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Tags Affordable Care Act , donald trump , health care issues , health insurance issues

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Old 24th January 2017, 11:34 PM   #321
Bob001
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Originally Posted by sunmaster14 View Post
.....
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.
.....
So it's the patient's fault? You don't say a word about prices charged by providers. Outside of things like nose jobs, health care is not a luxury good. People don't buy it unless they need it, and often they don't even know they need it because they weren't getting regular preventive care (blood pressure checks, diabetes screening etc.). And when the patient does need it, he's not usually in a position to comparison shop, and even if he wanted to, the necessary information isn't available. Other nations treat health insurance as a public utility providing an essential service, like power and water, and regulate insurers that way.

Journalist Steven Brill got a lot of attention last year for his investigation of medical pricing. Short summary: no rhyme or reason at all, incomprehensible even within the industry.
http://www.npr.org/sections/health-s...-law-wont-work
http://www.amazon.com/Americas-Bitte...QQ3APS5HS58ED1
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Old 25th January 2017, 01:22 AM   #322
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Originally Posted by sunmaster14 View Post
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.
So I'll take that as a "no" on being able to support any of your previous statements, shall I?
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Old 25th January 2017, 01:41 AM   #323
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Originally Posted by marplots View Post
What happens when the Queen gets sick?
The Royals have had their own private doctors for as long as there have been private doctors.
It's only in the past century that this has actually been to their benefit, but I digress.

I don't know how the bills are paid, but they most assuredly would be.

The super rich here get the same care that the super rich get anywhere in the world. They pay the same exorbitant prices for that care.
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Old 25th January 2017, 01:47 AM   #324
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Originally Posted by Ambrosia View Post
The Royals have had their own private doctors for as long as there have been private doctors.
It's only in the past century that this has actually been to their benefit, but I digress.

I don't know how the bills are paid, but they most assuredly would be.

The super rich here get the same care that the super rich get anywhere in the world. They pay the same exorbitant prices for that care.
It's not surprising. I don't think a hierarchy of services can be prevented, just controlled.
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Old 25th January 2017, 01:50 AM   #325
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Originally Posted by Bob001 View Post
Other nations treat health insurance as a public utility providing an essential service, like power and water, and regulate insurers that way.
Virtually the only way to appeal to conservatives on this score is to make it a national security issue. For instance, regular Republicans don't seem to mind insurance subsidies paid to farmers when its framed as "protecting our food supply," and "avoiding dependence on foreign countries."

We need healthy citizens to defend the homeland and protect ze Führer. It's disgrace that so many young men are too overweight and unfit to serve in the military. Make America Glorious Again.
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Old 25th January 2017, 06:14 AM   #326
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Originally Posted by Emily's Cat View Post
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.
I recently had an argument with someone who insisted that when they looked at forgoing health insurance, it would be a $5000 penalty and he only makes $48,000. I asked him how he got to that number, and they stated that it's what the ACA says. I responded that's not what the law says, and in order to have to pay $5000 you would first have an adjusted gross income of
$200,000 and that's ignoring the cost of a bronze plan. He still insisted I was wrong and it was $5000. I showed him the law and various calculators to demonstrate it couldn't have been $5000. Didn't convince him - I was lying apparently even though he couldn't explain how he got to his figure.
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Old 25th January 2017, 06:19 AM   #327
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Originally Posted by Ambrosia View Post
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.
Just to nitpick. Prescriptions are free in Scotland.

Carry on

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.
And this seems to me like the underlying issue. I apologise if my thinking is not clear here, I think about this emotionally rather than rationally in many ways.

That's what happens with socialised medicine, and that's a good thing. In the UK, public healthcare is paid for via taxation. More of that is contributed by those who can afford it and, broadly speaking, more of the service is used by those who can't. And that's a good thing.

I am relatively well paid, and have very little use of public health services. I don't care. If my contribution is helping others stay healthy, then I am happy. Indeed many people from the wealthy end effectively contribute twice because they pay their taxes (avoidance aside for the moment), but also have private healthcare provision which they pay for, so they are not only contributing to the public pot, they are also not taking anything out because they have their own arrangements.

The same is true of many public services. It's not about getting what I paid for, it's about trying to make sure that need is covered. Tax dollars are used to pay for all sorts of things that I don't use. And that's a good thing.

I get the sense that the US political culture is just not in a place to accept that underlying premise. Is that socialism? My political compass is nonexistant.
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Old 25th January 2017, 08:19 AM   #328
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Originally Posted by Cain View Post
regular Republicans don't seem to mind insurance subsidies paid to farmers when its framed as "protecting our food supply," and "avoiding dependence on foreign countries." farmers vote for them.
A minor fix. Regular Republicans don't actually care about ideology, they'll change to whatever gets them the most votes. Currently the unions are turning red, so expect to see the farm subsidy rhetoric switch to "keepin' 'Merican jobs in 'Merica" without a hitch in between.
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Old 25th January 2017, 08:53 AM   #329
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Originally Posted by sunmaster14 View Post
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.
On this I completely agree with you. Both of these reasons are much easier to sustain in a complex market that puts insurers between the consumer and the provider. It makes the consumer think the insurer is looking out of their interest, but in fact the insurer is just looking out of rate bottom line.

Replace the complex web of insurers with a single entity and you increase the transparency and reduce the complexity. When one entity is paying the bills and we are that entity then we can demand more form our medical providers.
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Old 25th January 2017, 09:09 AM   #330
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Originally Posted by Dr. Keith View Post
On this I completely agree with you. Both of these reasons are much easier to sustain in a complex market that puts insurers between the consumer and the provider. It makes the consumer think the insurer is looking out of their interest, but in fact the insurer is just looking out of rate bottom line.

Replace the complex web of insurers with a single entity and you increase the transparency and reduce the complexity. When one entity is paying the bills and we are that entity then we can demand more form our medical providers.
But that would put evil government bureaucrats in charge of our health.

The ACA created a system that lets a private company run the paperwork. Think of it as a 10% to 15% tithe to the Gods of the free market in the memory of Saint Regan. A single payer system would be more efficient but totally unacceptable to the real Americans. Who know that government is pure evil and will kill grandma and force their daughter to have an abortion and their son to have a sex change.
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Old 25th January 2017, 10:08 AM   #331
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Originally Posted by Kestrel View Post
.....
A single payer system would be more efficient but totally unacceptable to the real Americans.
.....
And yet Medicare is recognized as one of the most successful government programs, even when the doddering elderly shout "keep the government away from my Medicare!" A gradual introduction of a Medicare-for-All plan, starting with allowing younger people to buy into it with reasonable premiums, would probably get pretty broad acceptance.
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Old 25th January 2017, 10:24 AM   #332
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Originally Posted by Kestrel View Post
But that would put evil government bureaucrats in charge of our health.
Don't let the government touch my Medicare!


(Since Bob001 has taken the fact based approach.)
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Old 25th January 2017, 01:59 PM   #333
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It's funny when people interpret "free preventive coverage" to mean "free healthcare." They expect their insurers to cover all their visits for stuff like diabetes, hypertension, heart disease, etc under free, no-copay, preventive coverage. I hear arguments like: "but I come to the doctor to prevent problems from my {insert chronic disease}! They should cover that for free!" Or "This is just a follow up of my preventive visit, I shouldn't be charged because the law says preventive coverage is free!"

And then of course, they come in for their yearly preventive visit with a laundry list of medical problems and expect them all to be covered. And then when you ask them, "Have you stopped smoking? Have you implemented the dietary changes we talked about? Etc?" They either get mad and ask us to stop prying into their personal lives or just lie and say yes. In their eyes, a doctor's job is to fix the problems that come up as a result of their normal lifestyle. Preventive medicine=preventing the chronic problems they already have from becoming bigger problems. It's hard to convince some people that that isn't preventive medicine, that's medical treatment!

The biggest problem we have is that people don't actually take their health seriously. They treat their bodies badly and then whine when they can't afford the medical treatment required to mitigate their mistakes. If you make positive healthy changes to your life, you will prevent the most common problems that lead to death in our country. If you refuse to make those changes, then shouldn't YOU be the one that pays the bill?
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Old 25th January 2017, 02:58 PM   #334
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Originally Posted by xjx388 View Post
It's funny when people interpret "free preventive coverage" to mean "free healthcare." They expect their insurers to cover all their visits for stuff like diabetes, hypertension, heart disease, etc under free, no-copay, preventive coverage. I hear arguments like: "but I come to the doctor to prevent problems from my {insert chronic disease}! They should cover that for free!" Or "This is just a follow up of my preventive visit, I shouldn't be charged because the law says preventive coverage is free!"

And then of course, they come in for their yearly preventive visit with a laundry list of medical problems and expect them all to be covered. And then when you ask them, "Have you stopped smoking? Have you implemented the dietary changes we talked about? Etc?" They either get mad and ask us to stop prying into their personal lives or just lie and say yes. In their eyes, a doctor's job is to fix the problems that come up as a result of their normal lifestyle. Preventive medicine=preventing the chronic problems they already have from becoming bigger problems. It's hard to convince some people that that isn't preventive medicine, that's medical treatment!

The biggest problem we have is that people don't actually take their health seriously. They treat their bodies badly and then whine when they can't afford the medical treatment required to mitigate their mistakes. If you make positive healthy changes to your life, you will prevent the most common problems that lead to death in our country. If you refuse to make those changes, then shouldn't YOU be the one that pays the bill?

Do you have insurance? If so, you are sharing your medical costs with everyone in your group. If not, and you get run over by a bus or develop a brain tumor, you will get expensive care that you will either pay for yourself well into six figures, or -- more likely -- you will get care without paying your bills, ultimately leaving all of us on the hook one way or another.

There are a variety of mechanisms to encourage more healthy habits. But ultimately everybody needs health care, sooner or later, more or less, and every other First World country finds ways of sharing the costs equitably. Telling everybody they're on their own is just a couple steps from returning to caves.

And it's just ridiculous to claim we wouldn't need health care if we would just shape up. Disease is a little more complicated than that, not to mention accidents and trauma.
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Old 25th January 2017, 04:01 PM   #335
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Originally Posted by Worm View Post
The same is true of many public services. It's not about getting what I paid for, it's about trying to make sure that need is covered. Tax dollars are used to pay for all sorts of things that I don't use. And that's a good thing.
It's hard to calculate how much any specific person benefits from a universal healthcare program.

As a businessperson, I benefit when my employees and customers are healthy, for example. Severely ill employees don't produce profit for me. Severely ill people have less disposable income, and my customer base is smaller.

Health is like education: the rising water lifts all boats and pays dividends in excess of the original investment. This makes is a good model for a public service, which most countries have figured out.
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Old 25th January 2017, 04:09 PM   #336
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Originally Posted by xjx388 View Post
It's funny when people interpret "free preventive coverage" to mean "free healthcare." They expect their insurers to cover all their visits for stuff like diabetes, hypertension, heart disease, etc under free, no-copay, preventive coverage.
and in every other developed nation in the world all of that is free. And more.
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Old 25th January 2017, 04:22 PM   #337
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Originally Posted by Ambrosia View Post
and in every other developed nation in the world all of that is free. And more.
It's also generally free or cheap under most U.S. group health insurance policies too. The issue under discussion is whether people who buy their own insurance in the individual market can get the same prices and services as someone who is able to join a group. The answer is "Why not?"
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Old 25th January 2017, 04:57 PM   #338
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Originally Posted by Bob001 View Post
Do you have insurance? If so, you are sharing your medical costs with everyone in your group. If not, and you get run over by a bus or develop a brain tumor, you will get expensive care that you will either pay for yourself well into six figures, or -- more likely -- you will get care without paying your bills, ultimately leaving all of us on the hook one way or another.

There are a variety of mechanisms to encourage more healthy habits. But ultimately everybody needs health care, sooner or later, more or less, and every other First World country finds ways of sharing the costs equitably. Telling everybody they're on their own is just a couple steps from returning to caves.

And it's just ridiculous to claim we wouldn't need health care if we would just shape up. Disease is a little more complicated than that, not to mention accidents and trauma.
I never claimed we wouldn't need health care. But surely you can agree that people who don't smoke, eat a healthy diet, are not overweight, etc, tend not to develop the chronic diseases that are responsible for most of our death and disability. Just look at the CDC's stats: Heart Disease is the number one killer, followed by Cancer and Chronic Lower Pulmonary Disease. Let's focus on number one. Again, according to the CDC, Heart Disease risk factors include: High Blood Pressure, High Cholesterol, Smoking, Diabetes, Obesity, Poor diet, Physical inactivity, Excessive alcohol use. How much of that is lifestyle-related? I would say almost all of it. How much could we cut disease if people didn't smoke, ate right, moderated their drinking and lost some weight? I think it's clear that we could reduce those deaths by a significant margin.

A large percentage of people obviously don't really take their health seriously. If they did, they would fix their lifestyle. They would take their medicine the way they are supposed to. But since they don't, we have the high rates of lifestyle disease that we do.

You talk about dividing health costs equitably. How is it equitable that people who voluntarily and knowingly engage in behaviors that are detrimental to their health should pay the same as the people who don't? I don't really care if the rest of the world does it; I don't live there.
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Old 25th January 2017, 05:00 PM   #339
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Originally Posted by Ambrosia View Post
and in every other developed nation in the world all of that is free. And more.
It's not free. You pay for it in taxes and in cuts to other areas where the government might spend money: infrastructure, defense, etc. Let's not pretend that other developed nations are utopias. They have problems in other areas than health care and even health care isn't the perfect model. I believe we can do better.
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Old 25th January 2017, 05:31 PM   #340
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Originally Posted by xjx388 View Post
It's not free. You pay for it in taxes and in cuts to other areas where the government might spend money: infrastructure, defense, etc. Let's not pretend that other developed nations are utopias. They have problems in other areas than health care and even health care isn't the perfect model. I believe we can do better.
Well, if you're going by that metric, then it's not free in the US, either, because it's paid for by those who pay for insurance.
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Old 25th January 2017, 05:34 PM   #341
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Originally Posted by xjx388 View Post
You talk about dividing health costs equitably. How is it equitable that people who voluntarily and knowingly engage in behaviors that are detrimental to their health should pay the same as the people who don't? I don't really care if the rest of the world does it; I don't live there.
I don't drive and I don't have any children. Does this mean that it's wrong for my taxes to pay for education and the upkeep of the roads? I've never had cause to call the police, either. I probably ought not to be paying for them. I'll just let them bill me if I ever do.
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Old 25th January 2017, 05:43 PM   #342
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Originally Posted by Minoosh View Post
OK.

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.
Confidentiality of my employer, and the competitive discounts that we have negotiated with our contracted providers.

If you want it to be transparent, I suggest starting with the providers who don't want the left hand to know what the right hand is getting paid

Originally Posted by Minoosh View Post
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?
No idea. I know that it covers the cost of supplies used as well as the non-doctor salaries of the employees. Plus the hospital system's executive salaries and shareholder profits, of course. I don't know what the magnitude of those last two are, and I believe there's a significant amount of variation between private for-profit hospitals and county hospitals, plus a fairly good chunk of not for profits. It gets well beyond my bailiwick though.

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.
No argument from me. The underlying cost elements are massively engorged, and almost always ignored. There's often an assumption that doctors are noble beings only interested in doing good and saving people, that willfully ignores the luxury cars, golf club memberships, and enormous houses that doctors get in the bargain.
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Old 25th January 2017, 05:46 PM   #343
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Originally Posted by Squeegee Beckenheim View Post
I don't drive and I don't have any children. Does this mean that it's wrong for my taxes to pay for education and the upkeep of the roads? I've never had cause to call the police, either. I probably ought not to be paying for them. I'll just let them bill me if I ever do.
Roads: You benefit from roads even if you don't personally drive. Without them, you couldn't get supplies to your home. Roads are essential for modern life and, as part of infrastructure is one of the primary roles of the government.

Schools: I'm with you on that. I think education should be privatized. Eliminate the property tax levies for school and let people spend that money for their own kid's education as they see fit. Government should have as little to do with education as possible because they aren't particularly good at it.

Police: Security is one of the primary roles of the government. We all benefit from a ready and able police force regardless if you personally ever use them or not.

None of these are a good comparison to health care. The need for health care is largely dictated by lifestyle choices and thus is highly personalized. You should pay for your own risks. I could get behind government funding of broad public health initiatives: immunizations, infectious disease control, etc. But it really has no place trying to dictate a cookie cutter approach to health care.
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Old 25th January 2017, 05:46 PM   #344
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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.
That's not really as big a piece of it as you might think. Those who can't pay are a pretty small segment. Those who won't pay (Medicare and Medicaid) are a bigger piece. Those who are effectively coercing a captive consumer base at threat of death or significant quality of life reductions are a *much* larger piece of the issue. Those would be the pharmaceutical companies, device and supply manufacturers, and some specialist organizations. That's not even addressing the overall profit level of your average physician. That's just looking at the egregious cases.
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Old 25th January 2017, 05:47 PM   #345
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Originally Posted by Squeegee Beckenheim View Post
Well, if you're going by that metric, then it's not free in the US, either, because it's paid for by those who pay for insurance.
I never said it was or should be free. We should each pay for the care we need based on the lifestyle choices we make.
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Old 25th January 2017, 05:54 PM   #346
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Originally Posted by Emily's Cat View Post
Confidentiality of my employer, and the competitive discounts that we have negotiated with our contracted providers.

If you want it to be transparent, I suggest starting with the providers who don't want the left hand to know what the right hand is getting paid
I don't think providers are hiding anything. Our pricing for self-pay patients is very simple and given freely to any who ask. You can call a local hospital or stand-alone diagnostic center and get prices pretty easily. I think this idea that you can't figure out how much something in the healthcare industry costs is something of a myth.


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No argument from me. The underlying cost elements are massively engorged, and almost always ignored. There's often an assumption that doctors are noble beings only interested in doing good and saving people, that willfully ignores the luxury cars, golf club memberships, and enormous houses that doctors get in the bargain.
And what's wrong with people who have worked hard and acquired a highly specialized training and knowledge being able to make a lot of money? I don't understand this argument. We have no problem with athletes, movie stars, etc making a ton of money -much more than doctors- for relatively trivial jobs. Yet god forbid a doctor should be able to afford a fancy car and a nice house. Why?
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Old 25th January 2017, 05:58 PM   #347
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Originally Posted by sunmaster14 View Post
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.
Yes, high demand is part of it, because of the intermediary effect of insurance. That's an economic lever that will always exist as long as there is insurance. It's an element of moral hazard.

Supply in the US really isn't restricted in any meaningful way. In fact, we have far, far too many MRI and CT machines than are justified from a usage level. We have an extremely large degree of duplication of material and service within densely populated areas, far more than is needed based on per-capita usage. When you have an MRI machine sitting idle, doctors tend to request more MRI screenings.

The biggest single reason is that many of the suppliers of the service or good can leverage the "take this drug of you die" effect to increase their prices to exorbitant levels... because the consumer isn't the one seeing that price. The middle man (insurer) can't ethically refuse to pay the coercive price. It's price gouging.


Originally Posted by sunmaster14 View Post
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.
Meh. It's not the R&D element of it. It's the free market nature of the US health system at fault on this. Each separate insurance carrier ends up negotiating for themselves with each service provider. Some of those service providers (Pharmaceutical companies eg) are VERY big. Without collective bargaining for those goods and services, the supplier ends up acting like a monopoly.

The profit margins reported by many of these companies are reported AFTER having accounted for the investment in R&D.

Additionally, a huge amount of the base R&D is actually done through universities and is funded by government grants. The various companies then hire the people who did that research, or purchase the results of that preliminary research once it reaches a promising stage. Eli Lilly isn't really doing ground-up work to find a cure for Alzheimer's. They're just hiring the people who did ground-up work during their doctorate, who bring that research with them.
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Old 25th January 2017, 06:00 PM   #348
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Originally Posted by bonzombiekitty View Post
I recently had an argument with someone who insisted that when they looked at forgoing health insurance, it would be a $5000 penalty and he only makes $48,000. I asked him how he got to that number, and they stated that it's what the ACA says. I responded that's not what the law says, and in order to have to pay $5000 you would first have an adjusted gross income of
$200,000 and that's ignoring the cost of a bronze plan. He still insisted I was wrong and it was $5000. I showed him the law and various calculators to demonstrate it couldn't have been $5000. Didn't convince him - I was lying apparently even though he couldn't explain how he got to his figure.
It's not exactly a straight-forward calculation. I don't really fault anyone for getting it wrong. But hey - if he thinks it's going to be a $5000 penalty, then he's more likely to buy insurance. It'll likely be in his best interests in the long run. And if he lives in my state, there's some small chance it might benefit my company
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Old 25th January 2017, 06:05 PM   #349
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Originally Posted by Dr. Keith View Post
On this I completely agree with you. Both of these reasons are much easier to sustain in a complex market that puts insurers between the consumer and the provider. It makes the consumer think the insurer is looking out of their interest, but in fact the insurer is just looking out of rate bottom line.
The insurer's bottom line IS the consumer's price. A lower cost burden to the insurer literally translates to a lower premium cost in the market place. A higher cost burden to the insurer literally translates to a higher premium cost in the market place. Having high underlying cost structures from the suppliers of medicine is NOT in the best interests of the insurer, nor in the best interests of the policyholder.

Originally Posted by Dr. Keith View Post
Replace the complex web of insurers with a single entity and you increase the transparency and reduce the complexity. When one entity is paying the bills and we are that entity then we can demand more form our medical providers.
Increase transparency and reducing complexity are both admirable goals, and I'm fully behind that objective. But that alone won't address the cost element. If it doesn't address the costs being charged by the suppliers of care, the cost will still continue to rise astronomically no matter how transparent you are about it. That's one of the elements of ACA that made it a bad law - it did absolutely nothing to address the underlying cost trend.
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Old 25th January 2017, 06:07 PM   #350
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Originally Posted by Bob001 View Post
And yet Medicare is recognized as one of the most successful government programs, even when the doddering elderly shout "keep the government away from my Medicare!" A gradual introduction of a Medicare-for-All plan, starting with allowing younger people to buy into it with reasonable premiums, would probably get pretty broad acceptance.
Pair it with the private carriers of Medicare Supplement and Medicare Advantage to retain the element of choice, and you've got the makings of a pretty good win.
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Old 25th January 2017, 06:09 PM   #351
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Originally Posted by Bob001 View Post
Do you have insurance? If so, you are sharing your medical costs with everyone in your group. If not, and you get run over by a bus or develop a brain tumor, you will get expensive care that you will either pay for yourself well into six figures, or -- more likely -- you will get care without paying your bills, ultimately leaving all of us on the hook one way or another.

There are a variety of mechanisms to encourage more healthy habits. But ultimately everybody needs health care, sooner or later, more or less, and every other First World country finds ways of sharing the costs equitably. Telling everybody they're on their own is just a couple steps from returning to caves.

And it's just ridiculous to claim we wouldn't need health care if we would just shape up. Disease is a little more complicated than that, not to mention accidents and trauma.
You have some points... but we would need a lot less health care if we would just shape up.

Health care would cost a lot less if there were less moral hazard involved.
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Old 25th January 2017, 06:10 PM   #352
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Originally Posted by Bob001 View Post
It's also generally free or cheap under most U.S. group health insurance policies too. The issue under discussion is whether people who buy their own insurance in the individual market can get the same prices and services as someone who is able to join a group. The answer is "Why not?"
Because the employer is usually paying 80% to 90% of the underlying cost. There's nobody paying that 80% when they're buying it themselves.

ETA: Actual underlying claim costs are actually a little bit higher for group coverage than they are for Individual. It's just that the employers often heavily subsidize that coverage as non-wage compensation to their employees.
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Old 25th January 2017, 06:16 PM   #353
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Originally Posted by xjx388 View Post
I don't think providers are hiding anything. Our pricing for self-pay patients is very simple and given freely to any who ask. You can call a local hospital or stand-alone diagnostic center and get prices pretty easily. I think this idea that you can't figure out how much something in the healthcare industry costs is something of a myth.
Do you disclose the negotiated rates that you have with your insurance partners to your self-pay patients? Or to other insurance partners?

I'm not saying it's a myth, I'm saying that it;s a term of my employment that I don't disclose my company's confidential and proprietary information. Negotiated cost is one of those things.

Originally Posted by xjx388 View Post
And what's wrong with people who have worked hard and acquired a highly specialized training and knowledge being able to make a lot of money? I don't understand this argument. We have no problem with athletes, movie stars, etc making a ton of money -much more than doctors- for relatively trivial jobs. Yet god forbid a doctor should be able to afford a fancy car and a nice house. Why?
I'm all for a doctor being able to afford a fancy car... as long as we're not complaining about a 2% average profit margin being made by insurance companies in the same breath

I do have a problem with pharmaceutical companies and device & supply manufacturers consistently making 30% profits year over year, raising the price of drugs three-fold because "that's what the market will bear" when the failure to bear that cost is death or significant reduction in quality of life. Kind of the same way I would object to a farmer charging $700 per ear of corn during a famine. Holding people captive to their potential death is something I find unethical. A lot of the pricing practices in the medical industry come awfully close to that line in my opinion. But at the end of the day, it is a matter of opinion.
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Old 25th January 2017, 06:39 PM   #354
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Originally Posted by xjx388 View Post
If you make positive healthy changes to your life, you will prevent the most common problems that lead to death in our country. If you refuse to make those changes, then shouldn't YOU be the one that pays the bill?
For crying out loud. No. If it's cheaper just to deliver the health care, why would you want a punitive system?

How do you go about apportioning proper levels of blame? Certainly genetics testing would be required, with, for example, a clear genomic map between diabetes 2 and a sedentary life; heart disease genes vs. lifestyle. We could make HIV treatment dependent on a sliding scale of promiscuity. How much should convenience stores take the rap for selling 64-ounce Cokes? Yes, people can be stupid, no argument here but it doesn't matter to public policy if treating people is cheaper, damn it! Otherwise it's just punishment, and stupid. But I think you've hit exactly at how many conservatives think. Suck it up, it's your own damn fault.
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Old 25th January 2017, 07:00 PM   #355
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Originally Posted by Emily's Cat View Post
No argument from me. The underlying cost elements are massively engorged, and almost always ignored. There's often an assumption that doctors are noble beings only interested in doing good and saving people, that willfully ignores the luxury cars, golf club memberships, and enormous houses that doctors get in the bargain.
I remember back in my reporting on local government way back in the '80s that the county hospital was failing because physicians could not be lured to work there and Medicaid (slightly different in my state; we had a separate system) meant those patients could be treated anywhere. The slightly-inconvenient county hospital was supposedly too inconvenient.

Fifteen years later I dated a doctor and realized exactly what it would take to get doctors to make rounds there: Put a driving range/golf course next door.

This was a very real option in a community where South Side land had been ceded to the county for a number of government services (including juvenile detention center, Triple A/spring training facility and charity hospital). But it took me a long time to figure it out. And the "inconvenient" place, though perhaps 5 (4?) miles away, was almost a straight shot with very few traffic lights.

Per the New Yorker doctors have driven the defeat of UHC plans since the days of Harry Truman. I almost wish people would boycott doctors. Death rates would probably drop.
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Old 25th January 2017, 07:22 PM   #356
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Originally Posted by Cain View Post
regular Republicans don't seem to mind insurance subsidies paid to farmers when its framed as "protecting our food supply," and "avoiding dependence on foreign countries." farmers vote for them.
Except farmers don't vote for Republican voters, so your "fix" is incoherent. Of course Republican politicians will bow before the farm lobby, and they'll the same when it comes to Medicare. That's elementary.

Originally Posted by Beelzebuddy View Post
Regular Republicans don't actually care about ideology, they'll change to whatever gets them the most votes. Currently the unions are turning red, so expect to see the farm subsidy rhetoric switch to "keepin' 'Merican jobs in 'Merica" without a hitch in between.
I'm talking about framing issues for regular Republicans. There's certainly a contingent that is relatively non-ideological, but Americans/humans can't help but internalize poltiical beliefs via socialization. Arguments about health-care as a human right, or as a matter of economic efficiency, have left these people cold.
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Old 25th January 2017, 07:48 PM   #357
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Originally Posted by xjx388 View Post
I never claimed we wouldn't need health care. But surely you can agree that people who don't smoke, eat a healthy diet, are not overweight, etc, tend not to develop the chronic diseases that are responsible for most of our death and disability. Just look at the CDC's stats: Heart Disease is the number one killer, followed by Cancer and Chronic Lower Pulmonary Disease. Let's focus on number one. Again, according to the CDC, Heart Disease risk factors include: High Blood Pressure, High Cholesterol, Smoking, Diabetes, Obesity, Poor diet, Physical inactivity, Excessive alcohol use. How much of that is lifestyle-related? I would say almost all of it. How much could we cut disease if people didn't smoke, ate right, moderated their drinking and lost some weight? I think it's clear that we could reduce those deaths by a significant margin.

A large percentage of people obviously don't really take their health seriously. If they did, they would fix their lifestyle. They would take their medicine the way they are supposed to. But since they don't, we have the high rates of lifestyle disease that we do.

You talk about dividing health costs equitably. How is it equitable that people who voluntarily and knowingly engage in behaviors that are detrimental to their health should pay the same as the people who don't? I don't really care if the rest of the world does it; I don't live there.
A healthy life-style doesn't mean you don't get sick. It means you have more life-time in which to get sick.
Some studies show that certain unhealthy choices (like smoking) cause fewer health care expenses because less time (if any) is spent old and frail.
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Old 25th January 2017, 08:15 PM   #358
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Originally Posted by Minoosh View Post
For crying out loud. No. If it's cheaper just to deliver the health care, why would you want a punitive system?
How would it be cheaper to just provide the health care? Everyone agrees that prevention is cheaper than the cure so I'm not sure how one would arrive at the argument that actual prevention (better diet, increased activity, no smoking, etc) would be cheaper than widespread delivery of health care. Are you saying that better lifestyle choices would not lower disease and disability by a significant margin? I don't think the science is with you on that one.

Quote:
How do you go about apportioning proper levels of blame? Certainly genetics testing would be required, with, for example, a clear genomic map between diabetes 2 and a sedentary life; heart disease genes vs. lifestyle. We could make HIV treatment dependent on a sliding scale of promiscuity. How much should convenience stores take the rap for selling 64-ounce Cokes? Yes, people can be stupid, no argument here but it doesn't matter to public policy if treating people is cheaper, damn it! Otherwise it's just punishment, and stupid.
Nonsense. Do you smoke? Are you obese? Do you use abuse drugs/alcohol? Those questions are much better predictors of an individual's risk for future health problems than genetics. We know that obese people are much more likely to develop type II diabetes. We know that smokers are more likely to develop heart disease, pulmonary disease and cancer. We know that people who consume more fruits and veggies vs red meat and processed foods are less likely to develop colon cancer and other cancers. We know that abuse of alcohol can lead to liver problems, cancer, etc.

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But I think you've hit exactly at how many conservatives think. Suck it up, it's your own damn fault.
I think you'd better come to the realization that yes, indeed, it is mostly your own fault. Until we all realize that essential fact, our health costs will continue to spiral out of control.

I liken it to climate-change issues. Our need for gas-guzzling cars, reliable electricity, A/C and heat, global travel and mass production is killing the planet. That's just a plain fact. We know this but no one wants to actually stop doing those things. The proposed solutions to the problem don't address actually cutting these modern conveniences. Until we do, we just have to accept that climate change is an inevitable outcome of our irresponsibility.
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Old 25th January 2017, 08:17 PM   #359
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Originally Posted by GnaGnaMan View Post
A healthy life-style doesn't mean you don't get sick. It means you have more life-time in which to get sick.
Some studies show that certain unhealthy choices (like smoking) cause fewer health care expenses because less time (if any) is spent old and frail.
I don't think you are interpreting these studies correctly. Sure, if we didn't treat the problems that arise with smoking, it might be cheaper. But we can't have it both ways: keep smoking, insist that smokers be treated for the inevitable problems that arise and then expect to save money. It makes no sense.
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Old 25th January 2017, 08:30 PM   #360
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Originally Posted by xjx388 View Post
None of these are a good comparison to health care. The need for health care is largely dictated by lifestyle choices and thus is highly personalized. You should pay for your own risks. I could get behind government funding of broad public health initiatives: immunizations, infectious disease control, etc. But it really has no place trying to dictate a cookie cutter approach to health care.
So, let's take a look at one example. You are responsible for your own lifestyle, are young, fit and well. You are doing your usual afternoon jog, when a driver loses control of his car, runs you over, and turns you into a quadriplegic.

You require medical care for the rest of your life. Under the USA system, who pays for the initial and on-going medical costs?

For the sake of this, I am assuming that the driver of the car has not got any money, so a law suit is useless.

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