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22nd February 2017, 06:14 PM | #521 |
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22nd February 2017, 06:25 PM | #522 |
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22nd February 2017, 06:35 PM | #523 |
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22nd February 2017, 07:24 PM | #524 |
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I wonder what Stephen Hawking's lifetime expenses have been?
Or how well he would have fared if he had been an American? |
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22nd February 2017, 07:45 PM | #525 |
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22nd February 2017, 08:57 PM | #526 |
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I did not want it to be free but a single payer type of service you woukd pay monthly for. Once you are stable you have some health options. Many problems can be treated as outpatient service. When you are dead you have no options. You would have a card like a social security card that would cover all ER for all US residents or students with visa on a 1 year basis.
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22nd February 2017, 10:00 PM | #527 |
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If Ryan and co. are serious about freedom and personal responsiblility, this is exactly the solution. Let the free market sort out who's good enough to practice and how much they can charge. I'll save tons by getting treatment from some guy at the mall who's watched some medical videos on youtube and be laughing all the way to the bank.
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22nd February 2017, 10:31 PM | #528 |
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But if you have health insurance, the insurer paid most of the bill, probably at a discounted rate, right? If you don't have insurance and got hit with a full retail bill, that's really the issue, isn't it? Under a Medicare-for-All single payer system, everybody's basic care, including ER visits, would be covered, paid for by a tax that would replace insurance premiums.
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23rd February 2017, 09:57 AM | #529 |
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Yes it is.
That's why we need a different discussion. Simply saying that ERs should be accessible to everyone doesn't accomplish anything. Accessibility isn't the issue - affordability is. Affordability is a barrier to care, but not a barrier to accessibility. It's the cost of care that needs to be looked at. Not the cost of insurance, and not accessibility. It's the actual underlying cost of services that needs the most attention in my opinion. |
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23rd February 2017, 10:00 AM | #530 |
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23rd February 2017, 10:03 AM | #531 |
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23rd February 2017, 10:04 AM | #532 |
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They're fairly intertwined, I think, but mostly, I'd agree. I think doctors in the US are probably grossly overpaid*. Add into that that you run every test you can or risk litigation and the enormous admin costs brought about by actually having to have a decline process and generally deal with insurance companies and it's all a bit of a mess. *Although mostly they need to be to be able to keep up the payments on their education they paid a fortune for. |
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23rd February 2017, 10:08 AM | #533 |
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*** And their brand new Mercedes and their 4000 sf house in a gated community and their membership fees for the highly exclusive country club so they can golf 3 days a week
Obviously not every doctor... but an awful lot of them. It's not like most docs are just scraping by because of their crippling educational debt. They're in the same boat I am: I had a lot of debt from college, but it got me a very well-paying job, so the $400+ per month going to pay off my student loans just isn't that big a deal. I don't really have much sympathy for the cost of a medical degree, given the income level that is a result of that investment. |
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The distance between the linguistic dehumanization of a people and their actual suppression and extermination is not great; it is but a small step. - Haig Bosmajian |
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23rd February 2017, 10:14 AM | #534 |
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Your point is well taken. I suspect they'd argue that they deserve large rewards for taking a massive risk (All that debt without the diploma to back it up would pretty much end one's life prospects, I would guess?) and the massive amount of work they've had to do to end up a doctor. Whether the above is a valid argument I don't know. Any solution one implements is going to be opposed at every turn by those who have already climbed the mountain. |
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23rd February 2017, 10:26 AM | #535 |
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It would be the wrong kind of fun, I'll grant that.
On a more serous note along similar lines, I've heard it suggested that a certain amount of medical work that is currently done by doctors could be done by less expensive medical professionals (nurse-practitioners, nurses, physician's assistants and such) without significantly damaging the quality of patient care. Sounds reasonable to me, but I just don't know enough about the industry to know if it really makes sense. |
23rd February 2017, 10:35 AM | #536 |
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23rd February 2017, 10:44 AM | #537 |
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It's absolultey true that much of the work could be done by nurses or PAs... it's also true that there's a lot of industry opposition to that. Lots from doctors, some from insurance companies. I can only speak very broadly to the insurance side, as it's not my area of expertise. My understanding is that it gets complicated when the insurer is trying to balance their obligation to the safety and quality of care that is being accessed by their policyholders against the cost being charged to their policyholders. When there are doctors in the mix opposing that shift and arguing that the quality of care might suffer and that the risk to the patient is too great, it becomes a really difficult position.
Of course, my knowledge on this is only from within the insurance industry. And since it's not my particular area, I'm likely to be missing many other elements of the issue. Please assume that my response is both incomplete and likely to reflect some industry bias. |
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The distance between the linguistic dehumanization of a people and their actual suppression and extermination is not great; it is but a small step. - Haig Bosmajian |
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23rd February 2017, 10:45 AM | #538 |
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23rd February 2017, 10:54 AM | #539 |
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Not that I want to see our friend EC out on the street, but the fact that we have this massive health insurance industry in the US that eclipses similar industries in other western nations is our biggest problem. People don't need health insurance, they need health care.
Obamacare's bigger fault was in not offering a medicare for all option alongside the insurance options. We need to take out the middle man. |
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23rd February 2017, 10:57 AM | #540 |
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23rd February 2017, 10:58 AM | #541 |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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23rd February 2017, 11:00 AM | #542 |
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23rd February 2017, 11:04 AM | #543 |
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Actually they may do it better as they are more likely to follow guidelines.
Conversely in the US anaesthetics are often given by nurses, something always done by physicians in the UK (and any suggestion that they could be made redundant and replaced by nurses is not popular with anaesthetists!). The NHS has a pay structure that grades pay by responsibility, skills etc. So nurses like to do doctor-like jobs as they are well paid. Doctors are excluded from that pay structure because it would mean they would need be paid more than they already are! |
23rd February 2017, 11:29 AM | #544 |
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23rd February 2017, 12:43 PM | #545 |
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23rd February 2017, 02:29 PM | #546 |
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"Dogs in the wild" is kind of an oxymoron, IMO. Coyotes and wolves aren't fat. Dogs are domesticated creatures. People eat what's available too. But availability has gone through the roof.
I could be doing my laundry on a washboard with soap made of lye and bacon fat, true. I could chop the wood to build the fire to heat the water, but modern detergents mean the water doesn't need to be hot. I could at least put it on the line instead of tossing it in the dryer, but why? If evolution has favored conserving our energy, many if not most Americans face an uphill battle to lose weight. If there's famine, people carrying extra fat have an edge. Famines have been the norm around the world and through history. Are they, though? People are animals too. There's no evolved off-switch (AFAIK). People who binged while they could survived to breed. Evolution favors binging on fat, salt, refined carbs while we can. Middle age barely existed. We have information, and can act on it, but overweight people can still feel famished, and can easily feel too fatigued to exercise. That's why I mentioned barometric surgery: It builds discomfort into overeating. It's not a natural habitat, but humans (Americans, but others) have created an environment that might as well be our natural habitat if that's all we've ever known. How many fat parents have fat kids? Is that the kids' fault? Mike Pence agrees with you on the responsibility thing, and maybe it's better to just cut everyone loose. If we make the right choices we won't get sick. Aging, for example, is a terrible habit. |
23rd February 2017, 02:43 PM | #547 |
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However I think real data would be better than our somewhat abstract philosophizing. Anecdotes not so much.
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23rd February 2017, 03:42 PM | #548 |
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In the UK NICE has a role in determining which treatments are worth paying for.
There is also a judgement based on Quality of life adjusted life years. trying to make the inevitable rationing as fair as possible. |
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OECD healthcare spending Public/Compulsory Expenditure on healthcare https://data.oecd.org/chart/60Tt Every year since 1990 the US Public healthcare spending has been greater than the UK as a proportion of GDP. More US Tax goes to healthcare than the UK |
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23rd February 2017, 03:58 PM | #549 |
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That's what I thought, but I don't know the specifics, so I didn't want to venture too deep.
The point is that the determinations aren't made on a case by case basis (is this person worth this treatment) but on a treatment by treatment basis (when is this treatment worth the expense, if ever). |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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23rd February 2017, 04:30 PM | #550 |
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I don't know how it works in other countries, though
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23rd February 2017, 04:51 PM | #551 |
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Here we ask our insurance company if it is covered. They either allow or deny the procedure with almost no insight into why. Most normal stuff is covered most of the time. If it is denied the patient can appeal the decision within the insurance company if the doctor is willing to go to bat for them and say it is necessary. If it is still denied I would assume you go to arbitration. I don't think these cases often make it into court because the insurance companies don't want them to.
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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24th February 2017, 12:39 AM | #552 |
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In principle what you say is true. In practice there remains one doctor and the patient in front of her. Excepting very expensive treatments, the doctor can give any treatment. They may be queried on it, but if there is some justification, e.g. the patient will not take any blue tablet, then it will go through.
Most of NICE guidance is more about what the health service should supply, e.g. that hospitals should have thrombolytic service for patients presenting within four hours of a stroke. This then means having an infrastructure of 24 hour emergency brain scans and people to report them. This may mean the scan reported at a neuroscience centre or diverting the patients to the neuroscience centre (depending on time for transfer). The major cost here is not the clot buster drug, but the infra structure. Some individuals will do very well, some will be killed by the treatment, so the QUALY is an average for a population, not an individual gain. FWIW NICE defines cost effective treatment as < £20,000 per QUALY, and >£30,000 as not cost effective. There is obvious wiggle room. A Qualy is a quality adjusted life year, so if a treatment gives you one year of perfect life that is a QUALY, two years but with significant disability might be a QUALY. Average expenditure per person on the NHS is about £2,100 / year. Although much of the headlines focus on NICE saying a new cancer treatment is too expensive (which usually results in a back room deal; the NHS is a big purchaser, and the cost of production of a drug is low, the real cost is the investment in getting to market; so any sale is worthwhile), what is missed is the permissive drive from NICE saying that certain things must be delivered. NICE also sets standards that services should achieve. |
24th February 2017, 10:04 AM | #553 |
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24th February 2017, 10:23 AM | #554 |
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It does seem like a dream system compared to ours.
Why people trust an insurance company that slow paid them on their clearly covered car repair and haggled over the hail damage to their greenhouse to be fair when it comes to determine whether they get very expensive cancer treatment is beyond me. |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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24th February 2017, 10:45 AM | #555 |
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I've seen several arguments against NHS that are reasonable. I don't necessarily agree with them, but the arguments themselves were valid. But I've never seen a valid and reasonable argument against NICE. NICE is nice.
See, now we're stepping into grounds where I'm going to end up getting pedantic . First off, Property, Auto, and Health insurance are all completely different entities, with different standards of practice, different rules, and different regulations. Lumping them all together in your comparison is kind of (but not exactly!) like lumping credit unions, banks, and investment firms in the same bucket. Sure they all deal with money... but they're not interchangeable. Beyond that... Most of the time (not all the time!) health insurers are quite fair when they come to their determinations. They are fair to the contractual obligations that they and the policyholder are both bound by. The insurer has an obligation to the policyholder receiving treatment, but they also have an obligation to all of the other policyholders that are paying for that treatment. They have a duty to be a prudent and ethical steward of their policyholders' finances. Insurance is first and foremost a vehicle for financial protection. It is NOT a vehicle for delivery of care (with the exception of staff-model HMOs, an entirely different topic). Insurers do not provide care; they contract with providers of care to ensure access and discounted rates for their policyholders. An insurer will (and should) deny care that violates the terms of the insurance contract - failure to do so would disadvantage their other customers by imposing a financial burden to which they did not agree. Now... that said... it is also absolutely true that in the past, some insurers have taken their obligations waaaay to far to one side or the other. The ones who take it too far in support of the patients using high-cost services tend to become insolvent and go out of business. The ones who take it too far in support of the policyholders not using services tend to be universally hated by the small number of patients for whom they've denied care who are often quite vocal and outrages... and they also go out of business because nobody buys their product. It's a really skinny fence to sit on. Insurance companies have a lot of splinters in really uncomfortable places. |
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The distance between the linguistic dehumanization of a people and their actual suppression and extermination is not great; it is but a small step. - Haig Bosmajian |
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24th February 2017, 10:49 AM | #556 |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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24th February 2017, 10:54 AM | #557 |
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I know you do
Well, they pay **me** pretty well. But if you're talking about the industry as a whole... those splinters are surprisingly mediocre. The average profit margin in the health insurance industry is around 5%. And it's only that high because there are a very few national for-profit companies that skew the averages. Humana, Aetna, and United tend to run at a slightly higher margin - around 8% IIRC. But most of the regional and/or not-for-profit insurers tend to run closer to 2%. In just about any other industry, a consistently low 2% profit margin would be considered ridiculously low. Heck, even hospitals, pharmaceuticals, and medical device/supply companies have significantly higher margins than insurers do. |
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The distance between the linguistic dehumanization of a people and their actual suppression and extermination is not great; it is but a small step. - Haig Bosmajian |
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24th February 2017, 11:03 AM | #558 |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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24th February 2017, 11:59 AM | #559 |
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Median doctor pay 170 to 200K for their education, and the median GP get 200K per year. Specialist can earn more than the double.
https://thedoctorweighsin.com/how-mu...-doctors-make/ I doubt the median doctor will be long saddled by debt. |
24th February 2017, 01:25 PM | #560 |
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Most companies are pretty executive friendly... but most of them are investor friendly as well.
Maybe some day I'll be an executive. Still not there yet. ETA: On second thought, I'm not sure I really want the headaches and the responsibility that comes with that job. Manager is sufficiently exhausting and gray-hair-ifying already. |
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The distance between the linguistic dehumanization of a people and their actual suppression and extermination is not great; it is but a small step. - Haig Bosmajian |
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