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17th January 2017, 12:40 AM | #81 |
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Why is dental separate anyway? In the veterinary field, there is no distinction. Dental health is absolutely part of, well, health.
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17th January 2017, 12:55 AM | #82 |
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Wrong with it? Nothing jumps out. I was just trying to explain the difference between what was described an the US system. Both have limits, it's just that the limits kick in in different places.
The question was what happens when a limit is hit. I claimed the same thing happens in either country - you pay for it yourself or you do without. Is my claim correct? I don't live in Australia, so maybe I'm wrong. The "kicks in in different places" comes from my experience under various health care systems in the US. Over the years I've been a) without health care b) under a government low-income plan c) in the military health care system d) privately insured. All of those systems paid different amounts for different things. |
17th January 2017, 01:14 AM | #83 |
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Trump also says he will negotiate drug prices for Medicare. His HHS proposed secretary Tom Price voted against that when he was in congress.
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17th January 2017, 01:17 AM | #84 |
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There is no limit on Medicare covered health care. If you want care above that covered by Medicare you pay for it.
And to Tsukasa, you can get free emergency dental care through public dental hospitals, but non-emergency preventative care you pay for. I have no problem with this. Funding elective health care, private rooms, cosmetic surgery and so on across the nation would be a huge drain on Australia's budget. We have a generous welfare system as it is. |
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17th January 2017, 02:08 AM | #85 |
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there is no limit on health care in australia as such...the whole elective issue is a shady one, People don't go without on the whole.
if you are ill you go to the doctor, as many times as you need, if i was terribly ill, or a nut, i could go once a week, i would still be covered, the doctors may hide from me.. if you need a specialist you get referred to one, if you need hospital you go to one. in the country at least, there appears to be little tangible benefit to the cost of health insurance. the city may well be different. |
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17th January 2017, 02:17 AM | #86 |
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17th January 2017, 03:09 AM | #87 |
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17th January 2017, 03:17 AM | #88 |
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They use that language in the US too. Sometimes an insurance company will deny payment because "you don't need it." They say it a bit nicer though: "not medically justified."
Sometimes they have turf wars over it. Your doctor might say you need it and their staff doctors say not. It can become a mess. It can become, "care delayed is care denied." Sometimes lawyers get involved. |
17th January 2017, 03:47 AM | #89 |
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no, not like that... non life saving surgeries are classified as elective, but good surgeons gwr around that,
nothing like that could ever happen in australia, we have a right to that medical care. |
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17th January 2017, 03:54 AM | #90 |
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17th January 2017, 04:00 AM | #91 |
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17th January 2017, 04:59 AM | #92 |
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This is a curious strategy.
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17th January 2017, 06:06 AM | #93 |
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17th January 2017, 06:13 AM | #94 |
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17th January 2017, 06:51 AM | #95 |
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17th January 2017, 07:05 AM | #96 |
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Some people thought the Affordable Care Act was going to create "Death Panels", groups of bureaucrats with no medical training who would decide if people received medical treatment or not. They obviously didn't realize that we already have them, but they're called insurance companies. |
17th January 2017, 07:14 AM | #97 |
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17th January 2017, 07:23 AM | #98 |
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17th January 2017, 08:42 AM | #99 |
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Yeah, this was always my argument. Every time people talk about the supposed evils of having the government involved in paying for health care, I just think "But... that problem already exists. It's built into the insurance companies, and they are motivated by profit".
My wife is PA and because a particular disease that makes up the bulk of her patient's problems is cured by an insanely expensive drug, she has to argue with insurance companies constantly. Sometimes they are still denied despite her and her supervising physician spelling out why the treatment is necessary. And they try anything to deny the treatment - one insurance company had extremely limited hours in which she could call and she'd be on hold for hours. It once took her 2+ weeks to get in contact with the person who could do the approval. Another example is my sister. She moved to the UK years ago and moved from one side of town to another. The move meant that she couldn't use the doctor she liked because she moved to a different catchment or whatever. To my parents this was a complete indictment of the NHS and absolute proof of how horrible it is. To which I responded "Didn't you JUST have to change primary physician because he's no longer in your insurance network?" They STILL bring this up years later as evidence of the evils of socialized medicine, despite my sister being a vehement supporter of the NHS, despises the US model, and now actually works for the NHS. |
17th January 2017, 09:01 AM | #100 |
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Medicare and Medicaid are not currently allowed to bargain with drug companies over prices, even though private insurance companies are. Combined, they insure over 100,000,000 Americans. They could negotiate far better prices for medicines. This wouldn't change the copays for the insured, though. They'd still be spending the same amount of money. But the government would see savings. That savings would be, maximum, $16B a year. That's not nearly enough to pay for anything Trump wants to do. It won't lower taxes. It'll lower the federal deficit by only 3.2%. So, in sum, the US could "magically" get drug companies to lower their prices but Trump is wrong wrong wrong that this money would magically make a damn bit of difference to any consumer or the government's budget. |
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17th January 2017, 09:02 AM | #101 |
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It's still the cost of the care that drives this whole mess. We keep attacking the wrong problem.
It doesn't matter how accessible insurance is or what cost they assign to premiums as long as the cost of care keeps increasing exponentially. "Affordable insurance" just leaves more out of pocket expenses for deductibles, co-insurance, and co-pays. Regardless of how much insurance pays, there is still an allowable cost that the doctors and hospitals expect to have covered. In part, I get it. They leave school with $200,000 in student loan debt and want to be rewarded for their 10 - 12 years of effort. Pharmaceutical companies that patent new treatments want to be reimbursed (and profit) from all the research money spent that didn't lead to anything or led to the drug being released. Of course hospitals need big fancy fountains in their lobby and architectural masterpiece facilities so their patients are more comfortable and think, "Look at that fountain. They must be a great facility!". It's cost, cost, and cost that is the issue. "Fixing" insurance won't change a thing if they can't control costs. I know someone very well who works in a hospital setting. It's ridiculous the things they do to drive revenue. If I have a maintenance drug, the hospital won't let me bring it with me and self administer while under their care. No problem if I take it at home, but I have to get it from them at their hospital prices if I'm under their care. Not all hospitals do this, but it is being done by some and looked at by many others. $5 a pill for a drug that I can fill a 90 day supply for $10 cash (without insurance). |
17th January 2017, 09:11 AM | #102 |
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Personally I was bitterly disappointed that there were no government Death Panels. I had hoped to be appointed to one if they ever formed. There are some people I know who I would have loved to have come before my panel...
More seriously, your point about insurance companies is absolutely accurate. In most cases, even when the insurance company ultimately agrees to pay for very costly therapy, that only happens after a great deal of phone tag and long discussions/much paper work and repeated discussion between the patient, the doctor, the insurance company, the pharmacy, and the hospital billings department. It involves whether the insurance company will cover the expense at all, and if they finally agree the expense is indeed part of their obligatory contract, what the co-pay will be (these various interpretations can involve the patient paying anywhere from hundreds of hundreds of thousands of dollars to a few thousand dollars). In all reality the insurance company not only has the power to determine if a patient must co-pay $5 or $20 more for an antibiotic, but in the most serous cases, if a patient will live or die. And if the insurance company continues to deny overage, ultimately the final resort of the patient is civil litigation, with the outcome likely to be way too late to help the patient obtain the treatment needed when they needed it. I cannot image how an elderly or very sick person living alone can handle all the red tape, or even understand what is going on. I suspect a lot of these people, when first told that the insurance did not cover a major medical need of theirs, simply accept it and either exhaust their savings or do without. All of this is enormously expensive for everyone involved, including the insurance company. Yet another augment for single payer or universally available health care. |
17th January 2017, 09:12 AM | #103 |
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17th January 2017, 09:15 AM | #104 |
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As a rule, service is never denied. In Aus there is a co payment for GPs and specialists. Hospitals are free.
In the UK we have full access to GPs, specialists and hospitals. Prescription medication is 'free', except for a dispensing fee. In reality there may be waiting lists for some treatments, and expensive medication is controlled. You can also take out private insurance, so you can get a nice private room with a TV, access to non NHS specialists, and shorter queues. But in an emergency, anyone can go to a hospital and be treated immediately for nothing. And you stay there until the problem is sorted. |
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17th January 2017, 09:17 AM | #105 |
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17th January 2017, 09:27 AM | #106 |
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That has nothing to do with the cost of the pills, and everything to do with not getting sued because you OD'd on goofballs under their watch. If they're responsible for you taking a medication, it'll be their medication. Full stop. Even in situations where the rule is completely silly, it's just not worth the risk of something going wrong otherwise.
The in-house cost of everything is so high for you because you're already subsidizing healthcare for the uninsured. And not in the cheapest way. If you don't have health insurance and you can't pay for treatment, you have to wait until it's a real emergency and then go to the ER. They have to treat you, and you'll rack up a hundred times more charges than if you had health insurance and could have gotten your problem fixed months ago. Now, like I said, you can't pay those exorbitant bills. So the hospital gives the bill to some debt collection agency to collect on you, with all the scum-of-the-earth that entails, and resigns itself to handling a major loss of revenue by boosting the prices for everything else across the board. Again. The solution is to insure everyone. Not to have insurance "available," but actual freakin' insurance you can actually afford and depend on. For everyone. It'll be expensive at first, because - surprise! - there are a LOT of people out there nursing serious medical problems they can't afford to treat. But, as the next batch of serious problems gets nipped in the bud by preventative care, costs will gradually drop and we'll get to enjoy having cheap, first-world health care like the rest of civilized society. |
17th January 2017, 09:28 AM | #107 |
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Insurance companies still make enough money to build the tallest buildings in downtown cities. I suspect that they represent a significant part of the problem.
But yes, the cost of treatment is extraordinarily expensive and from outside the system (and I am outside it- I do basic research in a non-clinical teaching department) it appears that much of the current expensive is inflated. But whenever I've looked into a specific high cost item, it gets more complicated. First of all, things were much cheaper when there was nothing really significant the doctors could do for you. But now they have ways of really helping you, but they can cost big time. No doubt the drugs I take are billed at many fold what the chemicals in them cost. Probably several fold more than the actual cost of the research to specifically develop those drugs. Yet the research to explore a lot of parallel drugs that never worked well enough to be sold also cost a lot of money, and someone has to pay for those too. On the other hand, pharmaceutical firms benefit for free from the drug research the government pays as NIH grants, etc. I honestly don't know how this all balances out, but I think that the pricing structure has to be re-examined, made more open, and reformed. And of course IMO there are many cases of truly and purely obscene greed (epipen anyone?). Much of the cost in hospitals/doctors offices includes dealing all the red tape in dealing with insurance and some government regulations, as well as fear of litigation. Probably this is why patients are not allowed to bring in their own drugs- it represents a loss of control but not a loss of liability for the hospital. Even if they trusted that you brought in the correct drugs your use of them would still need to be supervised by the staff (which is a major component of why the in-house drug delivery is so expensive). Believe me- I am certain that you would take them correctly but a very large percent of patients would not be able to do so. Particularly when they were very ill. [added} Plus what Beelzebuddy posted. What he/she listed greatly add to the hospital's costs. As already brought up in this thread, we all pay for others health costs even minus Obamacare. Often in obscure ways, and often very inefficiently, but we all pay. |
17th January 2017, 09:38 AM | #108 |
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You and I disagree on this and many broader points as a philosophical issues. But for me a simple line to draw is when an elderly or sick individual is mentally or physically unable to save their life (or is doomed to severe pain and suffering) without the assistance of the government, then the government (which in a democracy hopefully is the collective representation of the majority of the people in the society as a whole) should do so. I basic on my own moral code, in which helping others is very high in the listing of my ethical obligations. I see it as not very different from the city fire department throwing a life preserver to a man who fell into a lake and can't swim- should we just say that everyone should learn how to swim and to hell with him?
Obviously you are free to disagree if indeed you do. But given the basic difference originates in differing philosophies, I don't see that I could convince you otherwise. Regards! |
17th January 2017, 09:49 AM | #109 |
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17th January 2017, 09:54 AM | #110 |
Penultimate Amazing
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Another point in regards to the cost of health care and its availability:
Three options as I see it: 1. No rationing at all: the society is willing to commit enough money (private insurance or government run) to pay for any medical treatment the patient wants and a doctor is willing to do. I am unaware of any society willing to do this, and I believe most people would agree that the society as a whole should not pay for just every procedure a patient might want (e.g. purely cosmetic operations). In real life no society is willing to operate under #1. So health care delivery must be rationed: 2. In government-run health services the rationing is done by panels of appropriate experts based on the money they do have versus the potential benefit to the patient. The health service can afford to pay for one hip replacement: A person with a disease likely to kill them in 6 months will be denied the artificial hip operation (by the government program) to make that money available for a 19 year old with the same hip problem Seems sensible to me. 3. In the USA and similar systems, there still very much is rationing, but done primarily by the wealth of the patient or/and the willingness of their insurance company. A wealthy person likely to die of another disease in 6 months will probably be able to get a hip replacement from some doctors somewhere and a poor 19 year old is likely to be denied it. Both #2 and #3 are absolutely rationing. I think that #2 is much more logical, moral and fair. |
17th January 2017, 10:01 AM | #111 |
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Yes, but it doesn't have the abdication of social responsibility for the well-being of others.
There's still an undercurrent of Social Darwinism in American politics; an unspoken but nastily implied assumption that the problems one suffers from must be somehow one's fault, and any consequences therefrom justly deserved; a whisper of old Scrooge's "well if they'd rather die they'd better do it, and decrease the surplus population!" |
17th January 2017, 10:27 AM | #112 |
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There is no ACA replacement plan. There never has been. Republicans have used the ACA as a hammer against Obama since it was passed, encouraging the clueless public to blame every single problem they have with health care -- premiums, deductibles, choice of doctors, prescription costs, etc., etc. -- on Obama. The House voted 60+ times to repeal it knowing that the Democratic Senate would not go along. The Republicans never really expected to have to produce their own plan. Paul Ryan -- the alleged policy wonk -- has never offered a plan except in the vaguest terms. But they could claim they were trying to help their constituents and that nasty Kenyan Communist was standing in the way. Now that 22+ million people -- some with severe conditions, and all of whom vote -- are in danger of losing coverage, the Republicans have to acknowledge that the ACA has complex interlocked provisions that can't easily be pulled apart. But now they can't blame Obama.
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17th January 2017, 10:38 AM | #113 |
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17th January 2017, 10:55 AM | #114 |
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False, and The West Wing was leftist trash. You don't get to be as rich as Donald Trump because you inherited a little bit of money. He's going to deliver superior health-care ahead of schedule and under budget.
Trump should build a beautiful hospital atop Mt. McKinley: free care for anyone who makes it through the doors. He should also spend tens of thousands of dollars playing Powerball in the off-chance that a win would make lib heads explode. |
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17th January 2017, 10:58 AM | #115 |
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His plan is to not pay providers. It seems to work with the contractors on his hotel projects.
http://www.huffingtonpost.com/entry/...b043ad97e2b7fe |
17th January 2017, 11:18 AM | #116 |
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17th January 2017, 11:33 AM | #117 |
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Yes- many analyses suggest that he did considerably worse-off using his brain than if he had invested his inheritance in a stock index fund. Plus ripping off a lot of people along the way (how many people hurt in his repeated bankruptcies alone?). It doesn't promise well for his ability to construct a good health insurance/availability plan, does it! I will also mention not only the money given to him by his family, but all the contacts and friendships with important and/or wealthy people. Probably more important than just cash.
One of the skills I do recognize in Trump is his ability to convince other people that he has done anything extraordinary. I guess it is easy if you simply feel no obligation to sticking to facts. A trait of a good film-flam con artist. |
17th January 2017, 12:11 PM | #118 |
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1) While The West Wing depicted a Democratic administration, on more than one occasion Sorkin pushed misleading right-wing talking points as fact, notably the “Social Security is going bankrupt” dross.
2) The low end of estimates for his inherited wealth says $40 million minimum, not including the $200 million company he helped run for years before his father’s death. $40 million is not a little bit of money. 3) Nixon went to China, maybe Trump can fix US healthcare, although I can’t see how. If you want to provide affordable healthcare to all Americans and keep the profit margins of the healthcare industry nice and fat, you pretty much end up with Obamacare by default. If there is a different way of doing it, no one has really figured one out in the quarter century since Bill Clinton first proposed fixing US healthcare. |
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17th January 2017, 12:18 PM | #119 |
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Obviously.
I mean, come on! Think about it! There is no Sooper Sekrit Solution to health care that covers everyone and cuts costs. Anything that could possibly be done has already been suggested and discussed extensively. If it were as easy as having some people of Trump's transition team sitting down over the course of 2 months and getting it done, it would have been done years ago. |
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17th January 2017, 12:27 PM | #120 |
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Well, it is possible that the lobbyists and corporate overlords have prevented congress from fixing it, and Trump's drain-the-swamp transition team can come up with a reasonable solution that helps (most of) the people and just screws over the bloated corporate execs of the drug and insurance companies.
But somehow I doubt it's that simple... or even if it was Trump's plan would get through congress because we're back to the lobbyists and overlords who own congress. |
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