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

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Old 7th March 2017, 08:04 PM   #721
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Originally Posted by thaiboxerken View Post
For some reason, they want to push this through before the CBO can crunch the numbers and give us estimates on how much it will cost and how many more (or less) people will be covered.

Heck, they haven't even given their own estimates have they?
I think the House GOP plan is something like 1) create something that looks like an actual plan and push it through the House as quickly as possible before anyone realizes how much it sucks, 2) hand the stinking thing over to the Senate hoping that the Dems will filibuster it so we don't know how bad it is by practical experimentation, 3) allow it to die in the Senate, 4) loudly denounce the vile and evil Democrats for not caring about the sick, the elderly, America, apple pie, etc. 5) If anyone in the future points out how bad the plan is, scream "GOD BLESS AMERICA!" at them over and over again until they go away...
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Last edited by Random; 7th March 2017 at 08:05 PM.
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Old 7th March 2017, 08:08 PM   #722
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Originally Posted by pgwenthold View Post
That's what I've heard. If that is true, how can anyone support it? I'd like to hear from right-wingers how it would be acceptable to rush a bill through without a projection of costs?

Then again, rumors from the last GOP meeting is that they are going to need D support to get it to pass, because they don't have enough GOP votes.
Republicans can support it because they have no shame and don't actually care about fiscal responsibility.
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Old 7th March 2017, 08:11 PM   #723
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Originally Posted by thaiboxerken View Post
Republicans can support it because they have no shame and don't actually care about fiscal responsibility.
That and they never get sick. Or maybe all Republicans are rich. Or they just hate America, or drive to Mexico to buy their prescription meds, or are all secret nihilists and want to die.

It must be something. It can't be they actually think they have a better idea.
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Old 7th March 2017, 08:13 PM   #724
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Originally Posted by marplots View Post
It can't be they actually think they have a better idea.
I agree 100%. If they actually thought it was a better idea, they'd allow it to be vetted and checked by the CBO.
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Old 7th March 2017, 08:14 PM   #725
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Originally Posted by thaiboxerken View Post
For some reason, they want to push this through before the CBO can crunch the numbers and give us estimates on how much it will cost and how many more (or less) people will be covered.

Heck, they haven't even given their own estimates have they?
The GOP has been spreading a lie that the ACA wasn't even read before it was passed. That is why they are promoting this replacement with the hashtag #readthebill.

A rational legislature would #dothemath before voting on any complex legislation.
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Old 7th March 2017, 08:18 PM   #726
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Originally Posted by marplots View Post
That and they never get sick. Or maybe all Republicans are rich. Or they just hate America, or drive to Mexico to buy their prescription meds, or are all secret nihilists and want to die.

It must be something. It can't be they actually think they have a better idea.
Congress enjoys excellent health benefits as part of their generous compensation working for the government than half of them profess to be a wicked, evil thing.
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Old 7th March 2017, 08:25 PM   #727
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Originally Posted by Skeptic Ginger View Post
This is naive. Other countries have national health insurance and everyone pays less.

You right wingers need to open your eyes. Some things are better covered by the community than the individual just as much as some things are better covered by the individual.

Imagine a country withe libertarian road building. A conservative dream. No government interference ... or funding.

At least people would spend more time at home.
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Old 7th March 2017, 08:35 PM   #728
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Originally Posted by quadraginta View Post
Imagine a country withe libertarian road building. A conservative dream. No government interference ... or funding.

At least people would spend more time at home.
For what its worth, I actually did write a letter to the White House pitching my libertarian health care scheme. So if it happens you're welcome.
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Old 7th March 2017, 08:39 PM   #729
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Originally Posted by marplots View Post
While it is not true that "everyone pays less" it is true that healthcare can be delivered differently.



This too is a matter of choice. We could, for example, decide that gasoline was better treated as a utility, supplemented for the poor, and so on. It is not true that "healthcare" is some kind of natural right, nor that it has been for most of our country's history. Historically, you got the amount of healthcare you could afford and no more - just as you can get as much electricity or gasoline now.

I understand the idea that medical care is a commodity is met with moral outrage, but let's leave that card for the WWJD crowd to play. The truth is the life-saving bit is far outweighed by consumers desiring treatments not directly linked to mortality or even quality of life issues. In a commodity environment there is one tried and true path to cost reduction - buy less.
I notice you went with all your moral reasoning and completely ignored where the free market fails health care.
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Old 7th March 2017, 08:42 PM   #730
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Originally Posted by marplots View Post
That and they never get sick. Or maybe all Republicans are rich. Or they just hate America, or drive to Mexico to buy their prescription meds, or are all secret nihilists and want to die.

It must be something. It can't be they actually think they have a better idea.
Oh they think they have a better idea alright, but given no plan actually emerged after 6+ years, is pretty good evidence they don't actually have any better ideas.

The GOP sold slogans and lies. They flew off the shelves like hotcakes.
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Old 7th March 2017, 08:44 PM   #731
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Originally Posted by TragicMonkey View Post
Congress enjoys excellent health benefits as part of their generous compensation working for the government than half of them profess to be a wicked, evil thing.
Correct. And whichever party's legislation is adopted, they will probably be exempt.
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Old 7th March 2017, 08:46 PM   #732
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Originally Posted by marplots View Post
Correct. And whichever party's legislation is adopted, they will probably be exempt.
Are they exempt from the ACA now?
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Old 7th March 2017, 08:46 PM   #733
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Originally Posted by marplots View Post
While it is not true that "everyone pays less" it is true that healthcare can be delivered differently.



This too is a matter of choice. We could, for example, decide that gasoline was better treated as a utility, supplemented for the poor, and so on. It is not true that "healthcare" is some kind of natural right, nor that it has been for most of our country's history. Historically, you got the amount of healthcare you could afford and no more - just as you can get as much electricity or gasoline now.

I understand the idea that medical care is a commodity is met with moral outrage, but let's leave that card for the WWJD crowd to play. The truth is the life-saving bit is far outweighed by consumers desiring treatments not directly linked to mortality or even quality of life issues. In a commodity environment there is one tried and true path to cost reduction - buy less.
Do you really believe this?? This is so different from my own experiences and those of my family, friends, and acquaintances that you and I must be on different planets! The vast majority of the people I know desperately resist seeing seeking medical help! They hope against hope that they will get better on their own, and only make a doctor's appointment if driven to it by fear or when they become so ill that they come to believe that they have no alternative. Sure- most of their conditions are not "life-threatening" at the time they first see the doctor but they almost always impact significantly on quality of life. And many of even these conditions, if allowed to progress untreated, can worsen into much more serious, and yes, life-threatening diseases. I've had a common cold that, because I resisted seeing a doctor for something so trivial, progressed to pneumonia and came close to killing me. My sister put off a minor surgery because the problem wasn't too serious- until it suddenly impaired her breathing and she was hospitalized close to death for a month! Friends who were saved from blindness because they saw a doctor when their symptoms progressed enough to scare them into doing so when their condition was still reversible. I could name example after example.

Most people do not like going to doctors- it makes them nervous, they have to take time off work and/or other obligations, they have to find some way to get to the doctor, they then find themselves waiting and waiting in a room with lots of other sick people, and yes, it does cost them significant money even if they have insurance (if only as a co-pay). Virtually no one I know wouldn't prefer to do almost anything else.

You present it as if most people seeking doctors are seeking trivial medical interventions: cosmetic surgery perhaps, or perhaps hand-holding! Or are you setting an amazing high standard for "quality of life?" Are you proposing that kids with serious respiratory infections, adults in real pain, old people with multiple health issues that limit their day to day lives should either be able to fork over the dough or just buck up and suffer in silence if they are anything less than close to death? Apparently only wealthy people are allowed in your world view to "simply feel good" physically whereas poorer people have no such right unless they are actually crippled or dying. This has been tried before- look at Victorian England. I don't think it worked out too well for individuals or for society as a whole.

Last edited by Giordano; 7th March 2017 at 08:49 PM.
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Old 7th March 2017, 08:48 PM   #734
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Originally Posted by Skeptic Ginger View Post
I notice you went with all your moral reasoning and completely ignored where the free market fails health care.
You mean OTCs? Ever wonder what prescription aspirin would cost?

A good reason not to have a "free market" for healthcare isn't because of cost considerations, but because we don't want nefarious doctors having too easy a time stealing from the rest of us. We want them to be licensed and regulated. Oversight means regulation and restricts the market.

What isn't obvious is how far the regulations ought to go.
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Old 7th March 2017, 08:55 PM   #735
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Originally Posted by Giordano View Post
Do you really believe this?? (the rest of a good post snipped to save space)
We can look at some data: https://www.washingtonpost.com/news/...ription-drugs/

"Nearly 3 in 5 American adults take a prescription drug, up markedly since 2000 because of much higher use of almost every type of medication, including antidepressants and treatments for high cholesterol and diabetes.

In a study published Tuesday in the Journal of the American Medical Association, researchers found that the prevalence of prescription drug use among people 20 and older had risen to 59 percent in 2012 from 51 percent just a dozen years earlier. During the same period, the percentage of people taking five or more prescription drugs nearly doubled, to 15 percent from 8 percent."


Or this: http://www.cnbc.com/2016/04/27/ameri...id-supply.html

"Americans are in more pain than any other population around the world. At least, that's the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States."

How old are your friends and family? Maybe they haven't yet gotten on the healthcare bus - or they don't have the type of insurance that pays for it.

ETA: More stats from the CDC: https://www.cdc.gov/nchs/fastats/dru...herapeutic.htm

Last edited by marplots; 7th March 2017 at 08:59 PM.
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Old 7th March 2017, 09:00 PM   #736
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Originally Posted by thaiboxerken View Post
Are they exempt from the ACA now?
No. Members of Congress, Senators and their staff are required to have insurance just like most legal US residents. A clause in the ACA requires them to choose from the policies available to any DC resident on the healthcare exchange. The government pays about 80% of the premium and they pay the rest.
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Old 7th March 2017, 09:16 PM   #737
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Originally Posted by xjx388 View Post
Well, I for one am rather disappointed in this effort. This is only marginally different than ACA and it's certainly not seeming to be much better. The party in power seems to have cobbled together a crap plan quickly rather than taking their time to craft something truly innovative.

IMO they are just paving the way for the eventual single payer or government owned healthcare system.
The GOP plan is a step away from pools, not toward them. Without the individual mandate there is no UHC. The mandate was a conservative idea, but the GOP has been forced to disown it because they could not stand seeing it pressed into service by Democrats. It looks like we're back to a free rider/take your chances system.

The tax credit does not appear to be broadly means-tested (I could be wrong). Under the ACA subsidies were means-tested by way of federal tax returns. I get back some of what I pay; I think people can also pre-qualify to have it taken off their insurance premium.

With most Americans covered through work or by Medicare/Medicaid/VA etc., they are part of pools that can negotiate prices through volume. Will individuals have the same bargaining power? I doubt it.

A small thing is bothering me. My mom's provider said a liver enzyme was high and she needed another blood test. If it's still inflated Medicare will pay for an ultrasound. But today, before the 2nd blood draw, the ultrasound clinic was trying to get her scheduled. So it sounds like the clinic is doing it on spec, which it would only be doing if it has surplus imaging capacity (idle machine and/or staff). Meanwhile, also today, my aunt said her husband needs an MRI of his brain and she has to pay $200. I asked what they were going to do with that information and she didn't know. Both my aunt's and my mom's case came up in a single day. Just a coincidence, but imaging has been cited as a major factor driving up U.S. health-care costs.
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Old 7th March 2017, 09:23 PM   #738
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Originally Posted by marplots View Post
You mean OTCs? Ever wonder what prescription aspirin would cost?

A good reason not to have a "free market" for healthcare isn't because of cost considerations, but because we don't want nefarious doctors having too easy a time stealing from the rest of us. We want them to be licensed and regulated. Oversight means regulation and restricts the market.

What isn't obvious is how far the regulations ought to go.
Bah, Yelp will keep doctors honest. The modern medical licensing scheme predated the internet. Nowadays, bad actors could be outed and customers could choose the best available fellow in their price range. The only drugs that even need to be prescription-only are antibiotics. Let people buy their Viagra and Oxy at the gas station instead of that gentleman lurking around behind the gas station. Health care costs would plummet in short order. Doctors would compete like fast food stores for customers. Nothing could possibly go wrong.
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Old 7th March 2017, 09:29 PM   #739
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Originally Posted by Civet View Post
Bah, Yelp will keep doctors honest. The modern medical licensing scheme predated the internet. Nowadays, bad actors could be outed and customers could choose the best available fellow in their price range. The only drugs that even need to be prescription-only are antibiotics. Let people buy their Viagra and Oxy at the gas station instead of that gentleman lurking around behind the gas station. Health care costs would plummet in short order. Doctors would compete like fast food stores for customers. Nothing could possibly go wrong.
I think you'd still see the emergence of a guild with self-regulation. If for no other reason than as a marketing tool. Presumably, and certainly for my child, I will be willing to pay more for a UL listed doctor or nurse.
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Old 7th March 2017, 09:58 PM   #740
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Originally Posted by Kestrel View Post
No. Members of Congress, Senators and their staff are required to have insurance just like most legal US residents. A clause in the ACA requires them to choose from the policies available to any DC resident on the healthcare exchange. The government pays about 80% of the premium and they pay the rest.
Ya, I know. I wanted Marplots to understand this.
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Old 7th March 2017, 10:13 PM   #741
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Originally Posted by marplots View Post
You mean OTCs? Ever wonder what prescription aspirin would cost?

A good reason not to have a "free market" for healthcare isn't because of cost considerations, but because we don't want nefarious doctors having too easy a time stealing from the rest of us. We want them to be licensed and regulated. Oversight means regulation and restricts the market.

What isn't obvious is how far the regulations ought to go.
No not OTCs! Not to mention aspirin is as cheap as dirt and is not a problem that I'm aware of (excluding the years the industry resisted proper hazard labeling so that manufactures could make 5 more years of profit at the cost of hundreds of needless deaths from Reyes Syndrome, but selling science doubt is another issue).

Just as I thought, you prove you don't know what you are talking about nor have you considered actual issues with the free market.

Allow me to repost my very simple examples. Maybe this time you'll actually read past the first line in my post. I'm not holding my breath.
The uninsured get emergency care and leave the hospital with bad debt that paying consumers end up paying.

The market encourages copycat drugs to take a share of the known market usually by marketing and almost never by being better drugs.

The market is not conducive to investing R&D in new antibiotics until deaths from drug resistant infections are rampant.

The list goes on. The market does not solve all ills and it's not just about the right to healthcare.

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Old 7th March 2017, 10:34 PM   #742
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Originally Posted by Skeptic Ginger View Post
Just as I thought, you prove you don't know what you are talking about nor have you considered actual issues with the free market.
I am not arguing for a free market solution to healthcare costs in the US. If you think I am, you have misunderstood something.

Quote:
Allow me to repost my very simple examples. Maybe this time you'll actually read past the first line in my post. I'm not holding my breath.
The uninsured get emergency care and leave the hospital with bad debt that paying consumers end up paying.

The market encourages copycat drugs to take a share of the known market usually by marketing and almost never by being better drugs.

The market is not conducive to investing R&D in new antibiotics until deaths from drug resistant infections are rampant.

The list goes on. The market does not solve all ills and it's not just about the right to healthcare.
You are making things up to argue against. Healthcare can be run under the free market rubric - plainly this is so, since that's how it was done for hundreds of years. This is true even though all the downsides you mention are correct.

What you are missing is that we can choose those downsides. That's really all I was talking about - the way we run healthcare is a choice, we are not forced to act in some particular way.

Here is perhaps a less contentious choice: Allow nurse practitioners and physicians assistants more privileges and allow doctors to supervise more of each in a distributed system to lower labor costs. That's a choice we can make, but only with the condition that the choosers (John Q Public) understand the consequences, both good and bad.
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Old 7th March 2017, 11:01 PM   #743
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Originally Posted by marplots View Post
I think you'd still see the emergence of a guild with self-regulation. If for no other reason than as a marketing tool. Presumably, and certainly for my child, I will be willing to pay more for a UL listed doctor or nurse.
Oh, absolutely. To treat the subject a bit more seriously than I did before, I think we'd see significant levels of self-regulation by the medical service provider community and a quasi-regulatory role for the insurance industry. For health care providers, we'd probably wind up with a multi-tier system. Something like: 1) Accredited - people with some kind of certification very similar to what health care providers have today; 2) Unaccredited - people with widely varying skill sets and education levels who would be able to effectively treat some basic ailments but would be a risky and cheaper choice for people with more serious or less common problems; 3) Wildcats - guy in a van with some gear he bought off eBay who totally doesn't think this looks that hard. The pharmaceutical sales market would just go buckwild and that could create some serious problems.
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Old 7th March 2017, 11:15 PM   #744
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Originally Posted by marplots View Post
I am not arguing for a free market solution to healthcare costs in the US. If you think I am, you have misunderstood something.
Let's start here. Cost is only one issue of many. Your tunnel vision is not doing you any favors.


Originally Posted by marplots View Post
You are making things up to argue against. Healthcare can be run under the free market rubric - plainly this is so, since that's how it was done for hundreds of years. This is true even though all the downsides you mention are correct.

What you are missing is that we can choose those downsides. That's really all I was talking about - the way we run healthcare is a choice, we are not forced to act in some particular way.

Here is perhaps a less contentious choice: Allow nurse practitioners and physicians assistants more privileges and allow doctors to supervise more of each in a distributed system to lower labor costs. That's a choice we can make, but only with the condition that the choosers (John Q Public) understand the consequences, both good and bad.
The choice you are stuck on has already been made. Nurse practitioners fought that battle in the 70s and 80s. I know, I am a nurse practitioner.

As for, 'always been run that way', we used to take lots of tonsils out until we discovered evidence based medicine.

Take a breath, forget market driven costs and either look again at the issues I pointed out, or stop wasting my time with your tunnel vision.
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Old 7th March 2017, 11:15 PM   #745
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Originally Posted by marplots View Post
We can look at some data: https://www.washingtonpost.com/news/...ription-drugs/

"Nearly 3 in 5 American adults take a prescription drug, up markedly since 2000 because of much higher use of almost every type of medication, including antidepressants and treatments for high cholesterol and diabetes.

In a study published Tuesday in the Journal of the American Medical Association, researchers found that the prevalence of prescription drug use among people 20 and older had risen to 59 percent in 2012 from 51 percent just a dozen years earlier. During the same period, the percentage of people taking five or more prescription drugs nearly doubled, to 15 percent from 8 percent."


Or this: http://www.cnbc.com/2016/04/27/ameri...id-supply.html

"Americans are in more pain than any other population around the world. At least, that's the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States."

How old are your friends and family? Maybe they haven't yet gotten on the healthcare bus - or they don't have the type of insurance that pays for it.

ETA: More stats from the CDC: https://www.cdc.gov/nchs/fastats/dru...herapeutic.htm
And what is your evidence that this prescription drug use is mostly inconsequential and of no significant benefit to most of the users. One reason for increased drug use is that there are more drugs that can help people. Or even more important what is your evidence that imposing a financial test is the best way to differentiate between those obtaining important benefits versus those not? That how much money one has is more important than the judgement of the FDA and the practicing physicians in terms of who can benefit from a prescription drug?

Sure I see the TV ads too and there are efforts by drug companies to increase the use of their drugs even when not necessary. But shouldn't that logically be dealt with by increased oversight and regulation, rather than "free market? ". Why assume that the ability to afford a drug reflects the need for it?

Is that legal opioid use? And if so, just how much of the total cost of health care does that represent?

In terms of age, the people I refer to do have good health insurance and are mostly middle age to seniors. The young people I know use health care even less.

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Old 7th March 2017, 11:51 PM   #746
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Originally Posted by marplots View Post
Yes it is. At least, the vast majority of it is. The fact that occasionally, medical intervention is life-saving is no different than everything else, which under certain circumstances can be life saving. If the only way to escape the murderer is a gun, then healthcare won't help.

Lest this sound like argument for argument's sake, I'd like to point out that underlying the issue, in a major way, is how much healthcare is the "right" amount and what are we willing (as a society) to pay for. We must not lose track of the choice element in play.
Apart from say a country like North Korea which countries that have a universal health scheme also removes the choice/s the people in the USA currently have (that was also available under ACA, and this new scheme and before ACA)?
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Old 8th March 2017, 12:00 AM   #747
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Originally Posted by Giordano View Post
And what is your evidence that this prescription drug use is mostly inconsequential and of no significant benefit to most of the users. One reason for increased drug use is that there are more drugs that can help people. Or even more important what is your evidence that imposing a financial test is the best way to differentiate between those obtaining important benefits versus those not? That how much money one has is more important than the judgement of the FDA and the practicing physicians in terms of who can benefit from a prescription drug?

Sure I see the TV ads too and there are efforts by drug companies to increase the use of their drugs even when not necessary. But shouldn't that logically be dealt with by increased oversight and regulation, rather than "free market? ". Why assume that the ability to afford a drug reflects the need for it?

Is that legal opioid use? And if so, just how much of the total cost of health care does that represent?

In terms of age, the people I refer to do have good health insurance and are mostly middle age to seniors. The young people I know use health care even less.
My contention was that decoupling payment from services in a consumer-driven environment leads to increased use, in contrast to your experience where people avoided going to the doctor. The data I had handy was about increased consumption in the US - that's all.

I think the disconnect came because either the people you knew were exceptions to the general trend, or because you were thinking by "healthcare" I only meant time spent at the doctor's office or hospital. But I am also including the continuing use of prescription medications, for which I think the US does have an appetite.

None of this has to do with whether or not we are taking the "right" number of pills. That would require demonstrating an outcome that differs based on how much medication we (as a society) take. What I don't think is disputed is that the cost of pharmaceuticals (and hence treatment with pharmaceuticals) has, and continues, to rise - sometimes dramatically.
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Old 8th March 2017, 12:20 AM   #748
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Originally Posted by Darat View Post
Apart from say a country like North Korea which countries that have a universal health scheme also removes the choice/s the people in the USA currently have (that was also available under ACA, and this new scheme and before ACA)?
The main choice is whether or not to pay for healthcare or forego it and keep the money. In the US, we pay part of the cost (co-pays/deductables) even though having insurance is mandatory. I believe the NHS in the UK is funded by tax dollars whether or not someone uses it and they don't recover costs by not seeking treatment. (I'm not under the NHS and don't know it very well.)

Here's an example of how it might differ.
There is some dispute about whether or not senior citizens should take cholesterol reducing drugs. If you only have a few years to live, why bother?

So I'm 70, 75, or 80...
If I pay, I probably would rather not and stop taking the drugs.
If I pay partially, it might depend on the cost and my income.
If I pay nothing, I might take them "just in case."

That's the choice matrix - the idea that healthcare decisions, and the associated costs, don't happen in a vacuum and aren't so easy to put on the better-to-best scale.
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Old 8th March 2017, 01:06 AM   #749
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Originally Posted by marplots View Post
The main choice is whether or not to pay for healthcare or forego it and keep the money. ...snip...
But you have never had that choice (at least in recent times) since you have your various "medi-" systems and such areas as emergency healthcare has always been provided to everyone even those that can't pay for it. And as far as I understand it the new system will not remove all that "free" healthcare so those costs will still have to be paid.


Originally Posted by marplots View Post
Here's an example of how it might differ.
There is some dispute about whether or not senior citizens should take cholesterol reducing drugs. If you only have a few years to live, why bother?

So I'm 70, 75, or 80...
If I pay, I probably would rather not and stop taking the drugs.
If I pay partially, it might depend on the cost and my income.
If I pay nothing, I might take them "just in case."

That's the choice matrix - the idea that healthcare decisions, and the associated costs, don't happen in a vacuum and aren't so easy to put on the better-to-best scale.
Because evidence based medicine has made huge strides in the last couple of decades it is rather a straightforward matter of evidence sifting (granted often that isn't easy) - to put treatments on the "better-to-best" scale.

The UK only has one "better than most" feature left as part of its healthcare systems and that is NICE.
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Old 8th March 2017, 01:09 AM   #750
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Originally Posted by marplots View Post
We can look at some data: https://www.washingtonpost.com/news/...ription-drugs/

"Nearly 3 in 5 American adults take a prescription drug, up markedly since 2000 because of much higher use of almost every type of medication, including antidepressants and treatments for high cholesterol and diabetes.

In a study published Tuesday in the Journal of the American Medical Association, researchers found that the prevalence of prescription drug use among people 20 and older had risen to 59 percent in 2012 from 51 percent just a dozen years earlier. During the same period, the percentage of people taking five or more prescription drugs nearly doubled, to 15 percent from 8 percent."


Or this: http://www.cnbc.com/2016/04/27/ameri...id-supply.html

"Americans are in more pain than any other population around the world. At least, that's the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States."

How old are your friends and family? Maybe they haven't yet gotten on the healthcare bus - or they don't have the type of insurance that pays for it.

ETA: More stats from the CDC: https://www.cdc.gov/nchs/fastats/dru...herapeutic.htm
Firstly this is an aggregate and tells nothing about the situation of various "class" of people.
And it here clearly spells out that in some case insurance status PLAY a role into getting a prescription
Quote:
Non-Hispanic white Americans take prescription drugs at roughly twice the rate of Mexican Americans. Researchers offered no clear explanation but said the disparity "was not entirely attributable" to differences in insurance status.
Secondly they also count insulin (and estrogen/progesterone hormone) as prescription drug, which while true, is not what most people have in mind when speaking of taking too much drugs.

Thirdly note this is about prescription drug, not visit to the hospital or visit to a specialist.

When my US friends complain about healthcare cost, it is usually not about most prescription drugs, but rather treatment to real illness or accident which are extremely costly with often a high copay. Hospital being the number one culprit.

And then there is stuff like heart operation and similar.

How many people do you think would not be bankrupted by one if they had to pay the real cost ?

Last edited by Aepervius; 8th March 2017 at 01:11 AM.
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Old 8th March 2017, 01:28 AM   #751
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Originally Posted by marplots View Post
Here is perhaps a less contentious choice: Allow nurse practitioners and physicians assistants more privileges and allow doctors to supervise more of each in a distributed system to lower labor costs. That's a choice we can make, but only with the condition that the choosers (John Q Public) understand the consequences, both good and bad.
I agree that giving PAs more initial screening and assessment responsibilities is a good idea. However, your last point is unrealistic. Fully 20% of adult Americans think the sun revolves around the Earth. 40% think angels are real beings. At one point more than 50% of Republicans believed that global warming was a hoax. These, and countless other statistics, indicate that for good health care outcomes as a nation, we cannot assume John Q. can understand the consequences of their decisions.
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Old 8th March 2017, 01:34 AM   #752
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Originally Posted by Darat View Post
But you have never had that choice (at least in recent times) since you have your various "medi-" systems and such areas as emergency healthcare has always been provided to everyone even those that can't pay for it. And as far as I understand it the new system will not remove all that "free" healthcare so those costs will still have to be paid.
I have that choice now. I think we must be talking about two different things. Right now, under Obamacare, I can get my toenail fungus treated by seeing a podiatrist (free) and getting two prescriptions ($8 each copay x 3 months supply = ~$32) and the travel costs. OR, I can buy an OTC treatment for about $14. OR I can just live with fungus and some homecare until it eventually goes away (hopefully). So there's a choice element and a price coercion, coupled with my beliefs about which is the best treatment in my situation.

Quote:
Because evidence based medicine has made huge strides in the last couple of decades it is rather a straightforward matter of evidence sifting (granted often that isn't easy) - to put treatments on the "better-to-best" scale.
Unfortunately, that is an aspiration which doesn't seem to be getting met. Here are a couple of papers outlining the issues:
http://www.donaldmiller.com/Real_Wor...d_Medicine.pdf
http://www.cmaj.ca/content/163/7/837.full.pdf
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Old 8th March 2017, 01:35 AM   #753
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Originally Posted by marplots View Post
In a study published Tuesday in the Journal of the American Medical Association, researchers found that the prevalence of prescription drug use among people 20 and older had risen to 59 percent in 2012 from 51 percent just a dozen years earlier.
That highlight part says increased drug use went up less than 1% per year. Zowie! Katy, bar the door.

I'd guess that in an aging population like in the USA going through the latter stages of a baby boom, the percentage of old people went up more than 1%. That statistic you cited is underwhelming, to say the least.
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Old 8th March 2017, 01:43 AM   #754
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Originally Posted by SezMe View Post
I agree that giving PAs more initial screening and assessment responsibilities is a good idea. However, your last point is unrealistic. Fully 20% of adult Americans think the sun revolves around the Earth. 40% think angels are real beings. At one point more than 50% of Republicans believed that global warming was a hoax. These, and countless other statistics, indicate that for good health care outcomes as a nation, we cannot assume John Q. can understand the consequences of their decisions.
That is indeed a serious challenge. Where we end up does depend a great deal on how much freedom we allow in the system. There's a lot of room between "anything goes" and enjoy your crack, to the other extreme where I am treated like a foolish child.
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Old 8th March 2017, 01:48 AM   #755
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Originally Posted by SezMe View Post
That highlight part says increased drug use went up less than 1% per year. Zowie! Katy, bar the door.

I'd guess that in an aging population like in the USA going through the latter stages of a baby boom, the percentage of old people went up more than 1%. That statistic you cited is underwhelming, to say the least.
Are you assuming that older people should be taking more medication as a matter of course? Why?

But to your point, here is a graph showing the median age in the us. Look at the years from 2000 to 2015 to see if your point stands:
https://www.statista.com/statistics/...us-population/
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Old 8th March 2017, 01:57 AM   #756
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Originally Posted by marplots View Post
I have that choice now. I think we must be talking about two different things. Right now, under Obamacare, I can get my toenail fungus treated by seeing a podiatrist (free) and getting two prescriptions ($8 each copay x 3 months supply = ~$32) and the travel costs. OR, I can buy an OTC treatment for about $14. OR I can just live with fungus and some homecare until it eventually goes away (hopefully). So there's a choice element and a price coercion, coupled with my beliefs about which is the best treatment in my situation.



Unfortunately, that is an aspiration which doesn't seem to be getting met. Here are a couple of papers outlining the issues:
http://www.donaldmiller.com/Real_Wor...d_Medicine.pdf
http://www.cmaj.ca/content/163/7/837.full.pdf
I'm not seeing the difference, you have the same choices in the UK and the same choices previously and under ACA and under the new system. Whichever way you slice it there isn't a difference.
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Old 8th March 2017, 02:44 AM   #757
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Originally Posted by Darat View Post
I'm not seeing the difference, you have the same choices in the UK and the same choices previously and under ACA and under the new system. Whichever way you slice it there isn't a difference.
The incentives are different. Under the NHS and free care, it costs me the same amount whether I get professional care or not. Under Obamacare, some options cost me more than others. Under the newly proposed system (Trumpcare?) the costs may be hugely different.

So yes, in a sense I have the same options, but there are different incentives pushing me toward one option over another. Income also has an influence - I might not see much difference between spending $32 and $14, or that may be meaningful if I'm poor enough.

(Also, I'm assuming the NHS is free, but I'm not very familiar with it.)
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Old 8th March 2017, 03:45 AM   #758
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Originally Posted by marplots View Post
The incentives are different. Under the NHS and free care, it costs me the same amount whether I get professional care or not. Under Obamacare, some options cost me more than others. Under the newly proposed system (Trumpcare?) the costs may be hugely different.

So yes, in a sense I have the same options, but there are different incentives pushing me toward one option over another. Income also has an influence - I might not see much difference between spending $32 and $14, or that may be meaningful if I'm poor enough.

(Also, I'm assuming the NHS is free, but I'm not very familiar with it.)
Treatment under the NHS is pretty much free at the point of demand. No one with a debilitating condition or suddenly suffering a major accident would be faced with a sudden crippling demand for money at a crisis point in their lives. In Scotland and Wales even prescription drugs are free, the logic being that it costs more to have a bureaucratic system in place to administer the payments for drugs than to allow free access to necessary medicines. It is far from a prefect system, but it works for the most part and is something the vast majority of people in the UK feel strongly about protecting.
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Old 8th March 2017, 04:46 AM   #759
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Originally Posted by marplots View Post
While it is not true that "everyone pays less" it is true that healthcare can be delivered differently.



This too is a matter of choice. We could, for example, decide that gasoline was better treated as a utility, supplemented for the poor, and so on. It is not true that "healthcare" is some kind of natural right, nor that it has been for most of our country's history. Historically, you got the amount of healthcare you could afford and no more - just as you can get as much electricity or gasoline now.

I understand the idea that medical care is a commodity is met with moral outrage, but let's leave that card for the WWJD crowd to play. The truth is the life-saving bit is far outweighed by consumers desiring treatments not directly linked to mortality or even quality of life issues. In a commodity environment there is one tried and true path to cost reduction - buy less.
Exactly the poor need to be left to die from easily treated issues. When will people learn that important foundation of libertain health care and when will our politicians just answer with "well in that situation if you can not afford the $1500 a month medication you die".
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Old 8th March 2017, 04:48 AM   #760
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Originally Posted by marplots View Post
That and they never get sick. Or maybe all Republicans are rich. Or they just hate America, or drive to Mexico to buy their prescription meds, or are all secret nihilists and want to die.

It must be something. It can't be they actually think they have a better idea.
No it will not apply to the elected officials. Trump voters many of them felt that he couldn't possibly do anything to remove their health care no matter how much he campaigned on it.

The people actually voting on it are safe, the people who voted for them will by what ever propaganda blames the democrats for their loss of coverage.
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