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

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Old 24th January 2017, 12:28 PM   #281
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Originally Posted by Beelzebuddy View Post
I know where he's going with this.

One current trend in health care is finding that too much screening can actually be disadvantageous, because all tests can throw false positives. If you get, say, a mammogram every week, sooner or later they'll find something that looks off enough for further investigation, despite it being intrusive, and expensive and almost certainly fruitless.

It may be hard to imagine someone able to understand the above without also coming to appreciate the positive effects of preventative care, but that's our sunmaster14. No facts are too apparent for him to circumspectly ignore in pursuit of his bias.
There is no reason ineffective preventative care can't be addressed when one offers preventative care. And in fact, that's why there are reviews in the first place of care that show if we are detecting/preventing disease or doing more harm than good.

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Old 24th January 2017, 12:41 PM   #282
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Originally Posted by Darat View Post
I was thinking about this earlier - do you know what the figure was?
According to this, millions. And keep in mind that in the U.S. the vast majority of people are covered by group plans that must cover everybody in the group. Applicants with pre-existing conditions were rejected in the individual market at a high rate.

http://healthnetwork.com/blog/before...ns-today-none/
http://www.healthinsurance.org/blog/...d-to-millions/
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Old 24th January 2017, 12:42 PM   #283
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Originally Posted by Emily's Cat View Post
Removing the state boundaries and the independent regulations within each state actually would help.
How? There's no Federal restrictions on insurance location, just local ones. Where the local restrictions don't exist the insurance companies have not taken up the offer to sell.

Its just the GOP mantra that they all say to make it seem like they have an idea. Its a variation on the 'we'll close tax loopholes' when asked how they would raise revenue on their lowering taxes.
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Old 24th January 2017, 12:57 PM   #284
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Originally Posted by Loss Leader View Post
I changed what I think was a mistake on your part. Preventative care is always less expensive than emergency care and is almost always more effective. All preventative healthcare should be free, especially female reproductive and prenatal care.

I agree with everything else you wrote.
[actuarial lecture]

Actually, preventive care is only less expensive when you're looking post-hoc at a person who contracted the condition. That is to say, the cost of a colonoscopy is less than the cost of chemotherapy and surgery for colon cancer. The problem is in the aggregations, and colonoscopies are a really good example.

These are made up numbers - I don't have real numbers easily accessible without having to do a lot of work AND there's a degree of confidentiality involved. The made up numbers are illustrative and directionally appropriate. appropriate.

Let's say that an average colonoscopy costs $250, and is recommended to all men age 50 and older, every 5 years. That equates to about 20% of men in that age range per year. Let's say that works out to 10,000 men in that risk pool. So that's a cost of $2,500,000 per year in colonoscopy costs.

Let's say colon cancer has an incident rate of 1 in 100,000. If colon cancer is identified early, it costs $250,000 to treat. If it is not identified early, it has a cost of $500,000 to treat. For the moment, we're going to ignore the survival rates - they add a high degree of computational complexity that is irrelevant to the pint I'm demonstrating.

The expected cost of early-diagnosis colon cancer treatment in a group that is all receiving preventive care is (incidence rate) * (number of people) * (cost to treat) = (1/100,000) * (10,000) * ($250,000) = $25,000.

The expected cost of late-diagnosis colon cancer treatment us (1/100,000) * (10,000) * ($500,000) = $50,000.

So even though the cost to treat is much higher than the cost to screen for an individual who is identified with colon cancer... the cost to screen everyone is massively higher.

Most preventive care is covered by insurers as goodwill. It's expected, it's the right thing to do, and it makes policyholders feel safer. But it's very rarely financially sound.

Childhood vaccinations, flu shots, and a handful of other immunizations are an exception. These are things that actually *prevent* an illness, and are generally low-cost to administer. Most of the other things that we call "preventive care" don't prevent anything, they're just early detection... and they're often not at all cost-effective.

[/actuarial lecture]
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Old 24th January 2017, 01:04 PM   #285
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actually, the costs of preventive care can be even higher if you account for false positives which trigger an unnecessary operation...
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Old 24th January 2017, 01:20 PM   #286
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Originally Posted by Emily's Cat View Post
Most preventive care is covered by insurers as goodwill. It's expected, it's the right thing to do, and it makes policyholders feel safer. But it's very rarely financially sound.
Actually, the fact (I agree) that preventative care is not financially sound is an argument why it is ludicrous to consider heath care from a free market perspective.

In your example, it is clear that it is far more cost efficient to let people develop advanced colon cancer and treat it than it is to catch it early and prevent it. But if you are going to let people get colon cancer, that means there are those who are going to die as a result. But hey, dying is more cost effective.

Screw that noise. Life has value beyond the cost of treatment.
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Old 24th January 2017, 01:29 PM   #287
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Originally Posted by Emily's Cat View Post
Removing the state boundaries and the independent regulations within each state actually would help.
What that would do would drive insurance companies to move operations to the states with the laxest regulations, like the credit card companies moved to North Dakota in the '80s. What would have helped would have been a national public option, along the lines of Medicare-for-All, that anyone could enroll in if they didn't like the private options available in their states. No chance we'll get that from the Repubs.
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Old 24th January 2017, 01:49 PM   #288
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Hope Change. Lets see what Trumps motto is?

Alimentary Canal?
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Old 24th January 2017, 01:53 PM   #289
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Originally Posted by Emily's Cat
respectful snip

I agree, but you're not counting all of the positive externalities. Reducing sick time with early detection and preventative care has an overall positive effect. You get a larger workforce that can work for years longer. You get grandparents who can babysit instead of being sick/dead. I think the positive externalities outweigh the costs.
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Old 24th January 2017, 01:54 PM   #290
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Originally Posted by pgwenthold View Post
Actually, the fact (I agree) that preventative care is not financially sound is an argument why it is ludicrous to consider heath care from a free market perspective.

In your example, it is clear that it is far more cost efficient to let people develop advanced colon cancer and treat it than it is to catch it early and prevent it. But if you are going to let people get colon cancer, that means there are those who are going to die as a result. But hey, dying is more cost effective.

Screw that noise. Life has value beyond the cost of treatment.
That's the real underlying difficulty. When life is given an infinite (or nearly) value, all the calculations go out the window. The only conceptual remedy I have found is to reframe the calculation from the specific to the general.

So, while my life (and the lives of those I care about) has an infinite value to me, when the available healthcare is finite, I must accept that my use of the system steals care from others. My calculation has to include others who are affected by my needs. Doing this allows me to cancel across infinities by setting one (mine) against other choices.

Maybe I can make another decision if I know the heart I'm not going to get is going to someone else and if I were to get the heart, they would die.

The same trick can be used for care that extends life or even just improves life. If I accept the care available is finite, any that I use necessarily takes away from the pool. Will I choose to live another year if I am convinced I am stealing this time from others?
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Old 24th January 2017, 01:59 PM   #291
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That's a differnet "preventative" then we tend to use in the UK. Preventative healthcare would be helping people lose weight, helping people give up smoking, ensuring they are eating a suitable diet and so on.
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Old 24th January 2017, 02:08 PM   #292
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Originally Posted by Loss Leader View Post
I agree, but you're not counting all of the positive externalities. Reducing sick time with early detection and preventative care has an overall positive effect. You get a larger workforce that can work for years longer. You get grandparents who can babysit instead of being sick/dead. I think the positive externalities outweigh the costs.
But do those positives make it back to the insurance company? EC was doing that analysis from the perspective of the insurer. Not the employer or society at large.
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Old 24th January 2017, 02:09 PM   #293
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Originally Posted by Darat View Post
That's a differnet "preventative" then we tend to use in the UK. Preventative healthcare would be helping people lose weight, helping people give up smoking, ensuring they are eating a suitable diet and so on.
If people can't figure that simple stuff out on their own then we deserve to pay for their catastrophic care!
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Old 24th January 2017, 02:10 PM   #294
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Originally Posted by CynicalSkeptic View Post
But do those positives make it back to the insurance company? EC was doing that analysis from the perspective of the insurer. Not the employer or society at large.
Which is why the view from the bottom of an insurance company ledgers is one of the worst ways to look at healthcare policy.
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Old 24th January 2017, 03:36 PM   #295
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Originally Posted by marplots View Post
....
The same trick can be used for care that extends life or even just improves life. If I accept the care available is finite, any that I use necessarily takes away from the pool. Will I choose to live another year if I am convinced I am stealing this time from others?
We know everybody dies, and we know that a lot of health care money is spent in the last few months of patients' lives. But serious discussions of how to responsibly identify useful measures vs. "prolonging the inevitable" are invariably portrayed as "death panels" or worse. So that's really a different issue. The question on the table is whether everybody should be able to get the same quality of health care, regardless of whether they have great corporate health insurance or must buy their own insurance in the individual market or must rely on public programs like Medicaid. If my insurance will keep me alive and active for another year, but yours (or your lack thereof) means you die without treatment, is that good for society as a whole? Most other major countries have determined that basic health care is every person's right as a human being. We have not made that decision.
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Old 24th January 2017, 04:09 PM   #296
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Originally Posted by Bob001 View Post
We know everybody dies, and we know that a lot of health care money is spent in the last few months of patients' lives. But serious discussions of how to responsibly identify useful measures vs. "prolonging the inevitable" are invariably portrayed as "death panels" or worse. So that's really a different issue. The question on the table is whether everybody should be able to get the same quality of health care, regardless of whether they have great corporate health insurance or must buy their own insurance in the individual market or must rely on public programs like Medicaid. If my insurance will keep me alive and active for another year, but yours (or your lack thereof) means you die without treatment, is that good for society as a whole? Most other major countries have determined that basic health care is every person's right as a human being. We have not made that decision.
At first I was with you, but I think you switched horses there, mid-race.

Equitable division of healthcare would mean, not just that basic healthcare is available to all (at whatever price that happens to be) but that all available healthcare is equally portioned out. There would be no excess to buy because being able to buy more reintroduces the disparity we set out to get rid of.

So you'd not only have to provide basic healthcare, but disallow additional healthcare to anyone. Everyone gets it or no one does. At least that's what we'd need if we want to say it's equitable. But it sounds like you are going to allow for the purchase of services above and beyond "basic" healthcare.

How does this work in practice in countries with universal medical care? Is there still a hierarchy of service driven by the ability to pay?
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Old 24th January 2017, 04:27 PM   #297
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Originally Posted by marplots View Post

How does this work in practice in countries with universal medical care? Is there still a hierarchy of service driven by the ability to pay?
In practice in the UK this means that if I get ill and need to see a GP, then I don't have to pay anything. If the doctor prescribes medicines, then these will likely be generic but I'll get treatment that's effective. I have to pay a nominal charge per prescription.

If I break my arm, I go to A&E and they patch me up. I pay nothing.

If I have serious accident, I go to A&E and they patch me up. I pay nothing.

If I have a serious illness my GP refers me to specialists and I get appropriate care, whatever that entails, provided that such a treatment is available via the NHS. I pay nothing. (A very small subset of treatments are not available, most things are covered)

For visiting GPs or A&E I might have a longer wait time if my case is not an emergency. I will need to wait a while for non emergency hospital care (things like hip replacements)

If I want to jump the queue and get immediate attention at A&E or the GP or for my non emergency health care. Or I want brand name medicines and not generics, then I am free to take out health insurance policies which can cover part or all of that, for various premiums.


Basically I get free healthcare if I choose. Some novel treatments might not be available, and I might have to wait a long time sometimes.

Private healthcare is available if I choose to pay for it too.

To pay for all of this I pay a higher rate of tax than my compatriots do in the USA, but this is more than offset by the fact that I never have to take out health insurance.

Employers health insurance schemes here are basically unheard of.
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Old 24th January 2017, 04:32 PM   #298
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Originally Posted by marplots View Post
.....
How does this work in practice in countries with universal medical care? Is there still a hierarchy of service driven by the ability to pay?
In most systems people can buy more elective stuff for themselves: nose jobs, Lasik, etc. Or maybe you get on a waiting list for a covered knee replacement, but you can get one next week if you can pay for it yourself. But everybody gets pretty much the same care at a high quality for major illnesses and conditions. And I note again that many UHC systems work through private insurers that are closely regulated, like our Medicare; people still choose their own doctors and hospitals.
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Old 24th January 2017, 04:43 PM   #299
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Originally Posted by Ambrosia View Post
(good explanation of UK system snipped)
What happens when the Queen gets sick?
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Old 24th January 2017, 04:45 PM   #300
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Old 24th January 2017, 04:49 PM   #301
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Originally Posted by Giordano View Post
Of course any action people take is because they choose to do it. Choosing to carefully test drugs before widely using them is a good choice. As mentioned, thalidomide provided an except example of what happens if one chooses to do otherwise.
Thalidomide is a lot more complicated than that. This off topic, I know, but thalidomide's right-handed isomer was tested, was safe, and was very good at controlling morning sickness. At that point in time we didn't even know that chirality *could* be a problem. It wasn't until the left-handed isomers got in the mix that we saw problems.

Yes, 100% testing is important. But you can't test for a thing you don't know is a thing.
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Old 24th January 2017, 04:51 PM   #302
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Originally Posted by Darat View Post
No I am not, I am trying to help you understand what NICE's role is. It is to determine what treatments are available in NHS England and what constitutes good practice. What "rationing" takes place in the NHSs are at a different point.
Speaking as an actuary, NICE does a pretty nice job. We applied their QALY scores in some of our formulary development, and drug management policies.
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Old 24th January 2017, 04:55 PM   #303
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Originally Posted by BobTheCoward View Post
A cost benefit analysis requirement is a form of rationing healthcare.
No it isn't. It's a measure of value. It might get applied when someone does rationing, but it's not implicitly a form of rationing.

NICE defines the value of a treatment or medicine, as based on the quality and life impact of that treatment.
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Old 24th January 2017, 05:14 PM   #304
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Originally Posted by zorro99 View Post
Trump signs executive order that could effectively gut Affordable Care Actís individual mandate

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

https://www.washingtonpost.com/polit...=.bf22632a84ee
Meh. The mandate is still not particularly toothy - it has only a small bite. For 2017, the penalty is the maximum of:
A) $695 Annual
B) 2.5% of your annual income (not to exceed the annual cost of a Bronze plan)

Average Bronze plan price is around $300 per month, so about $3600 annually. So if you happen to make over $144,000 annually and are single, you're looking at a penalty that costs you as much as coverage. For anyone making less than that, the penalty is still less than the cost of coverage. For most people in the US, the penalty is much less than the cost of coverage - especially if you aren't single.

All in all, the mandate isn't that big a deal.
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Old 24th January 2017, 05:19 PM   #305
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Originally Posted by Meadmaker View Post
Let me give you another one.

Everything that is provided in a free market system will only be provided if the provider can make a profit. To make a profit, a provider has to charge the cost of the product, plus enough of a profit margin to make it worthwhile for the provider to take the time to provide it. i.e. He has to make a living.

Medicines, health appliances (wheelchairs and such), the true cost of all the products used during surgery, never mind the actual salaries of surgeons and nurses, is more than poor people can pay. There is absolutely zero profit in providing certain forms of health care to poor people, because they don't have enough money to cover the base cost, let alone provide a profit margin to investors, or a reasonable salary for the specialized labor providing the service.

A free market system would mean that poor people don't get health care, whether that's viagra, physical therapy, or heart surgery. Whether it's improving the quality of life, or keeping someone alive another day, the free market will leave poor people out.

So you have to have subsidies of some sort, or you have to let poor people do without, and suffer the consequences, whether that means dying or leaving their wives sexually frustrated.

ETA: And that doesn't mean there is no place at all for market forces in a health care system. You are alluding to that in your own posts. I was just reacting to the idea that a "free market solution" can solve health care problems. It can't. A true free market solution means some people don't get health care.

And, once you accept the idea that a pure free market solution can't solve the problem, Obamacare is about the closest thing to a free market system there is. The better one would be to get rid of the employer as the provider. That's a really stupid thing to do, but it's engrained in our culture.
Hey! Here's a novel idea! Why don't we take a look at the profit margins being made by those doctors, hospitals, pharmaceutical companies, and device manufacturers? Maybe we take a step back and question whether it's ethical for a medical supply company to make 40% profit year over year on something that can save lives. Maybe instead of just pumping more and more money into the system, maybe we take a look at whether or not the costs are reasonable. I mean, yes, medical school is expensive, but I'm not really convinced that my neurologist needs to me to pay the $800 per hour "protection" money to get her to write the Rx I need so I don't fry my brain in an epileptic seizure. Maybe she could get by with one fewer Mercedes and only a 3600 sf house... Worth a thought maybe?
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Old 24th January 2017, 05:29 PM   #306
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Originally Posted by Armitage72 View Post
The usual argument is that the methods that work just fine in multiple other countries will fail miserably in the US because...reasons. It usually involves some sort of vague handwaving about the size of the population.
In my view, the challenge in the US is one of infrastructure. It's that the industry itself has evolved in a for-profit environment, and the insurance mechanism evolved with it. Insurance invariably disrupts the supply-demand curve, because the financial intermediary explicitly protects the consumer of the good from the true cost of the good. The net effect of this is that the presence of a protective financial intermediary invariably increases the cost of the good sold. What we've ended up with is a highly entwined system. The number of people working in the medical industry (not just nurses and doctors, but the encompassing system of devices, orderlies, drug chemists, insurance agents, etc.) is very large, because the cost of the product is high... which is high because the industry exists in the form it does.

If you change that structure too quickly (a sudden shift to single-payer universal health care) without due consideration of the intricacies... you create many other subsidiary problems. How much of a spike in unemployment is acceptable in order to reduce the health care cost burden? If we switch it all to single-payer, how many people will be out of work, and how much will that increase the financial burden in other areas?

Intellectually I can argue for single-payer universal coverage... but only if I compartmentalize it and ignore all of the secondary impacts.

More pragmatically, I favor a highly subsidized private market, with a minimum care coverage requirement - similar to Switzerland's approach, and very much like Medicare Advantage today. Ideally, this would be paired with some degree of government negotiated cost controls on the delivery side.
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Old 24th January 2017, 05:39 PM   #307
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Originally Posted by Darat View Post
I was thinking about this earlier - do you know what the figure was?
I don't remember with any real accuracy. I want to say it's somewhere in the 3 to 5 million range, but I'm not sure the stats on it were ever really solid. More than none, less than the 30 million that got care through expanded Medicaid.

I'm making a minor distinction here, by not considering those who could not afford care (which make up the bulk of the increase in the Medicaid population).

The overall size of the Individual Market only grew by about 10% over the last few years... but I'd have to go do research to get you any real numbers.
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Old 24th January 2017, 05:43 PM   #308
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Originally Posted by Bob001 View Post
What that would do would drive insurance companies to move operations to the states with the laxest regulations, like the credit card companies moved to North Dakota in the '80s. What would have helped would have been a national public option, along the lines of Medicare-for-All, that anyone could enroll in if they didn't like the private options available in their states. No chance we'll get that from the Repubs.
I believe you misunderstood my post. Get rid of the ability for states to have different regulations. Move to a standardized and shared regulatory environment.
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Old 24th January 2017, 05:46 PM   #309
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Originally Posted by Loss Leader View Post
I agree, but you're not counting all of the positive externalities. Reducing sick time with early detection and preventative care has an overall positive effect. You get a larger workforce that can work for years longer. You get grandparents who can babysit instead of being sick/dead. I think the positive externalities outweigh the costs.
You snipped everything include the thread linky button. I'm not sure which post you're referring to. I'm guessing you're referring to the preventive care one?

The positive externalizes still don't outweigh the cost for most early-detection screenings. The incidence rate is still very low for the things being screened for, and the prevalence of screening is very high.

It unquestionably has high value to the individuals impacted. That's obvious. But taken from a policy perspective, it's not effective and the externalizes don't offset the increased cost burden.

But as I said, it's goodwill and it's the right thing to do. It's just not at all cost effective, no matter how you slice it up.
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Old 24th January 2017, 05:47 PM   #310
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Originally Posted by Darat View Post
That's a differnet "preventative" then we tend to use in the UK. Preventative healthcare would be helping people lose weight, helping people give up smoking, ensuring they are eating a suitable diet and so on.
You mean things that actually *prevent* illness? What a coven concept!
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Old 24th January 2017, 05:48 PM   #311
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Originally Posted by CynicalSkeptic View Post
But do those positives make it back to the insurance company? EC was doing that analysis from the perspective of the insurer. Not the employer or society at large.
Also note that the perspective of the insurer is the perspective of the people paying the premiums. The cost of care is a direct and substantial element of the premium cost.
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Old 24th January 2017, 06:04 PM   #312
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Originally Posted by Emily's Cat View Post
I want to say it's somewhere in the 3 to 5 million range, but I'm not sure the stats on it were ever really solid.
Hey, that's the exact number of fraudulent votes which cost Trump the popular vote in the election! Coincidence...?
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Old 24th January 2017, 06:16 PM   #313
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Originally Posted by Bob001 View Post
We know everybody dies, and we know that a lot of health care money is spent in the last few months of patients' lives. But serious discussions of how to responsibly identify useful measures vs. "prolonging the inevitable" are invariably portrayed as "death panels" or worse. So that's really a different issue. The question on the table is whether everybody should be able to get the same quality of health care, regardless of whether they have great corporate health insurance or must buy their own insurance in the individual market or must rely on public programs like Medicaid. If my insurance will keep me alive and active for another year, but yours (or your lack thereof) means you die without treatment, is that good for society as a whole? Most other major countries have determined that basic health care is every person's right as a human being. We have not made that decision.
The same way no one attempts to divert the trillion dollar useless supplement industry into more productive forms of medical care.

We should reassess both priorities, but .... death panels.
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Old 24th January 2017, 06:17 PM   #314
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Originally Posted by Emily's Cat View Post
You snipped everything include the thread linky button. I'm not sure which post you're referring to. I'm guessing you're referring to the preventive care one?

The positive externalizes still don't outweigh the cost for most early-detection screenings. The incidence rate is still very low for the things being screened for, and the prevalence of screening is very high.

It unquestionably has high value to the individuals impacted. That's obvious. But taken from a policy perspective, it's not effective and the externalizes don't offset the increased cost burden.

But as I said, it's goodwill and it's the right thing to do. It's just not at all cost effective, no matter how you slice it up.
I still subscribe to the broken windows theory. A healthier populace will lead to a healthier populace. When people see while-life medical treatment working, they'll want more of it. They'll want to twice smoking and drinking, clean the water, etc.

This may not be the best post on the day Trump started gutting the EPA.
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Old 24th January 2017, 06:18 PM   #315
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Originally Posted by CynicalSkeptic View Post
But do those positives make it back to the insurance company? EC was doing that analysis from the perspective of the insurer. Not the employer or society at large.
More people plaguing premiums longer. I think it can be made to work. In any case, I'd certainly like to try living in that kind of society.
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Old 24th January 2017, 07:01 PM   #316
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Originally Posted by Emily's Cat View Post
Actually, preventive care is only less expensive when you're looking post-hoc at a person who contracted the condition. That is to say, the cost of a colonoscopy is less than the cost of chemotherapy and surgery for colon cancer. The problem is in the aggregations, and colonoscopies are a really good example.
OK.

Originally Posted by Emily's Cat View Post
These are made up numbers - I don't have real numbers easily accessible without having to do a lot of work AND there's a degree of confidentiality involved.
Confidentiality of who? Physician owners of colonoscopy machines? Any profession that sucks this much revenue out of government or quasi-government entities ought to be transparent.

Originally Posted by Emily's Cat View Post
Let's say that an average colonoscopy costs $250, and is recommended to all men age 50 and older, every 5 years.
That's not too far off; in terms of physician billing. Facility billing, however, is $736.85.

Now: How many doctors benefit from facility billing? Does facility billing accurately reflect amortization/depreciation costs?

The lack of transparency helps drive up costs, IMO. For example your ballpark estimate was $250 against a reality of $1,000+. We treat medical costs like voodoo - utterly opaque magic, and questions are taboo.

Originally Posted by Emily's Cat View Post
So even though the cost to treat is much higher than the cost to screen for an individual who is identified with colon cancer... the cost to screen everyone is massively higher.
Bringing me back around to why screening costs are so high. Hate to be such a cynic here but doctors are very interested in their own bottom line and often have ownership interest in diagnostic equipment.

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Old 24th January 2017, 07:06 PM   #317
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Originally Posted by Minoosh View Post
The lack of transparency helps drive up costs, IMO. For example your ballpark estimate was $250 against a reality of $1,000+. We treat medical costs like voodoo - utterly opaque magic, and questions are taboo.

Bringing me back around to why screening costs are so high. Hate to be such a cynic here but doctors are very interested in their own bottom line and often have ownership interest in diagnostic equipment.

I feel fairly confident that costs are high because those who can pay are footing the bill for those who can't. It's almost as if we need a system where healthy people are required to buy medical insurance and companies/government can negotiate rates with the providers.
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Old 24th January 2017, 07:06 PM   #318
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Originally Posted by Minoosh View Post
The lack of transparency helps drive up costs, IMO. For example your ballpark estimate was $250 against a reality of $1,000+. We treat medical costs like voodoo - utterly opaque magic, and questions are taboo.

Bringing me back around to why screening costs are so high. Hate to be such a cynic here but doctors are very interested in their own bottom line and often have ownership interest in diagnostic equipment.

I feel fairly confident that costs are high because those who can pay are footing the bill for those who can't. It's almost as if we need a system where healthy people are required to buy medical insurance and companies/government can negotiate rates with the providers.
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Old 24th January 2017, 08:17 PM   #319
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Originally Posted by Loss Leader View Post
I feel fairly confident that costs are high because those who can pay are footing the bill for those who can't. It's almost as if we need a system where healthy people are required to buy medical insurance and companies/government can negotiate rates with the providers.
Sure, that's a big part of it. Since Obamacare there are theoretically fewer free riders.

But IMO there's also an awful lot of price gouging just because it's possible. And it's possible because in the past, a hospital that billed insurance $7,000 for an emergency appendectomy could bill an uninsured patient *$35,000* for the same procedure. So you get your appendix out, then keel over from a heart attack when you get the bill.

I googled "wildly disparate costs for similar procedures" and "widely disparate costs for similar procedures." Maybe this problem has been fixed by now.

Last edited by Minoosh; 24th January 2017 at 08:35 PM.
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Old 24th January 2017, 09:10 PM   #320
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Originally Posted by Loss Leader View Post
I feel fairly confident that costs are high because those who can pay are footing the bill for those who can't. It's almost as if we need a system where healthy people are required to buy medical insurance and companies/government can negotiate rates with the providers.
Fairly confident are you? I can prove you wrong with a couple of lines of math. Before Obamacare, the percent of uninsured was about 15% (it rose a little during the Great Recession).

If those uninsured used health care resources at the same rate as the insured (which of course they don't - not even close, because a lot of them are young or, if not, simply do without), then the burden they impose on the 85% who are insured increases the insured's costs by 15%/85% = 17.6%. If you think that our health care costs are only inflated by 17.6% over what they would be in a free market, then I have ski lodge in Florida to sell you. Of course, even then I have grossly overestimated the effect, since the uninsured use far less health care than the insured.

The real reason our prices are so high is two-fold: (1) there is simply too much demand because people do not pay directly for their consumption (broad insurance coverage mandates exacerbate this problem); and (2) supply is restricted by our screwed up system for training and licensing doctors and our screwed up system for approving drugs and medical procedures.

Well, actually there is a third reason. The rest of the world freeloads off of the medical R&D that our high health care prices incentivize.
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