The utility is in the simple fact that the lifestyle choices made by the patient directly affect their health outcomes. Thus, those that lead risky lifestyles should pay more for their risks. It works in every other facet of the insurance industry, why not health insurance?
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Old 30th January 2017, 11:08 AM   #406
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Originally Posted by Bob001 View Post
Here's what health insurance has meant to one family, and what losing it could mean to everyone like her:
http://www.internationalskeptics.com...315792&page=11
Coincidence or very clever? Post #404 contains a bad link.
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Old 30th January 2017, 12:01 PM   #407
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Originally Posted by paulhutch View Post
Coincidence or very clever? Post #404 contains a bad link.
Link fixed. Apologies.
http://www.slate.com/articles/busine..._repealed.html
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Old 31st January 2017, 12:08 PM   #408
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So I've been sitting here at my desk for most of the day listening to my co-worker try and figure out the awesomeness that is the US healthcare system. I've been getting a play by play as well as hearing her side of the conversation.

She has insurance from our company which is a PPO and it's decent insurance. She was referred by her primary care doctor for an ultrasound.

- Doctor suggested going to spot X, but wait... we're not sure if that's in network... I mean it should be, but it's not showing up in our system. *waits a while* Nope, can't get it to show up, but it SHOULD be in network. Call your insurance company to be sure.
- Calls insurance company. Ok, it is in network. And she's responsible for an $850 deductible? huh? How much could this ultrasound cost? Shouldn't that be covered? How do I find out how much this will cost?
- Calls doctor back. Insurance says it's in network, how much will this cost? Insurance will cover it? That didn't sound like what they said.
- Calls ultrasound office. Verify it is in network. Asks for cost. No I am not going to have the procedure then wait for a bill. I don't want a surprise $800 bill from you. Someone has to be able to tell me how much this is going to cost. *waits for call back*
- Call back comes $235 out of pocket. Other coworkers with same plan say that can't be right - they've never been charged for an ultrasound outside of a small copay.

It's not like she wasn't asking the right questions. It's been 3+ hours and she still isn't sure if this is going to cost her $200+ (which is a LOT for her) or next to nothing.
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Old 31st January 2017, 12:35 PM   #409
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Originally Posted by bonzombiekitty View Post
......
It's not like she wasn't asking the right questions. It's been 3+ hours and she still isn't sure if this is going to cost her $200+ (which is a LOT for her) or next to nothing.
I have no idea how much her ultrasound should cost. But I note that this kind of confusion and conflict and multi-level negotiation is a big part of why 25% of total U.S. health care expenditures go to administration. In universal health care systems, that number is as low as 10%.
http://www.bloomberg.com/news/articl...ance-companies
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Old 31st January 2017, 12:39 PM   #410
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Originally Posted by Bob001 View Post
I have no idea how much her ultrasound should cost. But I note that this kind of confusion and conflict and multi-level negotiation is a big part of why 25% of total U.S. health care expenditures go to administration. In universal health care systems, that number is as low as 10%.
http://www.bloomberg.com/news/articl...ance-companies
yep. My other coworker, who is originally from Canada, was just laughing.
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Old 31st January 2017, 12:54 PM   #411
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Originally Posted by bonzombiekitty View Post
yep. My other coworker, who is originally from Canada, was just laughing.
When I was still living in Canada, I had my now wife visit me. We were planning a nice vacation. She spent a week with me, we were going to spend a week driving across the country, and then I would spend a week out with her in Seattle.

Well, when we were packing up the car, I slipped, and ended up breaking my foot. We did a trip to the ER. 3 hours later, Xrays, a cast, and I was handed crutches to be sent on my wife. My (now) wife, being an American, asked where we went to pay. I looked at her like she had grown a second head, and said 'Pay? You don't pay for health care...'
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Old 31st January 2017, 03:54 PM   #412
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Originally Posted by Emily's Cat View Post
Because we're compassionate humans whose empathy emerged at the proper stage of cognitive development?
I could have bought that when you posted it. But reading it from this side of the weekend makes it harder to take.
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Old 31st January 2017, 04:28 PM   #413
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Originally Posted by xjx388 View Post
No need to get so detailed. Obese smokers who abuse drugs and/or alcohol should just pay more for their healthcare/insurance than people who are fit, active, don't smoke and don't abuse alcohol and drugs. Simple.
It's not simple by any stretch of the imagination. If you can get people to change habits by threatening to punish them, I don't really know. They are already being punished to some extent by poor decisions/poor genetics. Does society have to add to that? Do we need insurance companies to appoint lifestyle police when as a matter of public policy, single-payer UHC is cheaper in both prevention and cure? In the aggregate.

Originally Posted by xjx388 View Post
Thus, those that lead risky lifestyles should pay more for their risks. It works in every other facet of the insurance industry, why not health insurance?
Because the potential bill for health care is orders of magnitude greater than the maximum liability in other situations.

I knew a family with a $3 million health-care bill for a son who later died very young of a freak accident. Their assets have been permanently attached, and they are OK with this. They are both retired USAF veterans. Many Americans don''t have that kind of coverage.

This kid, Chris, ended up getting cared for as an indigent part of the time, because the care made him indigent PDQ. (This was before he could have been insured under his parents' plans.) Lots of effort to save his leg after he was smacked, flipped and dragged 250 yards by a drunk driver while he was crossing the street - on foot and buzzed. He tried to stand up with bones sticking out of his legs, but he was entangled somewhat with the car whose driver hadn't noticed hitting him.

Maybe too much effort was expended on saving his leg which ultimately was amputated due to hospital-acquired MRSA. His mom ended up stressed to the max trying to cope and her Type 2 diabetes got out of control and she became both insulin dependent and obese. Then Chris died anyway in a different freak accident.

And during this whole time she was a foster mom who adopted 2 young boys, a social good, probably, but still, is her insulin dependence her own fault? Yes according to you.

I asked for numbers regarding nature vs. nurture in maintaining health. If I find you have posted them, I will take a look.

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Old 31st January 2017, 04:44 PM   #414
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Originally Posted by Shalamar View Post
When I was still living in Canada, I had my now wife visit me. We were planning a nice vacation. She spent a week with me, we were going to spend a week driving across the country, and then I would spend a week out with her in Seattle.

Well, when we were packing up the car, I slipped, and ended up breaking my foot. We did a trip to the ER. 3 hours later, Xrays, a cast, and I was handed crutches to be sent on my wife. My (now) wife, being an American, asked where we went to pay. I looked at her like she had grown a second head, and said 'Pay? You don't pay for health care...'
Man, you should have been more careful. It's your own damn fault you slipped and it's a pity that taxpayers had to fork up dough for your own carelessness.

At least that's one argument here ...

I am assuming you were sent on your way and not on your wife ...
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Old 31st January 2017, 04:54 PM   #415
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Originally Posted by Minoosh View Post
Man, you should have been more careful. It's your own damn fault you slipped and it's a pity that taxpayers had to fork up dough for your own carelessness.

At least that's one argument here ...

I am assuming you were sent on your way and not on your wife ...
.. Damnit. Yes. Ahh well.
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Old 2nd February 2017, 11:37 AM   #416
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Originally Posted by xjx388 View Post
Yes indeed, that would be a life well lived. Imagine if you lived a long healthy life, needed very little medical care and then just one day died in your sleep of old age. I hope that's the way I go. If we all could live like that, we would spend so much less on health care. Isn't that the goal? Health care should be something you don't need to use very often. But that's not the way it works. We continue to live unhealthy lives and develop debilitating chronic diseases that require wheelchairs, multiple medications, pacemakers, amputations, oxygen tanks, etc. That leads to much lower quality of life and a long, slow, painful, expensive death.

So, while I realize that ponderingturtle was trying to be ironic, he/she's actually right on the nose.
*grumble* Or one develops life-threatening fibroids that hemorrhage and land one in the ER with blood transfusions, 4 months of incredibly expensive specialty drugs to keep one from dying, and a very expensive surgery so one can keep on living. Or maybe one goes on to develop frequent migraines that interfere with quality of life overall. Or maybe ends up with a diagnosis of epilepsy later in life that has massive impacts to how one goes about everything in one's life.

Or, hey novel idea, maybe one is unlucky enough to end up with all three of those happening. That would be me.

I suppose I'm just not taking good enough care of myself. Maybe it's righteous and appropriate that I either die from lack of care or face bankruptcy to cover the bills. That seems perfectly reasonable and compassionate.


******

Look, I get your point, and there is some validity to it. But I also feel that you're glossing over a significant amount of things that are completely outside of the control of the individual. You seem to approach it as if the huge majority of medical costs are from easily avoided chronic conditions... and that's not really true. I've said it before, and I'll say it again. Over half of the cost of care in the US is from non-chronic acute conditions, congenital illnesses (some of which are extremely costly like hemophilia), neonatal complications, and cancers. If you add in trauma events, and the repertoire of injuries and contagion, you end up with around 65% to 70% of the costs being non-avoidable, non-chronic instances.

So you've got 30% to 35% of the costs that are from *both* lifestyle-related chronic conditions, mental health conditions, *and* preventive & routine care. And of those chronic conditions, not all of them are perfectly avoidable. Just eating well and exercising won't prevent someone with a genetic predisposition from developing diabetes. Just exercising and avoid smoke won't perfectly prevent COPD.

Short story: please stop over-simplifying this quite so much
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Old 2nd February 2017, 11:43 AM   #417
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Originally Posted by Dr. Keith View Post
I could have bought that when you posted it. But reading it from this side of the weekend makes it harder to take.
Not my business, and feel free to tell me so... what happened over the weekend that leads you to believe that throwing the baby out with the bathwater is a more palatable approach?
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Old 2nd February 2017, 11:45 AM   #418
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Originally Posted by Minoosh View Post
Man, you should have been more careful. It's your own damn fault you slipped and it's a pity that taxpayers had to fork up dough for your own carelessness.

At least that's one argument here ...

I am assuming you were sent on your way and not on your wife ...
Originally Posted by Shalamar View Post
.. Damnit. Yes. Ahh well.
I just assumed he needed "comforting"
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Old 2nd February 2017, 02:53 PM   #419
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Originally Posted by Emily's Cat View Post
Not my business, and feel free to tell me so... what happened over the weekend that leads you to believe that throwing the baby out with the bathwater is a more palatable approach?
Trump's Muslim ban has me questioning whether "we're compassionate humans whose empathy emerged at the proper stage of cognitive development".
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Old 2nd February 2017, 05:39 PM   #420
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Redundant

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Old 2nd February 2017, 06:27 PM   #421
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Originally Posted by xjx388 View Post
That article doesn't really cover what you are discussing. It isn't about whether or not universal treatment is cheaper than universal prevention;
Which wasn't my point. Both prevention and care are covered. I am not comparing "universal prevention to universal treatment." It's cheaper to do it all for everybody. The whole thing. Less money, better outcomes. There are fat Canadians, I'm sure, but they spend less to get better outcomes.

Originally Posted by xjx388 View Post
It's about the plain fact that other countries spend much less than the US for healthcare than we do. The million dollar question is: Why?
Possibly because we don't have single-payer UHC. The patient would be seen, maybe required to attend four classes about diabetes, or sign up for smoking cessation, or offered alternative ways of nicotine delivery.

Instead you very arbitrarily IMO say "it was your own damn fault, pay for it yourself." Why is stigmatizing people a higher priority in your view than UHC, which is cheaper and has better outcomes?

Originally Posted by xjx388 View Post
The article also lists a table showing that 68% of Americans have 2 or more chronic diseases and 35.3% are obese, which are both higher than any other compared country by a significant margin. Obesity and Chronic disease are both primarily caused by lifestyle factors.
Seriously? There are tons of chronic diseases not caused by lifestyle factors. Type 1 diabetes isn't, rheumatoid arthritis isn't, lupus isn't, ALS isn't; polycystic kidney disease isn't, high blood pressure isn't, totally. Wider use of bariatric surgery could help the obese. Do you think these people LIKE being sick? Maybe we have more chronic disease because the system sucks? Pause to consider the variables.

My mom has dementia and peripheral vascular disease. She's 92. Her fault? She was a smoker for about 20 years early in life - before people knew it was bad for you. I suspect she drank a bit after losing my father - is that why she has no short-term memory?

My father and his 2 brothers died of prostate cancer. He also developed Type 2 diabetes, then rapidly became insulin-independent as a result of a course of prednisone having to do with the cancer. So we've got at least 2 chronic diseases, prostate cancer and insulin dependence. This is a man who got his testicles removed to slow down prostate cancer. By all means, let's punish my parents. Even though all 3 sons in the family died of prostate cancer.

Originally Posted by xjx388 View Post
The article also points out that the US has more adverse effects from diabetes, which is directly driven by patient non-compliance to medical treatment; we see it every day in our clinic -patients who have Medicare, are prescribed insulin and other meds but don't change their lifestyle.
They are people. They are imperfect. Go figure. Read "The Spirit Catches You and You Fall Down." Seriously.

Originally Posted by xjx388 View Post
No need to get so detailed. Obese smokers who abuse drugs and/or alcohol should just pay more for their healthcare/insurance than people who are fit, active, don't smoke and don't abuse alcohol and drugs. Simple.
Or we could make it simpler still: have UHC do all it can to prevent and treat diseases that have a behavioral component. No need to have second-class citizens, which you assume to insist on because - reasons? Don't know. My dad should have picked different parents, perhaps. You talk as if there would be no judgment calls; no shades of gray. You ignore who would make those decisions. We'd have to have some rationing system, which maybe could double as a death panel. I'm not totally against that concept.

Originally Posted by xjx388 View Post
That article doesn't really cover what you are discussing. It isn't about whether or not universal treatment is cheaper than universal prevention; it's about the plain fact that other countries spend much less than the US for healthcare than we do. The million dollar question is: Why? The article attempts to explain:
You are missing the main point: I am not comparing the cost of universal prevention and universal treatment. They're both health care. Other countries do more with less treatment which is that we could offer health care for all for less money with better outcomes. The patient would be seen, educated and maybe some of it would stick. Getting checkups would be a patriotic duty. Instead you very arbitrarily IMO say "it was your own damn fault, pay for it yourself." Why is stigmatizing people a higher priority in your view than UHC, which is cheaper and has better outcomes.?

Originally Posted by xjx388 View Post
The article also lists a table showing that 68% of Americans have 2 or more chronic diseases and 35.3% are obese, which are both higher than any other compared country by a significant margin. Obesity and Chronic disease are both primarily caused by lifestyle factors.
Wider use of bariatric surgery could help the obese. My mom has dementia and peripheral vascular disease. Her fault? She was a smoker about 40 years ago. I suspect she drank a bit after losing my father - is that why she has no short-term memory? Well, she is 92. My father and his 2 brothers died of prostate cancer. He also developed Type 2 diabetes, then rapidly became insulin-independent as a result of a course of prednisone having to do with the cancer. So we've got at least 2 chronic diseases, prostate cancer and insulin-dependent diabetes. This is a man who got his testicles removed to slow down the cancer.

By all means, let's punish both my parents. Even though all 3 sons in the family died of prostate cancer.

Originally Posted by xjx388 View Post
The article also points out that the US has more adverse effects from diabetes, which is directly driven by patient non-compliance to medical treatment; we see it every day in our clinic -patients who have Medicare, are prescribed insulin and other meds but don't change their lifestyle. The disease just keeps killing them despite the efforts of our doctors to get them to adhere to the treatment protocol. I think the data is clearly with me: The US's problem with lifestyle related disease is the big driver of the US's healthcare spending.
No. See highlighted. I refuse to let you get by with "I think the data is clearly with me." This took 2 minutes:

Originally Posted by Forbes
The first area is technology. There is consensus among experts that technology is the most important driver of healthcare spending increases over time. Installing and implementing electronic health records is costly – often as much as $25,000 per doctor for a system and a monthly subscription fee on top of that – and requires significant resources.
then:
Originally Posted by xjx388 View Post
No need to get so detailed. Obese smokers who abuse drugs and/or alcohol should just pay more for their healthcare/insurance than people who are fit, active, don't smoke and don't abuse alcohol and drugs. Simple.
Or we could make it simpler still: have UHC do all it can to prevent and treat diseases that have a behavioral component. No need to have second-class citizens, which you assume to insist on because - reasons? Don't know. My dad should have picked different parents, perhaps. You talk as if there would be no judgment calls; no shades of gray. You ignore who would make those decisions. We'd have to have some system; maybe it can double as a death panel. End-of-life care often costs a ton.

Originally Posted by xjx388 View Post
The utility is in the simple fact that the lifestyle choices made by the patient directly affect their health outcomes.
So, even if we can offer prevention and treatment to all for less money, we should have what, lifestyle police to spy on people or force them away from fast-food windows? That's your "simple" solution? BTW we would STILL be overspending and STILL having worse outcomes.

Originally Posted by xjx388 View Post
It works in every other facet of the insurance industry, why not health insurance?
Please give some examples/citations of how it works in other facets of the insurance industry. I want to see how analogous these comparisons really are.

IMO, a lot of health care expense can be saved if the patient has a support system. Rides to PT if they don't drive. Getting Mom to walk more. Helping figure out if she needs to go to the ER (almost took her today then didn't). My mom's has more support than many people. She pays a higher Medicare premium based on means. But not based on smoking from age 25-40 and having a couple of drinks at night. How the hell would you draw the line?

Last edited by Minoosh; 2nd February 2017 at 06:37 PM. Reason: This may be a bit choppy with redundancies. Can't editot more
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Old 2nd February 2017, 06:35 PM   #422
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Originally Posted by Dr. Keith View Post
Trump's Muslim ban has me questioning whether "we're compassionate humans whose empathy emerged at the proper stage of cognitive development".
Trump <> We

If Trump = We, then none of us would be objecting to the evisceration of ACA without a replacement. "We" oppose that evisceration because "we" developed empathy and compassion. I'm not including Trump in that "we".
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Old 2nd February 2017, 06:59 PM   #423
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When you make a stupid promise because it makes a great campaign slogan, no worries, you can just change the slogan when your bluff is called and pretend that's what you said all along. In a week, no one will notice.

"Repeal and replace" Obamacare has now become "repair" Obamacare. And, Paul Ryan is claiming, "you have to repeal and replace it in order to repair it."

No Senator Ryan, we're not that stupid, though maybe your base doesn't care that you've been lying to them for 6 years.

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Old 2nd February 2017, 08:10 PM   #424
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Originally Posted by Emily's Cat View Post
Trump <> We

If Trump = We, then none of us would be objecting to the evisceration of ACA without a replacement. "We" oppose that evisceration because "we" developed empathy and compassion. I'm not including Trump in that "we".
Some GOP congress members are using the word "repair."

There should be a broader choice of coverage IMO. There's no "shopping around" in my state and my BlueCross BlueShield coverage was dropped for something called Ambetter, which has 2 plans this year in my state, but no choice to pick a different company. This one has something to do with Health Net. I'm not sure the insurance-across-state-lines is a good idea.

I can afford a pretty high deductible, but my actual income is paltry. The 2 choices were essentially $600 or $700. I will probably get some money back because my income is so low. I don't want to go without insurance. In my state there are just 2 choices - both from the same company.

Ambetter has a monopoly and is subsidized by the government - I would like to see more transparency at least. At least my benefits are portable. I hope they're not crappy! I'm kind of afraid to look.

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Old 2nd February 2017, 08:29 PM   #425
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Originally Posted by Emily's Cat View Post
Trump <> We
No, but he has a lot more support than I ever would have imagined. He is not alone even if we are not with him.
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Old 2nd February 2017, 11:09 PM   #426
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I had to get turned down for health insurance, than stay uninsured for 6 months, after which I was very simply covered by transitional Obama care. My state did not have a high-risk pool so I was directly insured by the federal government. And they wanted to keep me insured.

I would have even waived coverage for my biggest pre-existing condition, since treatment is not terribly effective. Just to get insured.

So now the premiums are much higher, but the Obamacare one was cheaper at $271 or something.

The stupid thing is I have put off the full physical I should be getting. Some bloodwork a couple of years ago was normal. So I'm part of the behavioral problem too. Not using the doc for too much, but for too little.
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Old 3rd February 2017, 01:39 AM   #427
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Originally Posted by Minoosh View Post
Which wasn't my point. Both prevention and care are covered. I am not comparing "universal prevention to universal treatment." It's cheaper to do it all for everybody. The whole thing. Less money, better outcomes. There are fat Canadians, I'm sure, but they spend less to get better outcomes.
. You seem to be brushing aside the idea that the USA is a different country with a different population makeup. There is no guarantee that in the US, prevention+treatment for all = less money with better outcomes. And better outcomes is debateable. What criteria? This has been argued about in the literature for awhile now.

Quote:
Possibly because we don't have single-payer UHC. The patient would be seen, maybe required to attend four classes about diabetes, or sign up for smoking cessation, or offered alternative ways of nicotine delivery.
How do you require people to attend these things? You can't find them or jail them obviously. So what if they don't go and don't listen? You still have to treat. In our clinic anyway, we "require" our patients to attend free diabetes education. We offer smoking cessation classes through the hospital. The resources are there right now in the US for free or very low cost. People don't go.

Quote:
Instead you very arbitrarily IMO say "it was your own damn fault, pay for it yourself." Why is stigmatizing people a higher priority in your view than UHC, which is cheaper and has better outcomes?
I don't see it as me stigmatizing anyone. Let's take smoking for example. It's a completely voluntary activity that everyone knows is very bad for your health. If there's a stigma, it's one voluntarily taken on by the person. All a medical system can do is say, "don't do that, you are killing yourself." The sad fact is that any ill effects are indeed "your own damn fault." Same goes for the diets some people eat and other lifestyle choices that are bad for your health.

Quote:
Seriously? There are tons of chronic diseases not caused by lifestyle factors. Type 1 diabetes isn't, rheumatoid arthritis isn't, lupus isn't, ALS isn't; polycystic kidney disease isn't, high blood pressure isn't, totally. Wider use of bariatric surgery could help the obese. Do you think these people LIKE being sick? Maybe we have more chronic disease because the system sucks? Pause to consider the variables.
Reduce the number of chronic illnesses caused by lifestyle and we have more resources to spend on treating the ones that aren't.

Quote:
My mom has dementia and peripheral vascular disease. She's 92. Her fault? She was a smoker for about 20 years early in life - before people knew it was bad for you. I suspect she drank a bit after losing my father - is that why she has no short-term memory?
Reduce lifestyle disease; have more resources to treat other disease.

Quote:
My father and his 2 brothers died of prostate cancer. He also developed Type 2 diabetes, then rapidly became insulin-independent as a result of a course of prednisone having to do with the cancer. So we've got at least 2 chronic diseases, prostate cancer and insulin dependence. This is a man who got his testicles removed to slow down prostate cancer. By all means, let's punish my parents. Even though all 3 sons in the family died of prostate cancer.
I won't repeat myself.

Quote:
They are people. They are imperfect. Go figure. Read "The Spirit Catches You and You Fall Down." Seriously.
I don't find the "people are fallible" argument very convincing. How far should we take this argument?

Quote:
Or we could make it simpler still: have UHC do all it can to prevent and treat diseases that have a behavioral component. No need to have second-class citizens, which you assume to insist on because - reasons? Don't know. My dad should have picked different parents, perhaps. You talk as if there would be no judgment calls; no shades of gray. You ignore who would make those decisions. We'd have to have some rationing system, which maybe could double as a death panel. I'm not totally against that concept.
We don't have to make those decisions; nature does a good job already.

Quote:
<snip repetition >
So, even if we can offer prevention and treatment to all for less money, we should have what, lifestyle police to spy on people or force them away from fast-food windows?
No need for lifestyle police. Answer a few questions, take some lab tests, get a physical. You'll still get insurance but you'll pay for your risks. Incentivize healthy lifestyles. If economics has taught us anything it's that incentives work.
Quote:
That's your "simple" solution?
In a nutshell.
Quote:
BTW we would STILL be overspending and STILL having worse outcomes.
If people live healthier lives, we will have better outcomes and spend less than we do now.

Quote:
Please give some examples/citations of how it works in other facets of the insurance industry. I want to see how analogous these comparisons really are.
If you have more auto accidents or traffic tickets or if you drive certain types of risky car or if you are young, you pay more for auto insurance. If you smoke or don't pass a physical/lab tests you pay more for life insurance. If you make claims on your homeowners policy you pay more. You pay for your risk profile in the insurance industry.

Quote:
IMO, a lot of health care expense can be saved if the patient has a support system. Rides to PT if they don't drive. Getting Mom to walk more. Helping figure out if she needs to go to the ER (almost took her today then didn't). My mom's has more support than many people. She pays a higher Medicare premium based on means. But not based on smoking from age 25-40 and having a couple of drinks at night. How the hell would you draw the line?
Keep it simple. Risk.
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Old 3rd February 2017, 02:28 AM   #428
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When the tobacco industry, or the asbestos industry, or the mining industry (etc.) find themselves in court their primary tool for absolving themselves of responsibility is to argue that it couldn't be proven their product was responsible for any particular individual case of illness. That it could have come from other sources.

Why should it be different when contemplating responsibility for getting the illness? The same logic applies.

So. No need to look for blame when considering the cost of treatment. Just take care of them.
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Old 3rd February 2017, 03:57 AM   #429
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Originally Posted by xjx388 View Post
. You seem to be brushing aside the idea that the USA is a different country with a different population makeup. There is no guarantee that in the US, prevention+treatment for all = less money with better outcomes. And better outcomes is debateable. What criteria? This has been argued about in the literature for awhile now.

How do you require people to attend these things? You can't find them or jail them obviously. So what if they don't go and don't listen? You still have to treat. In our clinic anyway, we "require" our patients to attend free diabetes education. We offer smoking cessation classes through the hospital. The resources are there right now in the US for free or very low cost. People don't go.

I don't see it as me stigmatizing anyone. Let's take smoking for example. It's a completely voluntary activity that everyone knows is very bad for your health. If there's a stigma, it's one voluntarily taken on by the person. All a medical system can do is say, "don't do that, you are killing yourself." The sad fact is that any ill effects are indeed "your own damn fault." Same goes for the diets some people eat and other lifestyle choices that are bad for your health.

Reduce the number of chronic illnesses caused by lifestyle and we have more resources to spend on treating the ones that aren't.

Reduce lifestyle disease; have more resources to treat other disease.

I won't repeat myself.

I don't find the "people are fallible" argument very convincing. How far should we take this argument?

We don't have to make those decisions; nature does a good job already.

No need for lifestyle police. Answer a few questions, take some lab tests, get a physical. You'll still get insurance but you'll pay for your risks. Incentivize healthy lifestyles. If economics has taught us anything it's that incentives work. In a nutshell. If people live healthier lives, we will have better outcomes and spend less than we do now.

If you have more auto accidents or traffic tickets or if you drive certain types of risky car or if you are young, you pay more for auto insurance. If you smoke or don't pass a physical/lab tests you pay more for life insurance. If you make claims on your homeowners policy you pay more. You pay for your risk profile in the insurance industry.

Keep it simple. Risk.
Would you rather not (as a population) pay less for your healthcare?
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Old 3rd February 2017, 04:26 AM   #430
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Originally Posted by xjx388 View Post
. You seem to be brushing aside the idea that the USA is a different country with a different population makeup. There is no guarantee that in the US, prevention+treatment for all = less money with better outcomes.
In every other developed nation that has implemented UHC healthcare outcomes are better and healthcare costs are lower. You can't in all good conscience argue that the USA is a special snowflake country with special snowflake citizens. (well you could, but you'd be very wrong)

Quote:
How do you require people to attend these things? [...] In our clinic anyway, we "require" our patients to attend free diabetes education. We offer smoking cessation classes through the hospital.
Smoking cessation is avoided like the plague because it doesn't work. I am an ex smoker. I know a lot of smokers and a few ex smokers and the general consensus among smokers that I know is that smoking cessation based on NRT is absolutely useless. There are studies that back that up as well.

Quote:
“This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one’s own,” Alpert said. He added that even though clinical trials (studies) have found NRT to be effective, the new findings demonstrate the importance of empirical studies regarding effectiveness when used in the general population.
[...]
Smoking cessation medications have been available over the counter since 1996, yet U.S. Centers for Disease Control and Prevention statistics show that the previous adult smoking rate decline and quitting rates have stalled in the past five years.
[source]

NRT is based on the premise that it's the mostly nicotine that's addictive. Which is fundamentally flawed Nicotine plays a part, but it's smoking that's addictive, it's a combination of nicotine and ritualistic behaviour and other things too.

Quote:
Let's take smoking for example. It's a completely voluntary activity that everyone knows is very bad for your health. If there's a stigma, it's one voluntarily taken on by the person. All a medical system can do is say, "don't do that, you are killing yourself." The sad fact is that any ill effects are indeed "your own damn fault." Same goes for the diets some people eat and other lifestyle choices that are bad for your health.
If the primary funder of UHC is the government, then tax the lifestyle choices that lead to worse health outcomes higher to put more money into the pot used to treat patients suffering from the effects of those choices. In the UK smokers pay a hefty amount of tax on tobacco.
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Old 3rd February 2017, 04:32 AM   #431
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Originally Posted by Darat View Post
Would you rather not (as a population) pay less for your healthcare?
b-b-b-b-but that would require an awareness of, and a care for, others
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Old 3rd February 2017, 05:30 AM   #432
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Looks like there are parts of ObamaCare that they want to keep. ("We like that part of the plan, we can keep it.")

I propose the combination be called either ObumpCare or TraumaCare.
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Old 3rd February 2017, 09:14 AM   #433
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Originally Posted by Minoosh View Post
Some GOP congress members are using the word "repair."

There should be a broader choice of coverage IMO. There's no "shopping around" in my state and my BlueCross BlueShield coverage was dropped for something called Ambetter, which has 2 plans this year in my state, but no choice to pick a different company. This one has something to do with Health Net. I'm not sure the insurance-across-state-lines is a good idea.

I can afford a pretty high deductible, but my actual income is paltry. The 2 choices were essentially $600 or $700. I will probably get some money back because my income is so low. I don't want to go without insurance. In my state there are just 2 choices - both from the same company.

Ambetter has a monopoly and is subsidized by the government - I would like to see more transparency at least. At least my benefits are portable. I hope they're not crappy! I'm kind of afraid to look.
Free markets do not guarantee that consumers have a lot of choice. In my area we only have two supermarket chains. Most retail segments are dominated by one or two big box stores. If I want cable TV service or high speed Internet the only choice is Comcast. On the other hand the highly regulated Obamacare exchange gives me seven choices for health insurance providers.

Your insurance costs are high because medical costs are high and people in your age group tend to require a lot of medical care. The only way to significantly lower the cost of comprehensive health insurance is to go after medical costs. The cost of prescription medications is clearly a problem. As are the costs of routine MRI scans and other testing. Hospital billing practices in the US are best described as insane. Even the people sending out the bills can't explain what is going on.

BTW: This will give you a quick estimate of insurance costs and subsidies.
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Old 3rd February 2017, 09:18 AM   #434
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Originally Posted by Kestrel View Post
Your insurance costs are high because medical costs are high and people in your age group tend to require a lot of medical care. The only way to significantly lower the cost of comprehensive health insurance is to go after medical costs.

I recommend having the government pay for a massive number of scholarships for doctors that ensure the doctors can graduate without debt and contain a rider that they must work for a reasonable rate at a government hospital for, say, seven years after completing their residency.



Just, in the parlance of my US friends, spitballing, really.
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Old 3rd February 2017, 09:35 AM   #435
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He has no plan.

Too busy pissing off leaders around the world and replacing science with Jesus?
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Quote:
Fielding questions from Democratic Sen. Sherrod Brown, Price seemed to suggest that he has not been working with the new President on a plan to replace Obamacare.
"President Trump said he's working with you on a replacement plan for the ACA which is nearly finished and will be revealed after your confirmation. Is that true?" Brown asked.
"It's true that he said that, yes," Price said, an awkward response that drew laughter from the hearing room.
"Not that he's every done this before but did the President lie? Did the President lie about this, that he's not working with you?" Brown pressed. "Did he lie to the public about working with you?"
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Old 3rd February 2017, 09:52 AM   #436
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Originally Posted by 3point14 View Post
I recommend having the government pay for a massive number of scholarships for doctors that ensure the doctors can graduate without debt and contain a rider that they must work for a reasonable rate at a government hospital for, say, seven years after completing their residency.



Just, in the parlance of my US friends, spitballing, really.
Wasn't that the premise of Northern Exposure?
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Old 3rd February 2017, 09:54 AM   #437
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Originally Posted by 3point14 View Post
I recommend having the government pay for a massive number of scholarships for doctors that ensure the doctors can graduate without debt and contain a rider that they must work for a reasonable rate at a government hospital for, say, seven years after completing their residency.

Just, in the parlance of my US friends, spitballing, really.
Becoming a doctor in the US requires four years of college, three years of medical school and one year as a resident. From what I understand it doesn't take as many years in many other nations including the UK. And I have seen no evidence to suggest that UK doctors are less competent than those trained in the US.
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Old 3rd February 2017, 10:21 AM   #438
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Originally Posted by Kestrel View Post
Becoming a doctor in the US requires four years of college, three years of medical school and one year as a resident. From what I understand it doesn't take as many years in many other nations including the UK. And I have seen no evidence to suggest that UK doctors are less competent than those trained in the US.
I think your information is awry

In the UK it takes at least 5 years to become a GP after completing your medical degree (four years), and at least 7-9 years to become a hospital consultant.


Where did you get your info from?
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Old 3rd February 2017, 10:39 AM   #439
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Originally Posted by Tero View Post
"President Trump said he's working with you on a replacement plan for the ACA which is nearly finished and will be revealed after your confirmation. Is that true?" Brown asked.
"It's true that he said that, yes," Price said, an awkward response that drew laughter from the hearing room.
"Not that he's every done this before but did the President lie? Did the President lie about this, that he's not working with you?" Brown pressed. "Did he lie to the public about working with you?"
Wow. So did Price actually admit that he has not been working with the President?

Did Brown actually ask the appropriate question, "So have you been working with the President on a replacement plan that is nearly finished and will be revealed after your confirmation?"

I think it's pretty obvious that the answer is no, of course.

Then again, nowadays, the GOP is not talking about repeal, but "repair." And if that is the case, they oughta be slapped. Figuratively, too.

It's been 6 years. If there were a plan to "repair" ObamaCare that actually does fix the supposed problems, why haven't they brought it up? Why have they wasted all their time with meaningless repeal attempts, instead of actually trying to make it work? Because if there were some great way to make it better, and they deliberately did not try to implement it, it clearly demonstrates that they are not there to govern or to serve the people.

"We have a great plan to help the American people. However, we won't let anyone know about it because it would require admitting that the ACA is not completely evil, and it would mean that we were working with Obama. Since we can't have that, we see to America, **** you. Continue to suffer."
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Old 3rd February 2017, 10:54 AM   #440
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The latest lie told by some Congressman last night on the news: the increase in numbers of people covered was because of the improved economy and not because of the ACA.

Look for it coming soon to a Trumpette near you.
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