Health Insurance
Health Insurance
(OP)
I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?





RE: Health Insurance
RE: Health Insurance
is this a company benefit (ie no charge), or a taxable benefit ? or can you opt out and arrange your own insurance ??
another day in paradise, or is paradise one day closer ?
RE: Health Insurance
http://www.commondreams.org/views/2009/09/09/medic...
John R. Baker, P.E.
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RE: Health Insurance
RE: Health Insurance
My employer pays a respectable share of my insurance, but after everything, my premiums still run very close to 10k annually, sans dental coverage. A flex plan helps keep my OOP manageable, somewhere around 4 or 5k for the family, if memory serves.
It's not that the healthcare system is broken, the US still has the finest in the world, it's just that the door is now wide open for gross opportunism with the whole insurance thing.
The cost to my parents for me to be born in a hospital, doctor's bill and the whole nine yards, was less than $200. Yes, the dinosaurs had all died off by that time, for those of you wondering. For my children, the 3 who were born in the US started somewhere in the $6 to 8,000 range (20+ years ago). Had basic commodity items followed that same curve, we'd be paying north of $25 for a gallon of milk and $100k for a new Chevy. Healthcare is just totally disproportionate from everything else, reality included. I'd greatly prefer healthcare in step with other costs, and the reasonable ability to opt out completely and just pay-as-I-go.
My afternoon rant thus concludes.
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
My employer pays most of our healthcare and it's a pretty good PPO. I forget the exact numbers but I think I end up directly paying less than half the amount ornery mentions in premiums.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
RE: Health Insurance
Now we have to pay part of the cost and the deductibles are much higher and the dental insurance is a separate policy, but optical is still covered (at least an eye exam and one pair of single vision glasses per year).
For my wife and myself, I pay about $3,500/year for medical and another $450/year for dental (pre-tax dollars). Note that it's a traditional PPO plan with deductibles of $500 per person and there's a $25 co-pay for doctor visits ($40 for specialists). Perscriptions are included with a co-pay based on a percentage of the retail cost. Generics are very low cost (I'm on 2 Rx's for high blood pressure, a thyroid replacement, a statin for my cholesterol and oral medication for my diabetes, and it costs me less than $40 every 3 months with the thyroid replacement being the most expensive, accounting for about a 3rd of the total).
Note that we also have a pre-tax medical savings account that I can put in up to $2500 so at least we can cover the deductibles and co-pays with tax-exempt dollars.
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
I am in favor of a single payer model, and it may likely require the addition of a national VAT to pay for it, as with most other countries. As I recall, 18% of the US GNP is ascribed to health care costs under the current model, yet there are many towns and counties in the US where there are no hospitals within 100 miles and no doctors within several 100 miles that would accept new patients using medicare.
It is strange that there is a hysterical reaction against "socialized medicine" but there is absolutely no complaint when we socialize the costs of the education system, the police, the military , the various welfare programs ( including corporate welfare via tax credits etc), and of course the government in general.
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
Should this be of interest, your senate has been looking at international systems. I simply loved watching, and adored what happened when the Republican tried to spank the Canadian:
RE: Health Insurance
RE: Health Insurance
Friends of mine run a mobile X-ray/ultrasound service. A few years ago they had 15 full time employers, five of whom were dedicated entirely to billing the 2000 or so payors, each with their own forms etc. Yep, that's private sector efficiency for you!
The Canadian system is far from perfect. We treat doctors as little "businesses" rather than as government employees who go where the work is. Dental care, which is essential healthcare too, is not covered publicly at all. We continue to make specialization much more attractive than family practice. We should be setting up more multidisciplinary practices which would take care of the majority of family physician visits with much lower-cost staff (dieticians, nurse practitioners, midwives etc.). We continue to clog up hospital beds with people who can't find subsidized long-term care beds, which can't help but affect wait times for somebody. But at least here, your coverage is NOT tied to employment, and there's no "pre existing condition" horsesh*t to worry about. Healthcare here is NOT a payroll tax- it is hence not a powerful disincentive to employment.
RE: Health Insurance
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
A hybrid system can work in the US as well ( or a 2-tiered system) with the lower tier similar to the VA hospitals ( socialized) with the 2nd tier of boutique hospitals and clinics, and there is always the availability of "medical tourism" to other countries for those that cannot afford the wait but can afford the airfare. Unfortunately , medical tourism brings with it the risk of transporting new diseases from overseas back to the US.
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
The bigest problem I would have with a single payer system, is the same problem I have with the post office, or DMV. Workers who are underpaid, and no longer care about the customers.
The comment about people not having a hospital within a hundred miles, is true, but it is also true some people live more than a hundred miles from any towns.
It is my openion that the free market, if allowed. will be able to solve many of these problems (towns in Alaska have doctors, because the state helpes pay part of the education costs).
Part of the problem is the political will, or lack of free market to provide the solutions.
RE: Health Insurance
Part of the problem is the political will, or lack of free market to provide the solutions."
That, by definition, is not free a market. A free market would not have a government subsidy or incentive. A free market will NEVER have incentive on its own to serve customers where profit cannot be made.
TTFN

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RE: Health Insurance
However, complaining about a problem, in hopes that privite industry will fix the problem dosen't work.
One new trend is doctors limiting there selves to fewer patents, but requiring upfrount yearly payments for being there exclusive patents (less the other fewer patents), is an idea taking hold. The problem is my insurance dosen't work that way. The advantage is less waiting in line for an appointment, and no fees (or reduced) for office visits.
The advantage for the doctor is they know there income, provided they manage there office correctly. And they get to better know there patents better.
RE: Health Insurance
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
The advantage for the doctor is they know there income, provided they manage there office correctly. And they get to better know there patents better."
Right, but only those who can pay. So who's going to take care of the 40 million that couldn't pay before Obamacare, as well as those that are currently getting shorted because their companies can now get away with it? And how well will the US handle the as yet to appear next pandemic disease, when all those people without insurance get really sick?
TTFN

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RE: Health Insurance
Medical tourism exists, for sure. But as cheap as hospitals can be in India etc., it's not a major cost saver for the system right now. The vast majority of healthcare needs are met by the local publicly-insured system.
Where the local system saves plenty of dollars and also keeps wait lists shorter is by providing the opportunity for people to get tests (primarily) done faster if they choose to travel to a MRI machine across the border. In that case you pay the travel but the public system pays for the test. Sometimes they pay for the travel too, if the local machines are clogged and there's a medical emergency requiring a test ASAP. The public system doesn't therefore have to build spare MRI capacity so it can sit idle most of the time so it's there to provide fast access during peak demand periods, i.e. the public system is taking advantage of the excesses of the US system to be efficient and keep its own costs low. Having a neighbour who spends an extra 7% of GDP on excess capacity that sits idle most of the time, definitely has its benefits!
BTW for every person going south of the border for a MRI, there are probably two retiree Americans going north of the border to load up on low price pharmaceuticals which are low price precisely BECAUSE the public system here negotiated bulk purchase pricing for us collectively from the pharma companies. So that border goes both ways, folks.
I forgot to mention the obvious- my friends who run the mobile medical imaging business are in the US. Here they would likely not have a business at all, or it would be a niche private business at most.
RE: Health Insurance
> Because of the lack of insurance, these people wait until their illness get so bad that that they have to go to the ER
> Which further jacks up the cost of what might have been a trivial thing to treat at an earlier time
> This delay in treatment has the potential of getting other people sick, who may, or may not, have insurance. In either case, more people get sick than is necessary
> The additional demand on ER resources means that critically ill patients wind up competing with those that shouldn't have had to go to the ER for those resources
> This further means that county ERs have to have additional staffing to treat all the extra patients
And, we pay for all of that through property or other taxes. In effect, we are creating a single payer system with a guaranteed poor outcome, because we pay for those services at ER rates, and have to spend even more because the patients are sicker than they could have been had they had insurance.
The bottom line is that those that have insurance are still paying for the uninsured, and the rates that we pay are higher because non-county hospitals are likewise building in operating margin to cover the non-paying patients. My son stayed in the hospital for 2 days for pneumonia and the "bill" as $10k, which is an insane amount of money.
TTFN

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RE: Health Insurance
RE: Health Insurance
I have a cabin just south of the US-Canada border, and a few years ago (2005) found an elderly man hitch-hiking on the side of the road. I asked him where he was expecting to go, and he indicated he just crossed the border from Canada, and needed to get to the US hospital in Bellingham, Washington state ( 30 miles away). When I asked him why he doesn't use the Canadian facilities in Abbotsford or Vancouver, he replied" I am 70 yrs old , and they found I have brain tumor , and that they can schedule the operation in Canada after a 2 yr waiting period . There is no way I will survive 2 yrs with this tumor, so I will have it removed in Bellingham , where they will backcharge Canada Health".
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
http://www.health.gov.on.ca/en/public/publications...
RE: Health Insurance
Tunalover
RE: Health Insurance
Please distinguish between family doctors, surgeons, and hospitals. My wife is the former, and spends about ~20 minutes per patient doing charts, for which there is there no billable, yet, the billables must cover her time spent, so she sees fewer patients. That means that she spends about 10 hrs a week just doing charts, and only 30 hours seeing patients. Refills, referrals, medical excuse forms, etc., are also not billable, and must also be accounted for in the actual revenue stream, as are the MAs answering the phones, and doing the routine stuff. So, for those that can pay with PPO, the rates have to cover this. Medicare is generally very skimpy, and she basically loses money seeing those patients, so she declines to see those.
TTFN

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RE: Health Insurance
Not so much the hospitals as the doctors. The hospitals have so many other tasks that aren't billable plus they have to somehow stay afloat in spite of the many uninsured/under-insured clogging the ERs. Granted the doctors have costs to bear besides a PA providing 20min of services, but there is no excuse for a rate of $540/hr for someone who isn't even an MD.
Tunalover
RE: Health Insurance
RE: Health Insurance
Don't get me wrong, I happen to think that MD or not $540/hr seems excessive for the actual services you received but you make it sound the like the PA is pocketing the cash.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
[Source: I work in medical devices.]
RE: Health Insurance
The problem of the poor will always be a problem, that will only increase as the cost of living or the definition of poor keeps growing.
If you need a resource of doctors, all you need to do is look at the number of doctors doing nose and face jobs for people who diden't take care of there skin in the first place. You don't see many of these doctors doing charity work, or performing procedures for medicare.
Another resource of doctors that don't do much charity work is the ones next to the pot shops that issue medical pot cards (Making pot legal might reduce the number of these, but I don't wish to discuss it here).
The bottom line is money talks, and there are far too few free clinics, and the wait time of several hours is needed to keep the greedy out.
RE: Health Insurance
All PAs, NPs, and MAs are technically under the direct supervision of the doctor who signs off on the charts and who pays for the liability insurance, and who is the one that gets sued if things go south. They get less than the 4 yrs of medical training, and ZERO residency training, and they're "ready" to do things that doctors are supposed to do. The risk and work content is still the same. The charts still need to be done or checked, by the doctor, as are any followups or telephone calls, etc. That's all part of the overhead of running the business, and specialists, like dermatologists, are billed out at higher rates than family doctors.
TTFN

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RE: Health Insurance
RE: Health Insurance
http://www.pnhp.org/resources/60-percent-of-health...
John R. Baker, P.E.
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Siemens PLM Software Inc.
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Siemens PLM:
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
Of course I realize that the PA doesn't get that rate! The rate goes to the practice who probably pays the PA a $50-$70k annual salary or the least they can pay to get the PA to do the job, whatever that is.
Tunalover
RE: Health Insurance
Medical school: The patient's wellbeing at any cost.-> Result = my HMO.
Solution: Let engineers run hospitals.
RE: Health Insurance
My wife and I are currently covered by the PPO plan and I'm assuming that we will continue with the PPO for next year, which will be my last before I retire and we move to Medicare starting in 2016 (I'll be 68 by then and my wife will be close to 70).
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
And it just might come to pass that companies will have there own medical staff so they can avoid the free loader fees of the current medical system.
RE: Health Insurance
Tunalover
RE: Health Insurance
TTFN

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RE: Health Insurance
RE: Health Insurance
Some of the best run companies in the world are run by exceptional engineers. It's the MBAs that have hurt their companies by focusing only on short-term profits, failing to gain an understanding of the departments they control, cutting training, shortening schedules, cutting budgets, and making asinine decisions affecting engineering and manufacturing. The success of a company depends on the sale of its products. It takes good engineers and production people to make these products of sufficient quality, function, and appearance to sell. Thus it takes good engineering and production for a company to be successful. Perhaps the biggest shortcoming of many engineers-turned-executives is their shortage of emotional intelligence and people skills. Exceptional engineers-turned-CEOs have these skills but also appreciate the profound effect engineering and manufacturing have on the company's success. Of course I'm probably preaching to the choir in this forum
Tunalover
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
I would argue that they WERE engineers, but mea culpa; I didn't fact check.
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RE: Health Insurance
RE: Health Insurance
My memory was faulty, and this was from 2006. The number with undergraduate engineering degrees was 23%, still greater than any other category.
http://www.arecentstudy.com/studies/S&P%20500%...
RE: Health Insurance
The other professions, including ours, have figured this out, at least better than the docs have.
...oh, and the medical error-related deaths too- if we killed even 1/10th as many people with our mistakes as doctors do, there'd be a Royal Commission of Inquiry into the profession of engineering in a heartbeat.
RE: Health Insurance
RE: Health Insurance
John R. Baker, P.E.
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Product Engineering Software
Siemens PLM Software Inc.
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Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
It is also not at all unique to Canada. There just seems to be no will for it to occur in the US.
It goes like this:
Gov: We'd like to negotiate a bulk-buy of your medication.
Producer: We don't sell in bulk or negotiate market prices.
Gov: Sure you do. Besides, you want to help us out.
Producer: It is our policy to no sell in bulk or negotiate market prices.
Gov: We've been thinking about passing legislation making it legal to copy your drugs without payment, and may also work to ensure that you cannot obtain any of our research grants, while denying any future approvals in order to deny you what is effectively a large fifty-first state of market share.
Producer: We'll take cost plus ten percent.
Gov: Make it five percent; Sign here, here, and here. Thanks. Knew you could help us make this work for everyone.
Many of the drug companies cave under very little pressure, and genuinely don't know that the Gov's both could not and would not follow through on any of their threats. Frankly I think the current government might actually follow through on some of those threats if they needed to, so it is likely wise that the drug manufacturers blink.
Note that it could be far more effective than it already is, and in fact I paid far less for drugs while living in New Zealand than I do here. It just isn't as bad as the states.
Business is business. As long as it is more production for more profit, the drug companies will negotiate and will set far lower prices than people in the States pay.
RE: Health Insurance
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
I suggest that we all stop thinking about these products as if the laws of the free market work on them: they're NOT commodities when a person's life hangs in the balance!
The reason the pharma companies cave is that they have to. They cave big time when the patents expire and the generics come on the market. The patents give them a monopoly on supply for 20 years- the government is merely being a monopoly buyer, leaning back a bit.
The provincial plan doesn't cover ordinary prescription meds- yet. Most people with decent company bennies get their prescription meds covered that way, just like in the US. The provincial plans vary in what they cover and what they don't, and for whom and under which circumstances, and those assessments for very costly but potentially life-extending drugs are based on medical evidence- there are still stories in the media about people mortgaging the house to pay for some of these high-cost drugs because they're not on the provincial formulary yet. But even for the drugs that aren't covered by the provincial plan for the average Joe, the provincial health system is a major purchaser simply because it buys all the meds used in all the hospitals. They are hence a huge purchaser and they use that power to lean back. The price they set is the price the local pharmacies buy at too, making the price for all of us lower.
RE: Health Insurance
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RE: Health Insurance
RE: Health Insurance
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
Then lets pretend that the Car Plans also cover gas, with a $5 co-pay at the gas station, regardless of how fat your car is. Well then nobody'd buy fuel efficient (skinny) cars, and nobody'd conserve their own gas use, and the cost of Car Plans goes up even more. Oh and since nobody's shopping for cheap gas, they can charge more per gallon as well.
Oh but each station only sells one kind of gas. If you need premium gas, you need a referral, and you can't get buy it unless you go to the Regular gas station, talk to the attendant, and he refers you to the premium gas station.
Also, wait a sec, he needs to be qualified to give the recommendation, with at least an 8 year college degree and another four years worth of residency at Quik Trip. So, you know, higher wages for him, and the price of the Car Plan continues to climb.
Then the Car Wash Lobby gets in and convinces folks to change the coverage rules, so Car Plans have to provide a car wash once a month. Everyone has shinier cars, and the cost goes up again.
And because the costs keep skyrocketing, everyone clamors about how the Free Market simply isn't working! Oh golly, shopping for Car Plans just isn't keeping our costs low. We need Single Payer car plans. Universal MediCar! ObamaCar!
...
So yeah. That's why health care is expensive here. If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it. My total cost to the system is ten bucks. If I get an ear ache in the US, I have to go to primary care, pay a copay, he bills the insurance company and says "go see an ENT," I go to the ENT, pay another copay, he bills the insurance company again, gives me permission to buy a highly proprietary patented expensive version of amoxil he's on the take to peddle, sends me to the pharmacist, and I pay another copay there while the pharmacist bills the rest of the bill to the health plan.
Unless you blow that completely stupid business model up, health care is going to continue to be completely stupid in the USA. It's got nothing to do with who shares the costs, whether it's public or private. It's got everything to do with the lack of an individual's motivation to keep their own costs down, and the systems motivation to do everything to drive costs up, since they're billing the shared pool anyway.
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RE: Health Insurance
The problem with the vision of a government that's "gone nanny", is that they don't know when to stop. This will continue to regress until the liberties and freedoms acknowledged by the constitution and bill of rights are simply a fond and faded memory, a footnote in the history books. Put some serious thought into it, 1984 is not that far off. (waits for the slight pause as the staunch traditionalists become alarmed and emit a proper blubbering of protest)
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
beej67, applying this same logic to other countries such as Sweden or the UK, it would seem that they too would suffer from a “lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”. Being publically funded (socialized), they should be even worse than the US. However, this is opposite from reality. The (2011) health expenditure cost per capita of both Sweden ($3,925) and the UK ($3,405) is less than half that of the US ($8,508). Furthermore, the socialized systems of the UK and Sweden should, according to this logic, be bogged down to bureaucratic inefficiencies. However, they ranked first and second in “efficiency”, while the US was dead last amongst other Western nations.
The free market is not the panacea of the health care system, quite the opposite. The free market is great at commodifying and profiting off things. Sometimes, it has the co-benefit of improving society but this is not it’s goal. If there is a conflict between profits and what’s in the best interest of society, profits win (actually, they LEGALLY must win due to Dodge v. Ford). This is fundamentally problematic for something such as healthcare which, as moltenmetal stated, is closer to a basic human right than a commodity.
The failure to recognize this by free market enthusiasts largely stems from a bizarre and contradictory notion that when good things happen, it was the free market working the way it should and when bad things happen, it was regulations preventing the free market from operating efficiently.
1) The free market is the most flexible, adaptable, responsive system ever contrived. It is the solution to all social and economic issues, under every possible situation. (i.e. free market during boom periods)
2) Regulations, regardless of their extent or rigidity, completely undermine the free market and destroy its ability to operate effectively. The free market is completely inept at being able to adjust to any and all regulations imposed upon it. (i.e. free market during bust periods)
1) Without the competition that the free market offers, companies will greedily raise prices and lazily let quality slide. Consumers, being mindless drones, won’t respond. A 1984-esque society will emerge. (i.e. socialized healthcare…despite all real world evidence)
2) Without the regulations and corporate laws, companies will act in the best interest of the consumer and society at large. Consumers, being citizens of change, will effectively boycott, in mass, those companies that don’t. An egalitarian society will prosper. (i.e. free market healthcare…despite all real world evidence)
1) The free market works efficiently because consumers respond strongly to price points and thus puts pressure on companies to improve efficiency and drive down costs. (i.e. why Walmart does so well)
2) The free market works ethically because consumers don’t respond strongly to price points and thus will encourage companies to act ethically and in the best interest of society even if that means increasing prices to do so. (i.e. why Walmart does so poorly…wait…)
Given this contradictory stance, it’s no wonder that some will continue to believe that the US health care system needs more free market solutions, not less, despite all the evidence supporting the opposite.
I’m getting déjà vu from this discussion…one side using belief that the free market will solve all life’s problems (and, conversely, regulations cause all of life’s problems) and the other side using real world evidence to counter this stance…sounds oddly familiar…
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
I agree it's the goverment that is the problem, not the solution to the problem.
However, local goverments can help, as long as they are restricted by the people in the community.
RE: Health Insurance
RE: Health Insurance
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
Then it turns out I misdiagnosed myself and the amoxil doesn't do anything to help 'cause it was a virus. However, it has handily helped set up an antibiotic resistant strain of some bacteria that later cause me to have such a bad infection I have to have a several night hospital stay on the strongest antibiotics available which have nasty side effects/end up needing an amputation/end up dead.
Yep, no downfalls in that system beej67.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
No no no.
Single payer would be cheaper than what we have now. A free market would be cheaper than what we have now. What we have now is a perfect blend of the worst and most expensive elements of both systems, because that's what funnels the most money to the following groups:
Doctors
Hospitals
Pharma
Insurance
...all of which have lobbyists, and the lobbyists write the laws.
What we had before Obamacare was a very terrible blend of highly restrictive government regulations and for-profit cost sharing mechanisms that forced costs up. All Obamacare did was double down on the stupid. It was supposed to be a bill to address costs, but instead turned into a bill to broaden the number of things covered (which costs more) and to force everyone to buy it (which sucks in more money) and to fuel the buying spree with federal dollars (which drives prices even higher).
We took a terrible, broken system and turned everything that made it expensive in the first place up to Spinal Tap Eleven.
Only an idiot would think that the best way to reduce costs is to make the insurance cover more stuff and then hold a gun to everyone's head forcing them to buy insurance.
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RE: Health Insurance
This sentence is contradictory, and speaks to your poor understanding of how business in the western hemisphere works. You say you're a mechanical engineer. What sort of engineering do you do? Do you bid on projects? Are they least cost bidder projects?
Let me break it down for you. The free market is great at commoditizing (not "comodifying") goods and services, but the act of commoditizing them reduces the profit to be made from them. In a perfectly elastic marketplace with perfectly robust competition, nobody makes money. Everybody saves money. You're falling into the common Blue Shirt trap of confusing free markets with capitalism.
Free Markets means you and I exchange goods or services for a price we both agree to.
Capitalism means I loan money to you and expect a return on my investment.
Capitalists are forever attempting to fight against free markets, because in a perfect marketplace there's no ROI. Capitalists want to corner markets. They want to be the only seller, or one of a very few sellers who can collude, so the buyer has to pay more than the product took to create. In a marketplace where 100% of the market share goes to the lowest price product, profits of all sellers shrink to the margin.
This is why ASCE wants to make all PEs get a masters degree. They want to reduce the number of 'sellers' to corner a market and drive the margins up. This is why the AMA has such a restrictive process to become a doctor, to create artificial scarcity of supply. This is why I can't just walk up to a pharmacist when I have an ear ache and buy the Amoxil that I know will cure the ear ache, without first going to a doctor, paying a copay, having the doctor bill my insurance, having the doctor refer me to an ENT, paying another copay, having the ENT also bill my insurance, getting a prescription for a highly proprietary and totally new version of Amoxil that costs ten times as much, going to the pharmacist, paying another copay, and having the pharmacist bill my insurance for the expensive alternative to Amoxil. All of those things obscure the marketplace, to drive up the margins.
If I was in Mexico, where there's a free market, I could walk up to to a pharmacist and buy the Amoxil, and my total cost to the system would be fifteen bucks.
See?
It's just like the car insurance analogy above.
Your comparisons to England and Sweden are hollow and pointless, because England and Sweden don't have anything like what we have here. Our laws are written by corporations.
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RE: Health Insurance
For many kinds of health care, the free market flat DOES NOT work. In order for a free market to work, you need to have two things:
1) the knowledge of what you're shopping for, and
2) the ability to shop at all
If I get in a car wreck, I can do neither. The free marketplace does not work for car wrecks. It doesn't work for heart attacks. It does not work for strokes. It does not work for any scenario in which an ambulance or helicopter shows up to rescue you from certain death and trucks you off to a pack of highly trained specialists. Trying to apply free market principles to that scenario is doomed to fail from the beginning.
If I were to craft the perfect system from scratch, all emergency services would be handled on a single government payer model, with the costs to the government published and critiqued by the media. Insurance would not cover emergency services at all. Taxes would.
On the other hand, prescription drugs are absolutely something that free market principles could be applied to, and the many layers of market obfuscation could be stripped out and replaced simply with education and individual responsibility. We could take 95% of the prescription drugs on the market today and make them over the counter. We could take the remaining 5% and allow them to be issued with merely the recommendation of a pharmacist, not a doctor. We could reduce the patent limit on drugs to 4 years. We could move cannabis off the schedule 1 list. Then once the costs plummet, we pull them off of the health plans.
Then, with no emergency services and no prescription drugs on the health plans, we make buying insurance optional again.
That's the kind of solution that would work. But look what it does:
Takes money from hospitals
Takes money from pharma
Takes money from doctors
Takes money from insurance companies
..which is why it won't be implemented. It won't be implemented because our very system of governance itself is completely rotten.
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RE: Health Insurance
The question I've never gotten an answer to is "exactly where in the U.S. Constitution is Obamacare, Medicare, or federal contribution to Medicade authorized?". I've read that document very carefully and I'm pretty sure that healthcare comes under the 10th amendment:
That seems pretty clear. The ramifications of that is at least 50 different ways to skin this onion. It is very clear from the discussion above that a plan that works good enough in Alaska would really be a problem in Florida. OK. Fine. That is why we have states and the free will to choose where we live.
There is one reasonable role of the Federal Government in health care -- Tort Reform. When a Doctor in New Mexico must spend more on malpractice insurance than on rent, heat, light, and office payroll combined something is messed up. When a one-doctor medical practice must spend $500k computerizing their medical records to comply with Federal requirements something is messed up.
I'm one of those "free market" guys denigrated above, but there is so much noise in this discussion that "truth" is in really short supply. People can find anecdotes to support any position that they want to take. Bottom line is that people get medical advice from medical professionals, and then either follow it or don't. I can't find a single example of where providing health care (or most any other service) is enhanced by a central government getting involved.
David Simpson, PE
MuleShoe Engineering
In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist
RE: Health Insurance
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RE: Health Insurance
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
14th amendment? It says Section 1 of the 14 amendment is all about states not revoking federal rights and privileges. To say it applies to health care is to say that Alaska is violating the 14th amendment because the Federal Government has provided subway's in Washington DC, but Alaska doesn't have any subways. Ludicrous on the face of it.
As to the Commerce Clause (Article 1 Section 8), the paragraph that people always point to is: but for that to apply you have to somehow read the foregoing 17 paragraphs to include some mention of healthcare. I can see support for a Navy, the Patent Office, and the Post Office, but not Obamacare.
According to the Federist Papers, the very reason that the framers of the Constitution went into such tedious detail on the things that the Federal Government was allowed to do is because they weren't allowed to do anything else. Interpreting the Commerce Clause or the 14th amendment otherwise is trying to revise the Constitution by tort. That attempt happens all the time, and everyone who believes in this country should resist all of these outrageous attempts.
David Simpson, PE
MuleShoe Engineering
In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist
RE: Health Insurance
RE: Health Insurance
David Simpson, PE
MuleShoe Engineering
In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist
RE: Health Insurance
John R. Baker, P.E.
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RE: Health Insurance
Strange how my doctor recommends antibiotics for viral infections, so why do I need him if the same antibiotics seemly work for both types of infections?
Also why don't I see price lists in hospitals? It would make it easer to shop around for my next set of tests.
RE: Health Insurance
We suffer from the same self-deluding BS on other issues, but nowhere near as often as the average US citizen when it comes to politics. It seems that if you introduce politics, you drop thirty points of the mean US IQ. I can't explain why; some of the smartest people I know are Americans, but you guys and gals suffer crowd think like nobody's business!
RE: Health Insurance
Capitalism sets up the “market” and the “free” part comes from removing restrictions and regulations such that consumers and producers can operate independently. In reality, you can’t have a producer (of any substantially large size…to say produce drugs safely) that operates independently of a capitalist market. Therefore, the free markets operates within a capitalistic frame work and advocating for a more free market healthcare system is to advocate for a more capitalist healthcare system. The only way it isn’t is if you are advocating for market anarchism (which I mean in an ideological way and certainly not a disparaging way. In fact, it would be quite interesting if you were). However, you’d have to not just blow up the entire US healthcare system but fundamentally change the entire US economic system (in which capitalism is just a little, teeny, tiny bit rooted). The only practical way to limit the effect of profit-driven capitalism on healthcare is to limit participation in the market and move to a universal healthcare system.
I agree with this for the most part. However, your (and my) issue with the prime objective being to funnel money to individuals and corporations is an issue with a right end aspects of this blended system, not a left end aspect. Moving towards the left end, and a universal healthcare system, addresses this issue. This is one reason why universal healthcare systems, in the real world, continually rank head and shoulders better than a privatized system. The other is that whole equity thing and supporting the disenfranchised in your society...you know, leftist nonsense.
How so? All countries that have universal health care systems moved from non-universal health care systems to universal health care (UK – 1948, Sweden 1955, Canada 1968, etc).
If we can’t use universal healthcare as an option to compare against than what are you advocating for? What is your plan? What is a “truly” free market healthcare system? What it sounds like is “if you can pay for it directly, you can get healthcare.” No insurance companies, no middle men, no support for low-income. If this is correct then you’ve describe a system that is the most apathetic, inequitable system imaginable.
So in this free market utopia every citizen has the access to proper medical education such that they can self-diagnose without error, won’t abuse an uncontrolled drug market and every citizen has the money to afford the drugs that they need (through accurate self-diagnoses). This system perfectly encapsulates the two fundamental and fundamentally incorrect assumptions of free market ideology:
1) Opportunity applies equally to everyone. There’s no such thing is social, cultural, economic impediments.
2) Once a fully free market is obtain, people will magically live altruistically, co-operatively, and efficiently. While under restrictions/regulations, people are selfish, greedy and lazy (“lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”).
Honestly?
It’s not right to pursue happiness, it’s right to life. Access to healthcare should NOT be a purchasable privilege in the richest country in the world, it should be a right. But at the end of the day, if you feel you have the “right to liberty not to pay for” others right to life, then what can I say – we wish to live in different ethical worlds.
RE: Health Insurance
The Court's third and final intervention in the 2000 presidential election came just days later. In its unsigned opinion, the Court explained that it had voted 5-4 to put a stop to the Florida recount. Allowing the recount to go forward, the Court said, would violate the Equal Protection Clause of the Fourteenth Amendment. The U.S. Supreme Court sent the case back down to the Florida Supreme Court, which had no alternative but to dismiss it. The presidential election of 2000 had been decided, in essence, by the vote of one Supreme Court justice.
For the full article, go to:
http://www.dummies.com/how-to/content/supreme-cour...
And if you'd like something from a source with perhaps a bit more credibility, here's a link to an item posted by Princeton University which reported the same bssic "facts":
http://www.princeton.edu/~achaney/tmve/wiki100k/do...
As for my humble opinion as to the consequences of the Cheney/Bush presidency, you only need to look at the recent headlines of any major newspaper in the world to see what they are.
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RE: Health Insurance
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;
To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.
General Welfare would seem to fit the bill, and is the basis for most of the arguments in favor of taxation for general welfare items.
Note that the Constitution doesn't explicitly acknowledge the right to privacy, so, kind of hard to argue narrowing the Constitution in one aspect, but expanding it elsewhere. SCOTUS has made the Constitution quite flexible and expandable.
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RE: Health Insurance
History judges past presidents. The further back, the more objectively it seems to me, and it is mostly looking more kindly on GW every year. Your opinion is clearly on record pretty much anytime anyone mentions a court case, or any President, or pretty much any topic. I hope you've noticed that people don't rise to drag the conversation into those particular weeds. Enough already, you didn't like Bush/Cheney, got it, don't know what it has to do with health care, but got it.
David Simpson, PE
MuleShoe Engineering
In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist
RE: Health Insurance
Section 8 seems to say the Presedent should not recieve better care than the remander of the US.
I don't think that is what this section means at all. I don't even think it was intended to apply to healthcare.
I still think it would have been better if we were allowed to purchase insurance over state lines, and not required to purchase insurance we don't need, or want.
After all if contraseptives are part of this health thing, don't allow them to be over the counter. Make people go to the doctor for a note to allow them to buy them.
This has no business in health care.
Another way to reduce the health care costs, is to reduce the regulations on bill collectors. Allow them to call people in the middle of the night, and during dinner. Allow them to staple signs on people frount door.
Regulate hospitals, not doctors, the way they do utilities, by state. Eliminate secondary billing by doctors you have not agreed to hire.
RE: Health Insurance
In the threads that I've decided to stop commenting on, I developed the habit of simply not reading your posts. I was doing that just now and noticed my handle.
Yes, honestly. Can you describe a single service (which doesn't include the military) that federal government does better than states? Education? Give me a break, I want education to be at the community level, but getting the Feds out of it is a step in the right direction. Regulation of hospitals? No question, the states do it worlds better (compare your local hospital to a VA facility). Aid to the poor? Again, communities do it better than states, and states do it better than the Feds. Federal social programs are simply too big to: (1) be effective; or (2) avoid fraud and waste.
Access to healthcare is a "right"? Take that to its logical conclusion and providing that "right" becomes an "obligation". Not for the government, but for providers. If a nose-job is a right and doctors are obligated to provide them then who would become a doctor? One person's "right" that requires a disinterested party to "contribute" is simply slavery. Pretty it up with a pretty diploma and assigned parking space and it is still whips and chains. How to you supply that "right" if all of the providers decide to find other ways to make a living? Oh yeah, it is only a "right" if you can coerce qualified people into supplying it. The only "right" I can see in this field is the right to live until you stop. We all stop living sooner or later. If the people of the world had a "right" to medical care, then it would be immoral to have a doctor/patient ratio disparity between the developed world and the developing world. It is not a right, it is a service that we should be willing to pay for. We should be willing to pay the portion of our income that it is worth to us. A Christian Scientist would tell you in the strongest possible terms that it is immoral for you to forcibly take his money to pay for someone else's trip to a doctor that the Christian Scientist does not believe is able to add value. Someone who is anti-vaccine resents paying for vaccinations. Someone who anti-birth-control resents having to pay for others to have access to that technology. "Right" to medical care is a really slippery slope.
The article you linked to has specific criteria (not disclosed) to place a country in a position in the ranking. This is common, and last year I tried to find raw scores and weighting algorithms for one of the studies. When I finally dug out the basis for a score, I found that they were heavily weighted towards "providing health care to all without stigma". "Quality of care" (measured by the number of fatalities compared to number of doctor visits) was weighted 10th in that study. It also gave zero credit to someone being able to walk into an ER and be seen, because there is a stigma attached. It gave no weight at all to ratio of patients to doctors, to number of citizens served by a hospital, or to geographic area served by a hospital. When a study considers these minor points the rankings change a bit.
David Simpson, PE
MuleShoe Engineering
In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist
RE: Health Insurance
To be totally fair, you'd have to include condoms in this as well . . . or are you going to suggest that that's different? If so, how so (be careful how you respond as we're now getting down to the real crux of the issue aren't we)...
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RE: Health Insurance
No.
Capitalists corner markets for profit. Free markets are not cornered markets. See above. I'm not going to type the same things again, I want you to read it the first time and take the time to understand it. Our current healthcare system is very capitalist, but in no way free. There are ten reasons I can't go buy penicillin, even if I need it, and someone else wanted to sell it to me. That is not a free market. Not a free market. It is a cornered market. If you think our system, before or after Obamacare, was a free market, then you are part of the problem.
No you would not. You would merely have to remove the obstructions to the free exchange of goods and services that I wrote about above. Further limiting people from participating in the marketplace only drives costs up, and entrenches the big money makers. That's why the big companies love regulation. Regulation squeezes out the little guy and carves their market position in stone. You Blues are the worst, because you think you're sticking it to the man, when in fact you're giving the man a free ride for the next century.
Read the post at (23 Sep 14 9:52).
I'm totally with you on car wrecks and heart attacks.
I'm virulently against you on prescription drugs and routine health care.
You can't compare us to Sweden because we're not made of Swedes. For that system to work here, we would need to replace our population with a bunch of Swedes, with the Swedish mindset, Swedish pride in their work, Swedish sense of cultural responsibility, and Swedish government that's not completely beholden to money. If you want to know how single-provider health care plays out in the United States, we already know how that plays out. We already have that. It's called the VA.
I don't know if you've noticed or not, but for 99% of ailments all the doctor is doing is spouting off the same BS you can get off WebMD. I've been misdiagnosed more than I've been properly diagnosed. Your position, and the position of the whole industry to date, suffers from the two fundamental flaws of nanny state progressivism:
1) People can't be trusted to do what's right for themselves
2) The government can't be bought
Your progressive government is bought. The people you voted for are bought. The head of the FDA is a Montsanto lobbyist. The head of the FCC is a Comcast lobbyist. Obamacare was written by lobbyists. The fundamental underpinnings of progressive nannystateism don't work if the government is bought. It works in Sweden because the Swedes don't put their government up for auction. That's why it won't work here.
I'm not saying it doesn't work there. I'm saying we are not them.
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RE: Health Insurance
John R. Baker, P.E.
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
s to the form of the objection, it was a speculative play at best. The recount which DID occur later as forced through court actions by Gore supported and the media (gee, I wonder what cause they had to see continued controversy) showed that, while smaller, Bush still had more than a marginal victory in Florida.
Look to the form of your elections if you want a constructive place to lay blame, not technicalities on vote counting. Your country was founded with an inherent paranoia regarding delay in declaring the uncontested winner. Together with that ungodly Electoral College system it has produced several permanently controversial results.
RE: Health Insurance
But back to the idea that IF the Florida recount had been allowed to continue. Well that would have been a lot better situation than having 5 activists judges make that decision for us when there was still a chance that a recount could have shown that Bush had NOT gotten the most votes in Florida. In some ways, we were damned lucky that the recount was finally done (which BTW was paid for by several Florida media outlets) and that it did show that Bush got the most votes and that he did deserve Florida's Electoral votes after all. But what would it have been like in this country if that exercise had shown the opposite? Just think about it...
John R. Baker, P.E.
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RE: Health Insurance
RE: Health Insurance
John R. Baker, P.E.
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
A sincere bit of praise, from a citizen of a country founded by the Loyalists who fled the American Revolution: You were founded by some of the greatest free thinkers of their time, men who demanded equal say in their futures. Many of them are inspirational even to this day... They also happen to be a well off group working for their own self-interest, a number of whom were terrified of the democracy they were creating. In many ways the fears Thomas Jefferson expressed when wishing for a revolution every twenty years have been realized.
If you think TJ's wishes unrealistic, just look to the French... That is if you can get over the whole "Freedom Fries" bit and see that they were once your greatest and most important ally. That and the fact that just because someone doesn't agree with you shouldn't mean they should be derided and mocked. Google "French Military Victories" and hit -I'm feeling lucky-. Classy.
Now how did we get here from health care? *sigh*
RE: Health Insurance
John R. Baker, P.E.
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
You're all getting hosed, big time, and there's virtually nothing truly effective you can do about it which is a political POSSIBILITY in the United States. There are too many people in your country that fear their own government to the point where any kind of trust is impossible. See where it's getting you on this one? Enormously greater cost than any other jurisdiction where this idealization of the so-called "free market" doesn't border on religion...And yes, despite its failings it does provide excellent health care- for the very richest among you, who will always be able to hire their own doctors.
RE: Health Insurance
Nope. That's definitely not what they were after. That's partly why we're in this mess now. Mob rule.
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
i thought the French had a hand in it, and the Brits, some 100 years before.
ok, they gave us the Loyalists, we gave them Cajans (Arcadians).
another day in paradise, or is paradise one day closer ?
RE: Health Insurance
You're quite right however, a gross oversimplification. Apologies to the other Canucks. *smiles*
RE: Health Insurance
Besides, the recount was something like in only 9 counties, and not the whole state of Florida. After all Al was not interested in what rural Florida had to say.
RE: Health Insurance
What concerns me is that many greedy people in Canada would also love to slice off an additional 7% of our GDP for their own private gain. They would like to subvert our single payor system by providing an "out" for the rich in the form of a parallel private system. While that apparently does exist without the total destruction of the public system in some jurisdictions, I can guarantee you that the minute rich people here were allowed to opt out, they would DEMAND a dramatic reduction to the taxes which fund the public system everyone else depends on. When there's no out for the rich and powerful, there's a motivation on their part to maintain the public system for their own benefit, which coincidentally also benefits everyone else in society. The very wealthiest can of course fly wherever they prefer and obtain whatever gold-plated healthcare they desire, irrespective of where they live normally.
RE: Health Insurance
Fundamentally, I feel we are pretty close to the same core understanding of the issue but our solutions go in completely different directions. We both see the US as an corporate oligarchy and that this has directly caused the healthcare system to not be in the people’s best interest. Your stance, if I can attempt to paraphrase and correct me if I’m wrong, is because of the corporate corruption of the political system, healthcare shouldn’t be controlled by the government (i.e. universal/socialized). Instead, it should be allowed to operate, as much as possible and as closely as possible, directly between the producer and consumer.
My stance is that the “producers” in this case will, as they always will in a capitalist economy, put profits before creating an equitable healthcare system. That same corrupting influence on our government is now directly, and with less regulation, in charge of the healthcare system. Even though the government is far from perfect, it is much more accountable to the people than a for-profit hospital or big pharma company. I just cannot understand how a producer in an idealized free-market is not the same as a producer in a capitalist economy. It is also easier to be much more equitable to all citizens in a universal, socialized sense than on an individual level. I feel that a free-market solution would “help those that can help themselves” and make it even harder for the disenfranchised in the society.
Now to your two objections to my ideology:
1) I think that people, in mass, will naturally do what’s right for themselves but not what’s right for society. That’s my point. Furthermore, culture and advertising tells people “what’s right for them”, which really may not be what’s right for them (hence why so many people live outside their means, eat terrible food, smoke, etc.). Free-market ideology promotes an individualistic society, centered around consumption and predicated on a “you get what you deserve” attitude. The disenfranchised are seen as people that do not want to work for themselves, which completely ignores any and all social, economic or cultural barriers. That’s just fundamentally not a society I want to live in.
2) I touched on this already but I absolutely agree that government can be bought. However, I still have much more say in how the government works than I do how corporations work. Mass boycotting of companies on ethically grounds (which is the only “voice” you have in an idealized free-market) is difficult for the average person, especially if the companies costs are lower than competitors (i.e. the Walmart example or why 99% of clothes coming from sweat shops, etc.). People respond to the product, not the means of producing the product. Therefore, while, in theory, an idealized free market should promote cheap, quality products, it has no control (nor does it care to control) the ethical and ecological means of production. This is a problem for me.
zdas04,
…I just deleted the rest of my reply to you after I read this gem: “One person's "right" that requires a disinterested party to "contribute" is simply slavery”. This is disgustingly apathetic and so grossly extenuates actual slavery. So you feel that universal healthcare is slavery - where you, the tax payer, are the “slave” and under privileged families, receiving free, publically healthcare, are the “slave masters”. The fact that you are “disinterested” in supporting the disenfranchised in your society does not make you a “slave”, it makes you egocentric.
Leave it to some white, middle-upper class, libertarian male to declare themselves a “slave” because they have to pay into social welfare programs that support the disenfranchised and most marginalized groups in their society. That’s insulting on so many levels.
RE: Health Insurance
RE: Health Insurance
This page has more information that you'll likely care about: http://www.uelac.org/ I'll warn you this is an old fashioned way of seeing the world which now seems to be finally waining; They aren't exactly tech savvy, and that page shows it.
You're quite right about the "Tory" bit. Pre-rebellion the folks who were most unhappy with the King and country (as it then stood) were the "Whigs". Roughly speaking, the Tories weren't all that happy either - They just did not support taking up arms, but believed that independence or equal representation in the British Parliament could be obtained through negotiation with the Crown. They, or rather their children, were a very prominent force amongst those who did indeed succeed in obtaining independence from Britain in a peaceful manner some years later.
Note that Tories who moved to Upper Canada (now Ontario), Nova Scotia, New Brunswick, etc, provided badly needed professionals and tradesmen. In many ways Canada was a minor outpost before the Loyalists arrived and the founding of the USA forced the British to refocus efforts. We are, to my view, the bastard child of one group's (fairly reasonable) refusal to pay taxes levied in order to pay for a war with France in absence of the right to vote, and another's placing loyalty to one's King (or, at a minimum, to the oath to the King) above all other concerns. Without both the rebels and the loyalists, we would never have existed at all.
Yes this is all a gross over simplification, but it is as valid as any other generalization.
RE: Health Insurance
RE: Health Insurance
WOW, are we going there now?!?! Yes, that is insulting, and you owe the forum an apology.
And Yes, coerced participation in social welfare programs can easily be viewed as a form of slavery. How about we look at the real reasons why healthcare is so grossly out of whack in the US to begin with, and is not affordable.
Google - Davy Crockett not yours to give
It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.
RE: Health Insurance
Social Welfare is not just healthcare, but also food, housing, energy, schools, goods, drugs, etc. and part of the problem is some of those people are just free loaders, and don't want to be productive.
I agree some of those people do need help, but the goverment just dosen't do a good job of removing the free loaders from the list of the needy. Also the black market makes it harder to measure real income.
This is why churches were the vehicle for help of the needy. They have people who can take the time to evaluate the needs of the needy.
But forced paricipation in anything is a form of slavery, and we are all becoming slaves of the goverment masters, in the name of the poor.
And no amount of goverment givaways has reduced the people begging on the streets.
RE: Health Insurance
Only for the things we can shop for. Not for the things we can't. We can't shop for emergency services, yet emergency services are the primary reason everyone pays insurance. Emergency services should be single payer, paid out of taxes, just like the police and the firemen. I am arm and arm with you on that one. If you don't know what you're shopping for, you can't shop. I can't even shop for insurance properly not knowing whether I'm going to get in a car wreck or have a stroke or none of the above. You can't shop when you don't know what you're buying.
Our system tries to make us shop for emergency ailments in advance. That's dumb.
Then our system obscures our ability to shop for ailments that we could ordinarily shop for. Like cancer or prescription drugs. Equally dumb.
Only because we're not allowed to shop around. The consumer can vote with his dollars if he knows what he's shopping for. Corrupt and Evil corporations go the way of the Dodo Bird once people are given the choice to spend their money elsewhere. General Motors makes crappy cars, therefore they fail and Toyota grows.
Right now, we don't have any real choice in the matter. And Obamacare is even worse, because those of us who chose not to pay into the pot are now FORCED to buy the flawed, screwed up product, by the very government you want to put in charge of everything.
No it's not. It's not it's not it's not. I can choose not to give a company my money. I cannot choose to not give government my money. And now, with Obamacare, the government is forcing me to give money to the very company you seem to hate so much. I remind you...
There is no vote I can cast on election day that is for someone who isn't bought.
And government will, in mass, naturally do what's right for the people who bought it, not what's right for society. That's my point. It's been that way since the Sumerians, and it has never changed. You have been duped into thinking that the people you vote for are doing what's right for society, when actually they're just jockeying for insider trading positions.
http://www.npr.org/blogs/itsallpolitics/2013/04/16...
...and funneling money to the people who donate to their reelection campaigns...
https://www.opensecrets.org/lobby/issuesum.php?id=...
...and cutting deals with those same corporations to find fat, high paying lobbyist jobs for themselves when they quit politics...
http://www.opensecrets.org/revolving/
You do not. You have an infinite amount of say in what a corporation does with your money because you can choose not to give them your money. You have no say in what the government does with your money, because when you go to the ballot box, you are choosing between two bought candidates with different colored shirts on, each of which is going to do the same thing once he gets to Washington, which is take money from lobbyists and then invite the lobbyist to write the laws. You have no say in that.
You have no say in state government either. You have some say in local government, because you can talk to your local representative, and your vote means something to them. Our modern system at a national level simply turns money into votes via marketing tricks. We're a cashocracy. Sweden isn't. That's why you can't do Sweden's system here.
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RE: Health Insurance
That's assuming there's no patent protection on the drugs. Up until recently Lipitor was still protected, and you paid whatever the drug company wanted.
"You have an infinite amount of say in what a corporation does with your money because you can choose not to give them your money. "
Not by your lonesome. Unless there's an en masse exodus, the corporations are only beholden to the stockholders. This is well-known and documented. Moreover, corporations rely on the typical consumer being totally lazy, otherwise, 7-11s would go out of business. But, they don't because people are lazy enough to go there and pay double or triple what it costs in a grocery store, because of the "convenience."
Likewise, people shop for doctors by convenience, and they would probably pay a premium for that. This is what makes ERs more attractive than most urgent care facilities; although, there are now more urgent cares that are open 24/7, and they generally have shorter waits.
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RE: Health Insurance
Firstly, you still seem to be trying to convince me that corporate money has corrupted politics. You don’t need to convince me (I’ve referenced it before, but I believe Lawrence Lessig’s “Republic, Lost” does a great job explaining the situation. I feel you’d enjoy it beej). However, where we differ is you want to scrap the whole system, I just want to remove the poison. You are using Sweden as an example that is unreachable (I disagree but it matters little) but the UK is much closer to the US in terms of corporate influence in government. While I agree, drastic changes in the American political system are required (speaking of Lessig, see the MayDay campaign), I feel it’s a stretch to say that it is forever doomed.
This nicely summarizes our second fundamental difference. While I agree this works to control product quality and cost, it does nothing to control the means of production (fair wages, local employment, treatment of workers, environmental impacts, usage of profits, etc.). As I stated:
But beyond this, and addressing the third difference, equity is none existent in this picture. All we are talking about is the “efficiency” of the system, not the equity of it. As a producer, if enough rich folk buy my product, I have absolutely no incentive to support the lower class. Quality becomes more and more a premium for those that can afford it. This may be fine for tee-shirts but it is not acceptable for a healthcare system. As a consumer, if I can afford quality, I have absolutely no incentive to support those that can’t. As a few posters have made abundantly clear, they have absolutely no issues with this scenario. I do. I hope that you, beej67, do as well. How does a free market solution, predicated on individual gains, create an equitable system?
So, we share a lot of ground but differ on these three areas:
RE: Health Insurance
Patents are one of the many ways that government obscures and interferes with the free marketplace. Patents need an overhaul. Five years tops. See above.
GM can make cars that explode, but if there's a marketplace (there is) then I can choose to buy a Ford. They make their choice, I make mine, and none of my money goes to the corporation that makes the exploding cars. Simple. That's the free market. If enough people decide they don't want exploding cars, GM goes away. (unless their lobbyists buy the government and in so doing buy themselves a bailout)
I cannot choose to stop paying taxes to the government, even when that government uses them to build bombs that explode, and I cannot influence in any way their choice to go bomb brown people in Iraq even though it didn't do us any good the last three times we tried it. Similarly, I cannot choose what government decides to cover with Medicare, and now under Obamacare I can't even choose not to buy insurance from a private, for-profit company.
So? Convenience is an aspect of quality. I fail to see the problem with 7-11s, nor with Urgent Care facilities.
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RE: Health Insurance
Would you at least agree that big-government progressive policies such as universal single payer healthcare can't work until the prior poison of money-in-politics is fixed?
Growing a broken government before fixing that government just entrenches the brokenness of the government.
Now I contend that power corrupts, and the more power you give government the more likely it's going to be to become corrupted. The more money you push through Washington DC, the higher the ROI is on trying to manipulate government to your own ends. And the higher that ROI climbs, the more lobbyists will descend on DC to try and squeeze more money for themselves or their companies from the public largess. It is inevitable, and the only way to stop it is to starve the beast. You may disagree with that, and I will respect your opinion.
But we should be able to build upon the common ground we do have, that we both realize that government is currently bought. Until it gets un-bought, how can we put it in charge of health care?
I agree. But it's great to control cost, and the problem with our healthcare system is the cost. That's why they oh so ironically named Obamacare the "Affordable Care Act." And that brings us to this:
I'm an engineer. When I see a problem, I identify the problem, and I develop a solution to that problem. When a politician sees a problem, they seek within that problem a way to grow government and kick more money back to whoever donated to their campaign.
The problem with health care was rising costs. Costs. Nobody complained about healthcare back when it was cheap because pretty much everybody could afford it, and the ones who couldn't could rely on public safety nets that didn't have to bear such a huge burden. Cost is what broke everything. Cost.
So what happens when the problem, Cost, gets put in the hands of politicians? We get a bill that does nothing to address cost, and does everything to expand coverage. Obamacare wasn't a cost bill, it was a coverage expansion bill. Their solution to the cost problem was to make everything more expensive and then force everyone to buy it.
Seriously.
Think about it.
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RE: Health Insurance
Did the mandates some how expose the problem is too many hospitals? Or that hospitals can't control costs in the face of (assumed) reduced number of injurys?
Just maybe we have too much health care?
RE: Health Insurance
The simple answer is that people are surviving the more severe collisions that would have killed them outright 20 years ago, both because the cars are more robust, and the emergency services do a better job of keeping victims alive in the "golden hour." This is corroborated by the fact that US soldiers fighting the last 3 wars are returning with more severe injuries that would previously have resulted in a combat death. That's one reason why VAs are swamped with more disabled vets than ever. Traumatic brain injuries (TBIs) are now survivable because of the better helmets, but the result is life-long mental and medical care costs.
So, not strange at all. It's essentially an unintended consequence of raising the threshold for causing a fatality.
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RE: Health Insurance
So that's what is driving the long-term disability insurance rates, and the fact that people don't want, or can't take of there parrents.
Just think that all this has led to more demand, so adding more demand on top of this is just going to increase costs. However, this is not the same as the hospital issue, as hospital stay rates seem to be on a downward trend.
RE: Health Insurance
There are a lot of things that drive the short term costs through the roof. A single premature baby can generate both increased delivery and NICU costs as well as long-term disability costs.
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RE: Health Insurance
RE: Health Insurance
https://www.youtube.com/watch?v=NcHdF1eHhgc
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RE: Health Insurance
RE: Health Insurance
Tunalover
RE: Health Insurance
RE: Health Insurance
Tunalover
RE: Health Insurance
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RE: Health Insurance
If you think of it as a form of stimulus, and you compare it with say bailing out wall st, GM or quantitative easing, its actually quite a bit bigger and probably preferable.
RE: Health Insurance
As someone once told me years ago, as long as it continues to COST hundreds of thousands of dollars to DIE from cancer, there will be little or no economic motivation to CURE it for less.
John R. Baker, P.E.
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RE: Health Insurance
RE: Health Insurance
"I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way? "
My company is offering a private, high-deductible plan with $3000 deductible for a family (I think $1500 for an individual), after which you pay only copays. The company starts off our HSA each year with a $1250 contribution. I don't recall what my out-of-pocket maximum is, but each year I end up spending the deductible and not a whole lot more.
David
RE: Health Insurance
I'm not so sure it that preventive care is what may be driving this, but if so many old people can't afford health care, and the goverment which has inserted itself can't afford, then we may have a large number of old people dieing in the streets, which would put the goverment in a very bad position. Tends to make voters change how they vote.
The healthy eating thing may also be in trouble because of the water issues in CA, which is where most of the fruits and nuts in this country come from. So we will be seeing more imported fruits and nuts soon.
The problem appears to be that socialists want to be the 'be all and end all' for everything, but they can't seem to fund it all.
RE: Health Insurance
- Steve
RE: Health Insurance
But maybe inefficiency is the answer. Aside from the millions of middle class jobs, all those high priced hip implants even create some engineering jobs! Doctors do have a bit of engineering fetish, and its possible that health care could be the new defense industry in respect to big stable R+D budgets. Like defense, we waste trillions of dollars on stationing troops in Berlin for decades, but the upshot was we got microprocessors. Massive efficiency followed in the form of the internet, so it was worth it. Would this have occurred if the DARPA folk were a bit more efficiency minded? Who knows what we boffins will come up with!
RE: Health Insurance
Now that we have shiped the production of those things we don't need to China, we now need to invent jobs for services we may not need.
RE: Health Insurance
RE: Health Insurance
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RE: Health Insurance
I don't think you need to import any more fruits and nuts. CA has plenty of those, water or not.
RE: Health Insurance
RE: Health Insurance
The term 'life begains at 40' is sort of a joke when viewed from the point that life at one time was only about 40 years.
The presumption the lifes will be longer in the future, assumes that we will be productive longer. And the issue resting that is that natural selection only eleminates desease, etc. that cut life shorter than reproduction. Man must step up to extend life beyond that. However if life does become longer, and the death panel charts don't follow that, then we will be truly wasting human experence for little political gain.
RE: Health Insurance
RE: Health Insurance
Yeah, that was supposed to be ironic...
Up until recently, care was was rationed, so it's not necessarily about affordability, but also about profit. There are stories galore about insurance companies that play the "coverage denied" game until patients give up, die, or sue, just to make an extra buck. Interestingly, people die on organ transplant lists because of the shortage of viable organs, but it's illegal to sell organs. Seems to me that this would be a perfect solution for redistribution of wealth in a truly equitable fashion. There are lots of poor, with lots of organs, and there are the rich, in need of organs..... Aside from the nagging ethical issues...
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RE: Health Insurance
RE: Health Insurance
Tough luck there, glass, they already do that, and already did so well before Obamacare. It's called a "QALY Calculation," and insurance companies have been doing it for my entire lifetime.
http://en.wikipedia.org/wiki/Quality-adjusted_life...
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RE: Health Insurance
RE: Health Insurance
http://www.huffingtonpost.com/2014/09/30/doctors-b...
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
The medical arenia is just like universitys, in that with insurance, the bill is tailered to what they can squeeze out of each victim/ patent. It's called an imperfect monopoly. They need to be regulated like the utility companies in each state.
RE: Health Insurance
Not sure where you've been for the last 20 yrs, but the state utility companies were deregulated, which is one of the reasons why PG&E has exploding gas mains.
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RE: Health Insurance
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RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
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RE: Health Insurance
RE: Health Insurance
If we're going to have a requirement for ER's etc. to provide Emergency care to all comers then shouldn't 'all comers' (i.e. tax paying public) be paying for it?
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
My point is that if companies did not include health insurance as part of a compensation package but instead gave the cash, when you had to write the check every month, you might pay more attention to whether or not you have the correct insurance and whether or not you have the best deal. If you cannot shop around because your employer provides insurance through xyz company then competition is stifled.
RE: Health Insurance
Competition is stifled, regardless. I don't think I'll get the same deal as an individual for the coverage I have now from a group coverage. Volume discount makes a big difference.
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RE: Health Insurance
RE: Health Insurance
Also, if running a health insurance bureaucracy is anything like running a consulting engineering office, the bigger you are the more overhead you have.
RE: Health Insurance
I don't think anyone has EVER argued that this was NOT the case. Executive compensation alone can eat up millions of dollars that could have been used to pay benefits.
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
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Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
Indeed, and despite what some in the US say, the Canadian system works well.
RE: Health Insurance
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
RE: Health Insurance
I hurt my knee playing soccer in June.
I went to the PCP. He said, "probably strained MCL or ACL, you'll be out six weeks, get an MRI." Gave me a number for a specialist. I paid $20, he billed the insurance company $200 or something.
I wait two weeks for my appointment with the specialist. She says "No, it's probably a bruised miniscus, go get an MRI." Gave me the MRI joint's number. I paid $20 and she billed the insurance company $500 or something.
I go to the MRI joint. Walk in, walk out, they tell me nothing, give me no data, and bill my insurance company $3000 or something.
Specialist never calls me back. I call them, they say they can't give me the results on the phone, I have to come in. Wait two more weeks for my appointment. I go in, lady says "well the MRI says it's just tendinitus, but I know that's not true because I can do this" (repeatedly pops my knee) "so here, do these exercises." "But what's wrong?" "We don't know." Sends me on my way, I pay another $20, and they bill my insurance company $500 or something.
So add all that up. $4,200? Something like that?
Europeans don't do this song and dance.
The song and dance is where the cost is.
If I was told I had to pay for all that crap out of pocket, I would never have gone to the doctor at all. I would have googled up some knee rehab exercises, and been doing the same thing the lady told me to do five thousand bucks later. But under our system, you're damn skippy I'm going to got to the doctor and go through the song and dance, because I've already paid for it. If I don't, then I don't get the value for the product I've already bought. It's pre-bought, and you lose it if you don't use it.
If everyone pre-bought into a shared "Food Plan," you think more folks would order lobster? Of course they would.
It's systemic.
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RE: Health Insurance
These drug research "games" also make it hard to measure real innovative drive, as this is frequently measured in large part through the number of research papers published. When a drug is "tweaked", manufacturers quickly conduct and publish as much info as possible, often of dubious merit, simply to have the latest drug research all be on their "new" drug.
I am the first person to point out that the US is a great nation, but also at the head of the line to condemn the tremendous wealth of your nation being concentrated into the smallest of minorities at the top. Many of the ills I see accross our southern boarder are extensions of the desire to become ever wealthier despite already being incredibly rich. Playing with drugs to keep them proprietary rather than working on new drugs is one such ill, and artificially inflates the research papers and apparent innovation without really being innovative.
RE: Health Insurance
CELinOttawa: Americans pay way more for drugs than Canadians. Witness folks who live in Detroit sneaking across the border to Windsor to stock up. In terms of drug companies finances, American customers carry the load, and the rest of the world picks up the product at its marginal cost of production. In terms of public research spending, the US may be about the the same as Europe per capita, but a large portion of bringing drugs to market is non-academic, commercial work. Not just R+D, but marketing, distribution networks, etc. Remember also that many drug companies are not American. AstraZeneca, Beyer, GlaxoSmithKlein and other majors are European/global but make most of their money in the US. Absent these profits, who knows whether the publicly funded research would ever reach consumers.
RE: Health Insurance
RE: Health Insurance
In the UK before I moved to the US you rarely saw adds for prescription drugs - presumably due to the National Health Service deciding what drugs you got, not you going into the doctor and begging for a specific brand name drug. Maybe things have changed in the last 10 years, I don't know.
Don't get me wrong, Drug reps still lavished their largess on Doctors to some extent but I doubt it reaches the overall marketing budget in the US (pro rated for population of course).
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
RE: Health Insurance
If you took the US profits out of the global marketplace, drugs would not disappear but would be ossified in time at 2014. I personally feel as though there is a lot of technical development yet to complete in the pharma world. Right now drugs are battle axe blunt tools that have 5 side effects for every primary effect.
RE: Health Insurance
http://fortune.com/2014/06/12/theranos-blood-holme...
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
RE: Health Insurance
That said, my tinfoil hat tells me that most $10000 toilet seats are actually $12 toilet seats and $9988 hidden procurement.
Hidden procurement isn't right, and I don't agree with it... But it is often what is really going on.
Besides these two alternative, there have been some boondoggles of mind-bending size, just not with the regularity people seem to believe. On the subject of stupidly crazy government waste, our Provincial government recently cost the tax payer $1Billion (yet, with a 'B') for TWO SEATS in the legislature. They were promptly rewarded with re-elect. As a larger proportion of the house. As a MAJORITY... My head nearly exploded. Frankly the Premier, former Premier, as well as the whole cabinet should have been ON TRIAL, not RE-ELECTED. *sigh* Okay, I'm done.
RE: Health Insurance
In the post 1989 military wind down days, a bunch of defense engineers shifted over the the medical devise realm. I work with one now who switched from Pratt & Whitney to a hip implant maker. Who is going to pay for the development of the 3D printed human livers and genetic therapy? Bad ass engineering is expensive, and its also the primary driver of civilization. If not medical kit then what? We beat the Soviets so that motivation is gone, but we are old and sick, so lets write a big check to the nation's nerds and send them to the lab!
RE: Health Insurance
I'd have fixed that problem. I'd have given the people of Mississauga and Oakville a choice: either allow the plant to be built, or a) pay the cancellation charges with a special levy on THEIR property taxes, or b) disconnect them from the province's grid and force them to make their own power. That the entire province has to pay the cost of the NIMBYism of the highest-earning postal district in Canada should make anyone's blood boil- but that's useless if it's just used in a, "Don't blame me, I voted for Kodos" argument!
http://en.wikipedia.org/wiki/Treehouse_of_Horror_V...
If I was building ANYTHING even arms-length government-related in this province, I'd spend far more time negotiating cancellation terms than worrying about what it would cost to build. There are some people that no doubt never have to work another day in their lives as a result of writing a particularly good contract in this case- good for them, terrible for the entire rest of us in this case.
RE: Health Insurance
RE: Health Insurance
Walmart's toilet seat ARE priced to cover all overhead in their manufacture and distribution. These companies have no other secret source of income. They work very hard at keeping general overhead costs down, and spreading the cost over very large sales volume.
Defense contractor's have exorbitant overhead, which just keeps growing, and that is spread over very low sales volume.
RE: Health Insurance
RE: Health Insurance
The overhead is because the public would be unwilling to accept product failures for their precious soldiers, but are willing to accept the failures for the products they pay for, because they can always take them back to the store. Kind of hard to do that sort of thing on the battlefield. This is all imposed by government contracts, so if you're complaining about the cost of military hardware, complain to the person in the mirror and your "representatives." As an example, consider the (in)famous MIL-STD-883B qualified integrated circuits, which are made on the exact same production line as the parts you'd find in your laptops. The difference in cost comes from the extensive testing, life testing, documentation, special handling, and yield loss from all the testing. When you drop your M14 equivalent in the mud, you stop, sit down, and clean it before trying to use it. The soldier using the M14 in the field often didn't have that option, and while US arms are known to be somewhat delicate, the Автомат Калашникова can be literally be manufactured in a barn and can work in pretty much any harsh conditions.
Much of this can be traced back to the False Claims Act of the Civil War, as well as the discovery during WWII that US fasteners weren't interchangeable with the British ones. Once the need for standardization became evident, it also became evident that the typical product and component is woefully under-specified. Contract law allows consumers to buy a product in a store based on a few sentences of description, and the understanding that such products are intended for, and designed for, a certain environment. However, the military has a much wider range of environments, including both temperatures, pressures, water immersion, vibration, etc. What is described in a few sentences on a placard in a store, or on the face of the product packaging, can be turned into 40 pages of single spaced specifications. These specifications protect both the consumer (the soldier) and the contractor, since the specifications are supposed to encompass almost all the conditions in which a soldier might use the product, and if the contractor has tested for compliance to the specifications, they are protected from the False Claims Act. The additional kicker is that the volumes that the military consume, while large in the military sense, are puny in the consumer sense. Trying to buy a part to a military specification from Samsung, or the like, and the first question they'll ask is, "how many are you going to order?" Your answer would be, "Well, we're only looking to buy about 100 now, but in 5 years, we might want 5000" They politely chuckle and point out that they sell millions of these things each month, and your business simply isn't profitable to them. This often forces custom designs, which are built to small production volumes, and which are then (over)extensively tested, all of which increases costs.
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RE: Health Insurance
Now with the goverment mandate, self insurance isen't allowed. So cost reduction never was the intent.
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
The one place you can "self insure" as an individual (i.e. go bare) is dental insurance. A root canal costs $3000 or so, which most of us have in our savings accounts. Why pay insurance company markups on that? The only things with it is you need a CAFE plan or similar so you can pay for it with pre-tax money.
RE: Health Insurance
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RE: Health Insurance
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(I know that the insurance company is not actually disinterested, in fact they have a stake in denying claims, but the point is there.)
RE: Health Insurance
RE: Health Insurance
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RE: Health Insurance
And here we have ONE MORE REASON for moving to a single-payer health care system not dependent on your employement status.
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RE: Health Insurance
RE: Health Insurance
John R. Baker, P.E.
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RE: Health Insurance
OR we have one more reason to make people responsible for their own burdens.
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RE: Health Insurance
Not likely, given the relatively even political split in Congress, made worse by the religious-like fervor in branding the opposing political party as "un-American" or worse.
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RE: Health Insurance
RE: Health Insurance
How do you explain that to someone born with a congenital condition, such as Type 1 diabetes? Or someone like my wife, who when she was a child contracted hepatitis through no fault of her own? What about people suffering from the long term effects of a childhood accident or a wounded veterans when they try to move back into the workforce after serving their country?
John R. Baker, P.E.
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RE: Health Insurance
RE: Health Insurance
The other constituency for single payer are the 50 and 60 something white and blue collar workers who have slightly out of date skills and are worried about getting laid off. How long would your savings pay for COBRA? 20 and 30 somethings either don't care or are more liberal.
The only constituencies really for the current private heavy system are men in their 40's with good jobs because they don't want to get lumped with paying for everything, and doctors who like getting paid $300k/yr.
RE: Health Insurance
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RE: Health Insurance
Amusing, but the costs are already pretty much near infinity. According to: http://www.forbes.com/sites/danmunro/2014/02/02/an... we're spending about $13,000 per capita already. That's at least double the annual premiums for a typical single-person insurance package. Given the median household income of about $52,000, we are, on average, as a country, spending more than our yearly salaries, so there's already a truckload of subsidization going on.
Going to single payer might actually drop the costs.
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RE: Health Insurance
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
RE: Health Insurance
Historically it seems in healthcare technological innovation often increases cost. This is because rather than using technology to do the same thing better & cheaper, it often plays a role in doing things they just couldn't before i.e. conditions where there was once minimal treatment options now have treatments that cost tens or even hundreds of thousands of $ per patient.
A big factor in growing health care costs regardless of how it's payed for or organized is just that the medical condition can do more and more and more then they could a few years ago and that 'more' ends up meaning more $.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
conditionprofession can do more and more and more than they could a few years ago and that 'more' ends up meaning more $What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
In my view there is a huge business opportunity for low cost health care technology. The medical industry is filled with routine commodity procedures with huge volume which are really expensive on a unit basis. Its classic industrial revolution stuff. Blacksmiths have been hand hammering the horseshoes, and someone is going to invent steam anvil which does it for 10% of the cost. Testing perhaps the most obvious area.
RE: Health Insurance
RE: Health Insurance
The problem is the song and dance, and on the sheer amount of stuff that we cover that other countries don't. It's not the profit that's the problem, it's the revenue. No other country in the world buys battery powered fat chairs for their Medicare recipients to drive around in Wal Mart. We do. That's a shared cost that other countries aren't sharing.
The problem is not how we share the cost. The problem is that we share the cost, without controlling how much cost we share.
In order for single payer to work here, we would need some kind of function that prevents unnecessary costs from being shared. In the USA, we have the opposite. We have a system where unnecessary costs can lobby their way onto the coverage list. In the USA, Medicare spent $172 million dollars in the last five years on penis pumps.
Let that sink in, before saying one more word about single payer systems here.
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RE: Health Insurance
RE: Health Insurance
That technology already exists; it's called a DOCTOR. The majority of added cost is not because of the equipment, per se, it's because of fear of malpractice suits, and the need to fill the time on the machine. Buying a $10M machine also entails making a return on it. But, most doctors are not in the mode of only using their own judgement in a diagnosis; they want the evidence from the CT or MRI, and they want the opinion of the radiologist to back them up. Changing the way malpractice is handled will go a long ways toward reducing unnecessary testing and imaging.
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RE: Health Insurance
Depending how it's set up single payer could also improve the mal practice situation and assorted costs attributed to that - not just insurance & legal fees but also the defensive medicine etc..
Depending how it's set if it might eliminate some of the billing mess, but of course many would expect that would get replaced by some government bureaucracy.
Bunch of other reasons too but if you haven't picked up on most of them yet I doubt I'll convince you.
Again depending how it's set up it would probably remove a bunch of the 'for profit'.
(* apparent because I admit I haven't researched it personally in great depth)
beej67 - careful you're getting into death panel territory with your penis pump line of thinking.
glass unless the big pharma etc. companies can be convinced that they can make more money with cheap solutions than what they currently supply there's not much incentive to find cheaper ways to do stuff. Getting drugs etc. through the FDA is probably enough of a hurdle to stop many smaller innovative efforts - especially if big companies decide to lobby against them.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
Medicine is presently different to engineering in that the diagnostic procedures are not accurate enough, and the grey gets filled in with a "human touch", which frankly is ineffective and cover for ignorance. Low cost point of use tests which are accurate are much better than any professional's eyeball. If the emotional response from a human touch is what's necessary, alternate medicine like naturopathy is much cheaper.
RE: Health Insurance
RE: Health Insurance
Medicine is not engineering. An MRI does not provide a diagnosis, nor does an ultrasound. All of these require "interpretation" by a TRAINED radiologist. As an example, I dislocated my elbow, and the ortho deemed that the x-ray was insufficient to tell what was going on, but his experience was that I probably tore at least a couple of muscles, and the only thing the MRI provided was a sheet of paper signed by the radiologist that specifically identified the muscles torn. No new information was provided that would have changed the diagnosis nor outcome given by the ortho.
What has increased the number of tests is the fact that there are tons more NPs doing diagnosis who were never trained as doctors, so they have to run tests to back up their diagnoses. The doctors do the same so that there's a paper trail of due diligence in case of suits. If there were no fear of suits, testing would drop substantially, as would secondary consults.
Obviously, there are those that need specialized tests because they've got oddball diseases, but most people don't have those diseases. The majority of sick people have common diseases, and the doctor will usually be correct by playing by the statistics.
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RE: Health Insurance
If no paddles are present, solder a capacitor between pins 5 and 7 of U12, or somesuch.
A truly fun few weeks, since I basically had to play the game to identify the fault, fix the fault, and play the game again to verify the fix and determine if there were any more problems. Of course, I never played Pong ever again...
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RE: Health Insurance
There are a bunch of first world countries with private systems that get more value for their money as well.
Everybody in the world, no matter how they do it, gets more for their value than we do.
Single payer is government cost sharing. Insurance is private cost sharing. Which way we share the costs does not make the costs go up or down. Over-use of the system is what makes the costs go up. The problem is the cost, not the way in which the cost is shared. The problem is the cost. It's not the profits, it's the revenues.
Private insurance already has "death panels" now.
http://en.wikipedia.org/wiki/Quality-adjusted_life...
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RE: Health Insurance
RE: Health Insurance
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
We are talking about replacing McDonalds checkout workers with touch screen displays because they want a pay raise from $11/hr to $15/hr, yet our $400/hr doc's are too precious.
-> I say let them have their investment banker salaries and restrictive business practices, but find ways of automation.
RE: Health Insurance
MediCal reimbursements are only on the order of $12 per patient visit. So even if a doctor could see 6 patients an hour, that would only get $72/hr, or less than $150k per year, out of which is paid salaries of the office staff, office expenses, including rental and supplies, and malpractice insurance. Medicare pays better, but not that much better. A typical single-provider family practice office must bill ~$400k/yr to net about $200k for gross salary for the doctor. Note that not all bills are ever collectible, and billings are often rejected or decremented by the insurance companies.
The one good argument to reverting to a reimbursement-style insurance plan would be so that the patient could see how much they're paying for the specialist referrals.
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RE: Health Insurance
All of them.
We are an outlyer not because of how we spend, but because of our lack of cost controls. Our system intentionally encourages and often mandates extreme over-use of the system. It is systemic, and changing who pays for it will not change the system itself.
We basically already have "single payer." It's just multiple single payer pools. The problem is not who shares the cost. The problem is the cost. All "single payer" really is, is everyone on the same insurance plan. We could achieve that just as easily by making everyone buy Blue Cross Blue Shield as we could taxing everyone more to pay for giving everyone Medicare. Doing either wouldn't significantly affect cost, because the profits aren't a significant amount of the cost. The margins on insurance are quite low.
The problem is if I sprain my knee in Denmark, I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage.
Changing who pays doesn't fix that.
I'll type it again, slower this time.
Changing who pays doesn't fix that.
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RE: Health Insurance
RE: Health Insurance
Most HMO plans already clamp down on that, because they ca deny referrals, but the "Cadillac" plans actually have gone the other way, with "self-referrals."
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RE: Health Insurance
It's interesting that the nations with equal-for-all systems - France, UK, Canada, Australia and the rest - are all in a cluster achieving similar results for similar expenditures, and out-performing the US system in both lifespan achieved and in per-capita cost.
RE: Health Insurance
Australia is not really an equal-for-all system, although it does have a publicly paid hospital system running in conjunction with a private or insurance based system. It's complicated, as most health systems are.
I think the high per capita spend and low life expectancy issues in the US are due more to lifestyle choices than anything else...too many fat people.
RE: Health Insurance
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RE: Health Insurance
FWIW, the British system is equal-for-all, except those with deep pockets (or a generous bennies package) can get private cover which allows them to jump the sometimes long waiting times for the routine stuff. I don't have a problem with that, except when the private work ties up resources and manpower in an NHS hospital which tends to happen more often than you might imagine. Unsurprisingly the insurers don't tend to cough up for the really big expensive emergency jobs like the operation which kept me out of a wheelchair four years ago; they still get picked up by the state. My family and I are all immensely grateful to the NHS for what they did for me, and even though I have good private cover through work I am a massive supporter of the state system.
RE: Health Insurance
RE: Health Insurance
It's not a question of sympathy, but sharing risk. Individuals will never get anywhere near the premiums that a group can get, precisely because of the lack of shared risk. For an individual policy, the premiums have to have a high probability of covering the risks, and will therefore be higher than for a group policy for the same individual, since the probability of everyone in the group getting the same diseases is lower. To make it deregulated simply adds to the cost, since the insurers would have no incentive to keep their profits down.
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RE: Health Insurance
RE: Health Insurance
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RE: Health Insurance
Any form of single payer system is, fundamentally, a far more noble, just, and democratic way to deliver health care. People who believe otherwise are heartless, brainless, souless, greed filled, or otherwise evil. It is nearly impossible to be naïve once you've had any opportunity to read about healthcare.
Not that I have an opinion...
RE: Health Insurance
You are entitled to your opinion, but do you have to be so harsh about it? Some of those adjectives are over the top, and just wrong.
RE: Health Insurance
RE: Health Insurance
Our system over here is far from perfect. It wastes money on a barely imaginable scale because of bureaucracy and inefficiency, and the layers of expensive underloaded management which have invented themselves over the past few of decades are a disgrace, yet it is so very good at the difficult things like fixing broken people and looking after those with long-term and chronic conditions without question or judgement. There is much to admire about our state-funded system, but many non-clinical aspects of the operation need to be run more like a commercial organisation where value for money is an important factor, except any savings aren't shareholder dividend but additional funds to spend on a better service.
RE: Health Insurance
The public hospitals are the large teaching hospitals and the place you want to be with something bad wrong. For instance, all organ transplants are done in the public hospitals.
For visits to doctors, not hospitalisation, we get government rebates, about half the cost of the visit, unless your doctor "bulk bills" or there are government concessions involved. Referrals are required for specialists, but if you have a continuing issue, the referral can be made continuing.
Every country has its variation, and it may be just good luck when a system works well.
RE: Health Insurance
Yes, but how much money does it take for the insurance company to "clamp down" on that? They end up spending a bunch of money on claims management to cut costs, but the claims management itself is a cost.
In Denmark, they just do what they're supposed to do.
Just like we used to do here when we paid for our sprained knees out of pocket, before the days of MRIs and Specialists and fancy MRI Reading People.
See my post above from 21 Sep 14 20:47. The reason they're not comparable is that health insurance isn't insurance at all, in the USA. It's a "Health Plan" that covers lots of things other than emergency care. If all health insurance covered was emergency care, it would work pretty much like car insurance does.
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RE: Health Insurance
RE: Health Insurance
1.a) Their government still works.
1.a.1) Their corporations aren't using the force of government to funnel money to themselves.
1.a.2) Their votes mean something.
http://en.wikipedia.org/wiki/List_of_freedom_indic...
(sort by democracy index)
2) Their country is small enough that corruption within the system has very little place to hide.
http://en.wikipedia.org/wiki/Corruption_Perception...
3) They don't sit around all day eating cheetos watching Maury Povich.
(sorry, don't have a link for world rankings of cheeto delivery / Maury reruns)
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RE: Health Insurance
not so much that they are both doing it right now, and making a profit. It's just a simple rationing system.
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RE: Health Insurance
And by making limiting collections methods used by bill collectors. This makes the healthcare system left with setting a high price for everything so they can offset the cost of those who can't pay.
If you had a members only hospital the cost would be much lower because those who can't pay woulden't be allowed.
So fix the free loader problem. Single payer dosen't do that, because the free loaders also don't usually pay taxes.
Now I am not saying we should let the poor die, but we need to put the problem into perspective in order to solve it.
I also agree that we are putting things as medical costs, that should not be. Electric wheel chairs, or power chairs are good examples. I have to move about under my own power, why not everyone else.
Lets face it, I can't count my allergy medicine as a medical expence, so why should someone be able to count sex drugs, or appritis as a medical expence?
There is a load of fat called medical need that really isn't needed at all.
RE: Health Insurance
That's the fundamental difference between the US and Canada; Canada decided that, as a society, it was better to use sales taxes to cover essential medical costs so that nobody had to worry about their healthcare costs. The US has a different belief on this.
It's a basic philosophical difference, that has led to a lot of misunderstanding, and fuelled many talk show performers who know nothing but how to spew the party line.
RE: Health Insurance
That's a problem, but it's only one of a dozen problems. But each of the problems are a result of people being encouraged, and often even required by law or regulation, to go through an expensive process that's not necessary or won't do any good.
When we all used to pay for our own stuff, we had incentive to tell a doctor "no, I really don't need that MRI for five thousand dollars if it's not going to change your recommendation anyway." When we pay into a shared pool, we have every incentive in the world to go get the free MRI that we don't really need, because why not? We've already paid for it. And the doctor has every incentive in the world to recommend the MRI, since we're not going to say no, and he makes more money when we say yes, and in fact he could get sued if he doesn't recommend it.
That's it. That's the deal. The U.S. system is a feedback loop of cost pressures. And flipping the switch between private cost sharing and public cost sharing will do nothing to fix that feedback loop. In fact, feeding the beast with tax money instead of premiums will just make it worse. The only thing more wicked than doing that would be forcing everyone at gunpoint to buy a private plan, and then forcing the private plan to cover things we don't want it to cover.
..sound familiar?
It should, because that's what Obamacare is.
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RE: Health Insurance
Depends to some extent on how it's implemented as I think I alluded to above.
Not that the lawyers and politicians would necessarily allow it (seeing as many politicians trained as lawyers) potentially going to govt central payer the malpractice suits could be significantly reduced if not eliminated entirely due to certain constitutional rights. In turn this could reduce some of the defensive medicine. Likewise no one directly getting money just from giving MRI's etc. removes their incentive to do as many as possible and so on.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
They already did exactly that with all the Obamacare plans. Forced things we don't need onto the plans, at the behest of lobbyists.
The fundamental problem is that government in the USA is broken, so any attempt to grant it more power just allows the people who broke it to break it further.
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RE: Health Insurance
The standard for determining tests used to be, 'what is the point? what will I do with the results, will it alter treatment in any way?' Now, the standard is, 'it's available, and the patient will complain if I don't order it, so I'd better order it'.
Like going to the doctor for a cold, what's the point? It achieves nothing, but yet, many people do it.
RE: Health Insurance
So a hip replacement cost is $2000 out of pocket, the same as the MRI. However if the doctor recommends you see a specalist for an in-grown nail, you might think twice as it's out of pocket for you.
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
...but...
...Plans like that were specifically made illegal by Obamacare. Specifically singled out to be made illegal. Because those people "weren't sharing enough cost." Translation: those plans didn't drive up the cost of healthcare enough.
Seriously.
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RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
You all deserve better, and I apologise.
RE: Health Insurance
Huh? One of my company's plans is a high-deductible with HSA.
But, an HSA's advantage is pre-tax, but if you aren't going to owe taxes, that's sort of irrelevant, so if you couldn't afford $2000 for medical expenses and owe little in taxes, an HSA-based plane is not particularly useful.
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RE: Health Insurance
RE: Health Insurance
- Steve
RE: Health Insurance
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RE: Health Insurance
I guess that makes for the best political commentary, though.
RE: Health Insurance
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RE: Health Insurance
TenPenny: the thing about Obamacare is that it is pretty much exactly what I would have expected the Republicans to have done had they reformed healthcare. It retains a fully private system and empowers individuals to get insurance independent of their employers. No corporation was harmed in the making of this bill! Its exactly what I would have expected from a Dick Cheney with his down home on the ranch / look a man in the eye before you shoot him / Ayn Rand ethics.
RE: Health Insurance
Is that not how it works?
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RE: Health Insurance
If you don't want people to die of causes which can easily be treated by medicine, and you are unwilling to let them die merely because they lack the money to pay for that medical care, then you have de facto rendered basic health care a human right rather than a commodity. You cannot trade human rights. A market cannot assign them a fair trade value.
It is also a mistake, proven easily by measurement and comparison, that the private sector always delivers goods and services for less total cost than the public sector can. Proof is the % GDP expenditure difference to provide health care to Canadians and Americans. Outcomes are similar- costs are VERY different, and the reason is simply this: the public system, though imperfect, is far more efficient than the mix of public/private you have in the US. Not by a little- by 7% of GDP.
The question really isn't one of government takeover of 17% of your GDP- it's whether or not you want to continue to spend 7% of your GDP to enrich people in return for NOTHING. Your country, your choice.
You need not fear, because in reality you have no choice. That 7% of GDP wields more power than the US military which in its entirety costs less than 5% of GDP. Those parasites are in your bloodstream and there's no drug which will remove them.
RE: Health Insurance
molten, I wish I could give you more than 1 star for this.
RE: Health Insurance
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.
- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground. Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.
- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.
- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.
RE: Health Insurance
If Canadian health care is so much better, then why do Canadians come to the US for health care? Or if our health care is so great, why is health travel happening?
In both cases the healthcare system is lacking something, and if free market were really allowed in the US, our insurance would pay for us to seek health care outside the US. The fact is our health insurance is regulated to keep people in the US, and not seek medical care in a free market of the world. Yea there might be risks, but what of the risks here?
Of course I am not talking about emergency care.
And let me say I am not concerned about the poor, I am concerned about myself. The poor can eat cake.
I see that maybe a dual system maybe an answer to this problem. A healthy privite free market system, and an under funded public system. And the public system needs to appear to be underfunded to encurage people to use the privite system when they can.
However, O care was sold as making health care equal for everyone. But apperently the VA did not get the message. Do you supose the White House doctor provides equal care?
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
HSA is perpetual, FSA is transitory.
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RE: Health Insurance
http://www.commondreams.org/views/2009/09/09/medic...
John R. Baker, P.E.
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
RE: Health Insurance
Prescription drugs are not covered by the Canadian plan, except for the very poor and for drugs given in hospital. But because the governments are a major purchaser and are unafraid to use their purchasing power to negotiate, we all benefit from lower prices. Think of it as a tax on profit. If the US didn't exist, drug companies would still exist, and would still do drug development. What you'd see though is far less peddling of drugs on TV- far less "market building" on the part of drug companies. Those ads you see on US TV- they are absent from Canadian TV entirely. The cost of drugs in Canada also comes with a dramatic reduction in marketing/advertising cost for the drug companies, not by their own choosing I might add.
The public system reduces the maximum profit attainable from such innovation but by no means does it prevent innovation entirely.
All this "innovation" your country is built on isn't making your healthcare cheaper for one simple reason: healthcare is not a market commodity. It's not an IPad you can choose to buy or not buy.
There are three core reasons your system is screwed:
1) You aren't a totally compassionless country and hence you have a parallel public system- just a totally messed up one which is fragmented into several disparate programs. This fact limits competition- sets a floor for the prices of services etc. But it's impossible to avoid, unless you surgically remove compassion
2) Your political system, like all others but moreso than most, is subject to the power of money. 7% of GDP buys a lot of political power to prevent government "innovation" which might take away private profit
3) You are a nation that from its founding has feared its own government. You don't view government as something you do collectively for each other's benefit- something you can do better together than any of you can do independently. Hence government is always viewed as an evil- by some among you, not even as a necessary evil. You therefore push things onto the private sector that it cannot efficiently provide
No, the fundamental problem is that the "commodity" of healthcare isn't a commodity- it's a human right. Accordingly the market cannot function to minimize its cost through competition. The insurance companies are a symptom of this problem- they are private entities set up to intercept the necessary and unavoidable flow of money from people needing care to the care providers, and take away as much of that for themselves as possible. They are, by definition, parasites.
RE: Health Insurance
I've often wondered how anyone could take her seriously, but many do.
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Care obviously becomes more expensive when we can do more- and when people live longer. That expense grows faster than the economy and there has to be a limit- somewhere. But that growth in cost doesn't explain the difference in % GDP expended between the US and Canada for essentially the same outcome NOW. That difference is almost entirely explained by the inefficiency of the combined private/public model in the US relative to the single payor public-only model in Canada.
We weren't always there: healthcare was once entirely a combination of private and church/charitable provision in Canada. We won the battle to put in place a public single payor health insurance system by fighting the doctors in one province- Saskatchewan - in the early 1950s. Many doctors left the province, but replacement doctors who believed in the system, came in to replace them. Eventually it spread to other provinces- once Tommy Douglas's CCF did the heavy lifting and prevailed, showing that the predicted end of the world and people dying in the streets didn't come to pass. Regrettably, the battle to have such a system for auto insurance was lost in most provinces- only a few have provincial auto insurance, and they pay vastly less for car insurance than we do here in Ontario .
Now we hear US media reports about how everyone in Canada is dying in a waiting line, how we ration the provision of essential health care etc. It's sickening how a distorted view of our system is presented in the US by people with a vested interest in maintaining the status quo. 7% of GDP buys a lot of airtime...
RE: Health Insurance
Canadian success notwithstanding, its not clear to me that a Euro style single payer system is right for America. I think America will forge its own path. In a bunch of instances where its looked like America was hopelessly behind, people start saying the US needs to become more like Japan/Norway/Germany/wherever, but the US comes from nowhere and invents its own stuff that turns out to be better. I remember a bunch of conversations from 2000 to 2006 about how much better Japanese cell phones were than US equivalents. All kinds of techno gloom post 2000 bubble bursting. Then 2007 rolls around, and Mr Jobs shows up with the iPhone. Had the government said that mobile communications are a human right, and that they were going to reimburse cell phone manufacturers at the cost plus 10%, we would still be carting around Blackberry's (sorry Canada) and thumbing out SMS's on a number pad. There is no way that a government bureaucrat could have picked Apple as the winner that they turned out to be.
This kind of entrepreneurial activity is the only thing which moves the needle of economic growth at scale. Like Norway, Canada has become a liberal petro-state - all manner of largess is financed by the tar sands of Alberta distributed among a small population. Much of the Euro breakup crisis of 2008 was a function of their governments having gigantic fixed costs with a shrinking tax base. Its arguable that the current sclerotic economy of France, Italy and Spain is due to their addiction to being taken care of. Frankly I would rather be a sick American with bad health insurance than an unemployed Spanish twenty-something living with grandma and contemplating suicide because there is no opportunity.
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I have a tendency to believe that there might be more options than just those two.
RE: Health Insurance
In places in South America you don't need a note from a doctor to buy medicines from a pharmacy. Which is really nice if you know what you problem is, you don't need to visit a doctor. And in many cases you know what you have. And maybe that is part of the problem, we are expected to see a doctor when we already know what problem we have. After all how many times has someone OD on butt cream. It is regulated for what reason?
So now, if I have a sinus infection, a visit to the doctor. A case of pink eye, a visit to the doctor. A rash, a visit to the doctor. An ear infection, a visit to the doctor. So the real problem really appears to be regulation, and not the cost of medical insurance, or a shortage of doctors.
So why can't I pay the pharmacy directly and get the medication perscribed by the nurse who usually gives the flu shots.
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RE: Health Insurance
I had a friend who almost died from a superbug infection he got at a hospital. The surgeons did all sorts of insane (and expensive, to keep it on topic) procedures to him to try to keep him alive, which included implanting tubes all through his body to pump certain antibiotics. Nothing worked. As his teeth were falling out, he went to a dentist, who decided to simply proscribe him a different (very powerful) oral antibiotic. He was cured in two weeks. By the dentist. The surgeons made over a hundred thousand dollars off him first though.
All because he was having a boil on his foot lanced.
Everyone actually knows what the problem is, because everyone knows someone who's been through the ringer of our healthcare system. We just don't stop and think about what the problems are when we watch others, or ourselves, go through it. The problem is that nobody is allowed to do anything for themselves, everyone must see a doctor for every little thing, the doctors are all trying not to get sued, and the doctors know that they can prescribe anything they want and the costs will be shared. That's the source of the problem, and that problem will remain whether the costs are shared through premiums, or shared through taxes.
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RE: Health Insurance
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The problem with antibiotics did not start with doctors, I believe it started with feeding it to animals, which is largely unregulated. The organic, and probiotic movements are currently making a dent in that issue, but it still exists.
And the best part of having your foot lanced at home is not having to visit a unhealthy hospital. Notice I say unhealthy, and not unclean. Hospitals typically look clean, but as they have pressures to reduce costs, they miss things.
The problem with percription drugs, is the perception that a magic pill will solve everything, and it won't. Just look at the side effects on any of them.
The medical profession started this dream, and they need to fix it.
RE: Health Insurance
People being over prescribed antibiotics, not finishing their courses as instructed, helping themselves to their friends/families medicine, diagnosing themselves and buying from pharmacy in other countries... are major factors in development of antibiotic resistant infections.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
But nobody's going to do that, because hospitals are big money.
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Part of the reason they are more obvious in hospitals is because the people there are already sick and so potentially more vulnerable to picking up an infection.
However, they also evolve at home/in the community.
http://newsinhealth.nih.gov/issue/Feb2014/Feature1 gives some information, or maybe you don't trust the govt but there you have it.
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RE: Health Insurance
http://www.scientificamerican.com/article/hospital...
Pretty strong numbers.
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http://www.mayoclinic.org/diseases-conditions/mrsa...
RE: Health Insurance
The hospital environment is tailor made to breed superbugs. If we could somehow decentralize the surgical environment, even going so far as to move the equipment to the patient's home and perform the surgery there, then this tailor made environment would not exist to breed such superbugs. The rapid evolution of superbugs is because of the high density of surgical procedures done in one place, with a continued culling of weak bacteria between each surgery, in the hospital. It is the hospital environment itself at fault for the evolution of these things.
The article I linked is a good one, and fairly comprehensive, but it's only one of dozens that say the same thing. Superbugs are not created by too many people taking Amoxil for ear aches. Superbugs are created in hospitals where there is a high density of exotic antibiotic use and open surgeries to act as petri dishes.
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RE: Health Insurance
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RE: Health Insurance
Why not make some medicines with ditastful side effects. Turns you whole mouth orange, tastes real bad, and smells like s**t (other than antibiotics).
No we make them look like gummy bears, with nice flavors. Easy to take narcotics, real bad thing.
RE: Health Insurance
RE: Health Insurance
My point, or at least one of them, is that the "We'll burn up all the antibiotics!" is always trotted out by the medical industry as an excuse for making everyone in the USA go to the doctor for every little ailment that may require antibiotics. When in truth:
1) other countries don't do that, so the amount of "burning up" that happens here is inconsequential, and
2) our doctors just hand out antibiotics anyway, and
3) the really nasty antibiotic resistant bugs aren't being created by over use of common antibiotics for common infections, they're being created in hospitals by the concentration of people having surgery, which is...
4) ...exacerbated by our system's priority to "cut first, ask questions later," because our system is dominated by surgeons who have no financial incentive to recommend paths to health that don't involve expensive surgeries.
Here's one of many articles on the higher rates of surgery in the US:
http://www.ncbi.nlm.nih.gov/pubmed/8073310
US citizens in 1994 had back surgery at five times the rate the English did. That contributes to both our overall increased cost of shared medicine, and also to the increased breeding ground for superbugs, which in turn cost more money. But since back surgery has the fiscal benefit of being A) expensive, and B) covered, our doctors jump at that as the preferred option for treatment.
..and that won't change by switching to a government-payer health care model, either.
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RE: Health Insurance
Isn't the lower rate of English surgeries cited done in a single payer system?
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RE: Health Insurance
Medicare is a single payer here in the USA, and Medicare recipients do not have a lower rate of surgeries than insurance buyers. The payer is not the only difference between England and the USA. The systems themselves are different.
Now, if we go full Communism and not only do single payer, but also single provider, then the rate of surgeries goes down. We have evidence of that. It's called the VA, who let people die because they were lazy and didn't have to compete with private care for the patients dollars. Not even one of the country's most decorated and dedicated Army Generals could steer the VA towards a semblance of respectability.
On that topic ..the whole "VA Reform" movement just kills me. We have Obamacare now, and it's not going away no matter how much some of us would love it. So why have a VA at all? Just fire everyone, give vets an Obamacare voucher, and sell the VA hospitals off to the highest bidder. Problem solved.
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Right, but it's not the single payer system that prevents that from happening either.
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RE: Health Insurance
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Regrettably, although the doctors and provinces are good at controlling the total number of doctors, they're less good at controlling the number of specialists. Specializing gives the doc a huge return on investment relative to staying a family doctor, so we have a shortage of family doctors- and are a net exporter of trained specialists to the US where the returns on that educational investment (for the person, not the province who subsidized it) is enormous. Time to start handing them a bill for recovery of those subsidies at the border in my opinion, until they've put in 10+ years of practice here at least.
RE: Health Insurance
Sure. So why is the whole debate about who pays for the overpriced dysfunctional product, instead of discussing the overpricedness and brokenness?
The primary thing that fuels the engine of our system's brokenness is the exploitation of the cost sharing mechanism by the medical industry itself.
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RE: Health Insurance
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We can call all of this 'nation building'.
So what I am getting is this is a political issue that is causing the rise in health care, and we have a goverment that has no desire to fix the real problem.
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but we are compassionate people who don't turn away the sick ( mostly ).
It seems there are only two ways to handle this.
1 Spread the cost out over the population and over time requiring people to pay in constantly for that day when they need it.
2 Government takeover of the health care system so whats available for free is limited and without risk of litigation.
Also I think every medical service and doctor must publish their fixed price to do procedures. They would have to weight in
their risks for handling complications ( resulting from treatment of a single condition named in the price ) and perform
the service at the quoted cost.
It simply won't work allowing the medical community to run a locked in system where the consumer is handed the bill after everything
is finished and just has nothing to say about it.
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Truthfully why is there a restrictive choke on the medical profession, but a desire to allow engineers from other countries?
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Not true. They generally have difficulties in the following:
> Passing the Step 1 and 2 medical exams, because they're in English
> Passing the TOEFL English exam
> Getting residencies, which are in limited supply.
> Passing Step 3 medical exam.
> Passing their respective board certifications
> Just because someone was a doctor somewhere else, does not mean they are qualified or trained to the same level as a US-educated doctors.
> For the limited slots available for residency, it's mostly a meritocracy, at least, in the sense that graduates of the best medical schools will tend to get the best slots.
Assuming that a foreign person does all of the above, they cannot be "denied" licensure. My wife is foreign born and trained, and is licensed, but went through all of the above hoops.
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The medical associations and provincial governments set aside enough residencies for the (controlled) number of local medical graduates, plus a small number (I think it's about 100 per year in Ontario total) for everyone else. If you have 1000 foreign trained doctors coming in and 100 residencies per year, you end up with trained doctors doing something else. So: why let the rest of them immigrate? That's been an argument for a long time- in all the professions- except in engineering, where the engineering community was basically asleep or in denial, thinking that we could accommodate any number of immigrants who chose to come.
In fact, they tried for a while in the late '80s to let doctors come in ONLY if they signed an undertaking prior to immigration stating that they would not seek licensure as doctors. Of those signing the undertaking, it was found that over 50% did actually seek licensure anyway...so they abandoned that practice.
Somehow, a doctor's training going to waste is viewed as a huge sin, but an engineer's training going to waste is not something anyone cares about. I guess we're not a profession after all, at least not in any way that truly matters.
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So at this point I need to ask why those doctors from other countries don't teach?
Also while observing the elections last night, I noticed the corner is an elected position, and I think, that a corner may not need to be a very good doctor as all their patents are dead.
RE: Health Insurance
For same reason that they have trouble getting residencies; they're competing with already licensed doctors who have the full paper trail of residency, board certification, etc. Given the number of foreign-trained doctors already working, I don't see that there is a real problem, those, like my wife were indeed able to get pass the medical exams, get residencies, and pass the board exams. I think that if we dug through the records, we'd see an equally large, if not larger, group of US-trained grads that fail to get into the path toward licensure. It's awfully easy to blame others for one's own failures.
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RE: Health Insurance
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Better using the training of doctors from overseas is one thing, but better using the services of doctors in general is another. Right now too much healthcare is delivered by people with too much training- a little bit of "division of labour" would help that profession a heck of a lot more than merely fixing the mess related to residencies.
RE: Health Insurance
- US med school needs to be cheaper
- Med school needs to be shorter, at least for some percentage of doctors.
- If education input is such an expensive piece of the puzzle, we should be looking to offshore to lower labor cost locations where possible.
RE: Health Insurance
Nothing about fixing that in the ACA.
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RE: Health Insurance
How about we tax the investment banker salaries, use that money to make the doctors government employees (with generous but limited salary) in a state monopoly for healthcare with strict limitations on being sued. Maybe negotiate better prices with various med suppliers due to the monopoly status. Little bit of central planning to cut down on duplicate facilities and equipment not being used to capacity...
You know, something like at least some of those damn commie socialist lazy Europeans do with their single payer systems.
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RE: Health Insurance
No, but there are people who fail to get into the US medical educational system and go elsewhere, because it is easily, like the D.R. Additionally, you don't know that a German doctor was actually trained in Germany, just like not all US doctors were trained in the US. The other issue is that the equipment and nomenclature and procedures are different, and while family practice could probably tolerate a doctor fumbling for the right phrase to use with the M.A., that might not go that well in the O.R.
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Teddy Roosevelt busted up Standard Oil and the railroads over a century ago with the Sherman Act. Watch out Yale School of Medicine! No more boasting about being selective!
RE: Health Insurance
We have engineers & scientists from all around the world here and language skills* & to a lesser extent general cultural norms can be an issue.
* I'm primarily thinking their English skills not always being fantastic but in fairness I'm mediocre at English, terrible at French and it goes down hill from there.
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RE: Health Insurance
RE: Health Insurance
Perhaps, but in reality this only works to the extent that our wealth and station in society allows us to...
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RE: Health Insurance
RE: Health Insurance
- Why is food any less of a human right than healthcare? Organic kale, whole grains, and humanely raised meat are much better for you than a deep fried hormone laden double down from Micky D's, though it is more expensive. Its arguable that we would have better health outcomes if food was tax deductible and healthcare was taxed. Lets give it to the underpaid farmers rather than the overpaid cardiologist.
RE: Health Insurance
http://www.fa-mag.com/news/meet-the-adviser-who-s-...
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- Steve
RE: Health Insurance
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RE: Health Insurance
Soda has an appalling amount of sugar it in, and it more responsible for more expensive health problems (especially diabetes) than practically anything other than cigarettes and alcohol.
-> Soda should be taxed like cigarettes
-> Kale should be income tax deductible
RE: Health Insurance
The problem is who decides what is good, and bad for us, and how much is too much. And how long ago were tomatoes thought a health problem? And what about those foods that are taboo in some places and not others? Any one try horse, pork, cow, deer, bear, carp, corn, beer, wine, dandelion, dog, cat, road kill? Where does it stop? (Not that I choose to consume all of these).
At some point a government who limits what we consume for health reasons, will over reach. Which is why we should not go down that route in the first place.
And at some point we should look at health at a multipoint level. There is what we need to live for after an accident. What we need to live for after we have over consumed. And what we want because we want to look better. And what we need because our body is failing us.
RE: Health Insurance
That's fine, but why are the rest of us forced to pay increased insurance premiums to cover all the health problems caused by the consumption of all these things? Juvenile diabetes rate is going through the roof, so we're all paying for the insulin now, and all the complications of their diabetes later. By ignoring the root cause, we guarantee the worst possible economic and health outcome. For a society that came up with pithy sayings like, "A stitch in time saves nine," and, "Penny wise, pound foolish," we seem hellbent on going the exact opposite direction.
It's all very fine and dandy to protest government intrusion into our lives, but is the willful negligence by others resulting in the sucking up of health care resources somehow better? If they want to do all these things in the name of freedom from government nannyism, that's fine, but they should pay for that privilege. You want to smoke and fill your body with carcinogens, fine, then every pack of cigarettes should include your share of your eventual burden on the health care system. To do otherwise is to simply toe some inane dogmatic line, bury your head in the sand, and open up your wallet and leave on the sidewalk.
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And in fact if I get a yearly blood test I get points into a health spending account, and even more points if I meet some targets. So I am infact penalized for not being healthy. And I have no government restrictions on what I eat.
In reality, peanut butter is a known chocking hazard, so why not outlaw peanut butter?
I am in favor of government restrictions like "no spitting on the side walk", or a waiting period if you have been eboli areas.
But why the double standard, don't eat this, but if you have a eboli you can go into public places.
RE: Health Insurance
In principle I am somewhat of a libertarian too and agree that tax is a perversion, but a soda tax to me is a no brainer. Its kind of is like the "no spitting on the sidewalk" rule in the sense that you are asking people to not make a mess for others to clean up.
America has a cultural problem with soda. There are many people in this country who don't like drinking water, and consider it normal to hydrate with soda. If we lived in a parallel universe where a person's sickness affected only themselves, that's one thing, but it doesn't work like that. If you let your boss down by not showing up for work because you just had a stroke caused by having chugged 6 cans of Dr Pepper a day, that's a cost.
Soda is a luxury!
RE: Health Insurance
> I don't trust them that much more than the government, possibly less, because their motivations are strictly monetary
> that sort of adder is based on self-reporting, for the most part. If the true cost of smoking were reflected in the premiums, smokers would LIE about it, and they would only get caught after they wind up diagnosed with a smoking-related disease.
Tying the consequence cost to the actual product eliminates all that lying, aside from the inevitable workarounds that resulted from the temperance laws we attempted at the front end of the last century.
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Its going to be hard to ban alcohol, but we have the more current issue of marijuana. Are we going to see an uptick in lung cancer in 10 years because of the current legalization effort?
RE: Health Insurance
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At the risk of being labeled a "nannyism" advocate, I could imagine doing adders and subtractors to the prices of foods to account for downsides and upsides, with the eventual goal of demonstrating that the true cost of the cheap sugary and starchy drinks and snacks belie their retail prices, and that vegetables and fruits would get priced more competitively, based on their benefits.
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RE: Health Insurance
I was the insurers dream. Company paid insurance, rarely go to doctor. In relatively good health (well into 50's). As far as individuals going into the marketplace and obtaining competitive insurance as opposed to a group policy that's just not going to happen. Unfortunately, as an employee you have no control whether your employer has a good or bad plan.
I was blessed to have a HR lady who worked extremely hard to negotiate the best coverage possible on an annual or two-year basis. It did mean switching providers from time (which did give some heartache when suddenly your primary care provider was no longer in the covered network). My own experience is therefore not against employer paid plans.
I am now in the free market place and what I am seeing is dreadful. $600 per month with $5000 deductible. I am better off without a plan and risking I won't spend more than $5000 (I suppose that's one hospital stay). There are plans with lower deductibles, but with higher monthly costs. It's hard to predict what will happen.
As far as the uninsured, I do believe there is some role for subsidies or low cost care to be provided for those that qualify. It ultimately results in an improved society (IMHO).
I am near that point now, being recently unemployed, unable to afford COBRA or any other health care. Yet somehow BIG BROTHER says I must have it. Just how? Unless it's GIVEN to me.
I don't really believe the US Government is going to deliver healthcare to me efficiently (too much bureaucracy, sloth, and graft). Not that I believe that the current system is very efficient or cost effective either (too profit driven).
One example I can provide is that the radiology departments act as their own revenue generating centers in the hospital. How often have you got a bill from them stating your insurance carrier hasn't paid? Thus your Doctor no longer truly reads your X-ray.
Well that's enough of my 2 cents.
RE: Health Insurance
Dream on, %5k was ONE DAY in intensive care, the last time that happened.
"I don't really believe the US Government is going to deliver healthcare to me efficiently (too much bureaucracy, sloth, and graft). Not that I believe that the current system is very efficient or cost effective either (too profit driven)."
Luckily, we're doing neither, or rather, we're doing both
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Have you ever been to a Scandinavian country likr Sweden or Denmark? If you're ever there, try buying a beer, or better yet, a bottle of liquor, and you'll experience first hand what it's like to live where they 'tax' your vices, at least the ones which tend to place an undo burden on their national health care system.
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I quite like that idea, actually. It would be a lot more grounded in realism than carbon taxes.
The thing to really tax, though, is sugar.
If all of Obamacare was funded out of a national sugar tax, and food stamps were instead replaced with "all you can eat free vegetables," this country would undergo a drastic change for the better, health wise. The corporate food lobbyists would never let that happen though.
All sorts of funny things show up when you start applying actual actuarial principles to health care. For instance, tobacco use is a net positive, because it kills people off before they get old and draw too much social security. Alcohol might be similar.
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-> It should not be affordable to get drunk every night. Buying a can of beer for $1 is perverse, it should be $10/can. Cigarettes are about $12/pack in the bodega downstairs from my office, which is still about half what it should be.
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One of the big problems with any of this high tax stuff, is what if the studies are wrong. What if a little wine is actually good for you? Who decides what is taxed and what is not, or what is good for you and what is not. Do you trust that person or group to be honest, and not payed off?
If you want to fix a disfunctional food consumption problem, then teach it in the schools.
Another option is make food that is good for you, to taste good to you.
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There is a correlation between mental illness and problem drinking (and other addiction issues) but the causation is not necessarily as simple as 'drinking/using drugs fried their brain'.
In many cases the substance abuse may be a form of self medication for pre existing mental illness - at least according to many psych types.
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How is that supposed to "fix a disfunctional food consumption," given that much of today's problems in nutrition can be squarely placed on the food pyramid that was taught in schools and media for 40+ yrs. Additionally, the same question of "who do you trust?" exists. The "war on fat" can now be traced to a certain zealot who cherry-picked his data and sold a bill of goods to the country that reverberates even now.
"Another option is make food that is good for you, to taste good to you. "
The only way to pay for that is to tax the bad stuff... But, seriously, the reason the bad stuff tastes good was the fat and salt and all that bad stuff. Put enough cheese and salt, even tomatoes might taste good. Of course, we've successfully removed 90% of the tomato's taste to ensure that we don't have go to the market every day to avoid spoilage and shipping damage. Almost everything that was tasty that we buy in the produce section has been bred into dull, lifeless, cardboard taste.
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Hence every few years a food that was meant to be 'bad' for you is now 'good' for you and vice versa.
The human body is an incredibly complex system, that varies somewhat amongst the population, in a variable environment... so to my mind to any claim that tweaking one input slightly can be expected to have a significant impact on overall health of everyone is worth of scrutiny.
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- Steve
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Part of the perversion in the US are the farm subsidies for corn growers. It artificially reduces the price of corn syrup.
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Then I am unreasonable, and apparently so are at least some scientific researchers.
http:/
http://n
http://
http://www.realbeer.com/edu/health/
Then again, as we don't trust them about the climate should we trust them about bear?
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Case closed.
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en.wikipedia.org/wiki/Shandy
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Make mine a turbo shandy (the version with alcho lemonade not those smirnoff ice abominations)
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That's certainly one way to make your credibility approach zero.
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Prohibition doesn't work, and cannot be made to work in an open society, since you can get heroin in a maximum security prison. QED.
If you want to reduce harm, that's one thing. If you want to enforce morality, that's something else entirely. Prohibition doesn't do the former at all effectively.
If you have public healthcare it makes sense to have taxes on stuff that prematurely kills people, including foodstuffs that contain nothing but empty calories. Most people don't mind so-called "sin taxes" and just take them in stride, so they're not all that effective, but they do deter some consumption. They also generate revenue to cover some of the cost of the negative outcomes from consuming these things, which is better than taxing income to do the same.
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Of course, the downside would be that roast duck would probably wind up being $40/each instead of the current $16/each
Current sin taxes are not sufficiently high enough to be deterrents, simply because they're not really actuarially prescribed. Rather, the tax is usually something that would up as a compromise between opposing sides that paid lip service to being a sin tax. This would be the biggest obstacle to a true valuation of the life cycle cost of most items; their manufacturers and their lobbyists would be crying a river about loss of jobs, restraint of trade, blah, blah, blah.
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Another difference is that the manufacturers of cigarettes now are quite large and there really aren't any small-scale suppliers that could be suborned into supplying them duty-free.
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Cheap junk food is actually the fault of we engineers - if we had not invented super efficient production lines, it would still be expensive and therefore not a health problem. Its kind of like the Formula One engineers who got the weight of the vehicle down less than the regulations allow, and you have to add a lump of lead in the trunk. Add enough tax to the Cokes and the Hershey Bars to bring the price back to what it would be if you actually made these things by hand.
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Maybe we should be making people do exercise? No more snow throwers. No more Sunday football. No more netflix.
Maybe no more electric shopping carts.
The problem is not what we eat, it's because we don't have anything else to do. We eat because it makes us happy. Does TV make us happy?
Try enticing people to do exercise. Maybe actually paying prize money for winning local sports teams.
I really think the over weight problem is people are board.
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However, it's harder to tax folks for not exercising enough so forget I said anything.
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Everyone gets govt issued pedometers (they may have to be implanted 'mark of the beast' style to cut down on fraud), you start off owing the govt X$ each day but for each bit of exercise over some sedentary threshold you can reduce that tax burden.
Excess exercise credits could be banked for future lazy days, or maybe even traded like carbon tax credits because we know that's a sure fire winner.
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From a health cost standpoint, exercise is low hanging fruit. Maybe $1BB spent on a national exercise promotion campaign would save $100BB in chronic health problems. Suburban lifestyles are a culprit here.
When I was growing up in Australia in the 80's, they had this ridiculous "slip slop slap" campaign to get people to wear sunscreen when they went to the beach. Most Australians are lilly white Euro descendants, and in the 70's it was considered wussy to wear a hat at the beach. As a result Australia was the skin cancer capital of the world. Pretty much everyone in my parents generation got skin cancer in some form, but now its much more rare, in part because of the "slip slop slap" campaign.
www.sunsmart.com.au/tools/videos/past-tv-campaigns...
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It was a pretty interesting ad campaign.
Interesting too, that these days, school children are mandated to wear a hat (think French Foreign Legion type) whilst in the school grounds, or no outside play.
Also, have you purchased alcohol in Australia recently? About AU$50 for a case of non-premium beer. Lucky I don't drink!
Cigarettes will set you back AU$20 a pack - and the photos on the packs of past smokers with cancerous diseases! Lucky I don't smoke!
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Actually, it is, at least partly. We've substituted starches and sugars for fats, specifically because of the USDA's "war on fat," which was specifically justified based on cherry-picked data. And, if we actually ate in moderation, we wouldn't need massive amounts of exercise to burn off the calories we ingested. Most restaurant meals contain twice as many calories as they should, and are often more calories than we need for an entire day. The Cheesecake Factory's walk of shame dinner clocks in at over 3000 calories.
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A magizene years ago had a funny exercise plan that went like placing strong springs on doors, and placing push signs on pull doors. They likely reused it many times like most of there work.
The whole exercise thing could be helped by getting rid of the TV, or making the fire lanes at stores bigger so people have to walk more.
In any case the drought in Ca won't help as it will rase good food prices.
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What's his face (actor) eschewed wearing a helmet and got into an accident, with head injury. I don't know if he paid for his hospital bills himself or through insurance. If the latter, then I would likewise advocate some form of "sin tax" that would cover those types of medical bills as well.
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"Whom the gods would destroy, they first make mad "
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Make sin taxes inclusive. Motorcycle drivers pay more in taxes, and even more if they don't wear helments.
It's the same a sin taxes on food.
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Of course, one of the outcomes of the statistical side of car insurance rate setting is that women tend to get charged less than men, other factors being nominally equal. Statistically total costs of accidents by male drivers is apparently higher.
In health care, the cost of care for women tends to be higher than for men. However, the idea of charging women more for healthcare is highly contentious and often legislated against. Mostly because much of the difference in cost is probably related to the role women pay in reproduction of our species and it is arguably a bit unfair to charge them more for doing the heavy lifting when it comes to maintaining our genetic line.
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cranky + Kenat: driving is an inherently risky business, and offloading your risk to other drivers is kind of sketchy. If you commute 100 miles a day at 90mph, you should not expect to be paying the same flat rate as someone who only drives on weekends. If we all had a straightforward metric we could track and control which is tied to our insurance premiums (like distance driven or speed), it lets us work to reduce cost. When we have no levers to pull, we finish up with the US healthcare system.
-> Could our health premiums be tied to our BMI's?
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http://www.today.com/parents/canadian-mom-who-give... note that the supposed charge was actually around $900k US
So, the baby was 10 wks premature at birth, hence neo-natal for 2 months. The roughly $15k/day is not that unusual, given that my kid's stay in the non-ICU hospital for pneumonia clocked in at $5k/day
Interesting that this is suddenly coming up now, even though the baby in question is almost a year old.
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Unless I'm crazy, it takes somewhere around 40 days for it to add up to $600,000.
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I pray not, BMI is an extremely crude measurement. People with a lot of muscle mass and/or naturally high bone density (i.e. those of us who sink in the swimming pool) may have very poor BMI scores despite being relatively healthy. Many serious athletes have poor BMI due to all the muscle despite getting lots of exercise and being relatively fit by most measures. (Obviously participation in sports increases certain health risks though.)
Don't get me wrong, I know I'm a bit overweight but my BMI gives a truly misleading impression of just how badly - at my last annual exam my doctor even came out and said so.
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So to me, it's too crude.
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BMI is too crude, but timing a one mile jog wouldn't be a bad idea at all.
Good luck getting that past the voters.
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While obstetrical is certainly a factor adding to the discrepancy in male and female health care costs, women still consume more across the board healthcare than men.
If you are in favor of a high sin tax to pay for the future care of alcohol and tobacco consumers, what is the difference between a government taxing those consumers in order to offset the perceived future costs they will cause a public service, and a tax on say parents to compensate the government for the perceived cost of educating their child.
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"An athlete with six pack abs is going to have lower BMI than couch potato with a different kind of six pack"
In many cases, the BMIs for athletes, particularly those that require strength muscular as opposed to fast twitch, will be considerably higher than BMI guidelines for obese. BMI is so blunt that a weighlifter or bodybuilder can have substantially higher than 30 BMI. Of course, one might possibly argue that neither of those are particularly healthy...
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This is one of the horns of the dilemma of insurance, "pre-existing conditions" generate definitive, nearly certain, cost exposure, which is not really the model of classical insurance.
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IRStuff: Showing 10,000 steps a day on a pedometer is good idea. Though it will be unfair to bike commuters such as myself.
Agreed with you both that exercise makes a big difference to health. I know that I always feel better when exercising.
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How is that the problem? Is compassion "the problem?" Do you wish an early death to all those that suffer from this illness? Or are you suggesting that we abort any fetus that lacks a working CFTR gene? That would save lots of money. Should we likewise put out all the frail, aged, etc., into the wild and let them die? Where do you want to draw the line? Or do you want someone else to draw that line?
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On the other hand its not a problem if you believe that the technology, now invented will not get uninvented and will get cheaper in the future. We may get gouged by the drug maker for the 20 years of the patent, but when it expires the technology will be free. Or perhaps its not a problem if the $300k/yr drug cost is actually cheaper than all the other treatments the patients are currently receiving. Or if you think that the mad profit that the pharma company is making inspire them to find cures to other diseases.
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It is possible that we can all be educated about what really goes into the health care costs, and buy insurance accordingly. If an individual places a priority on being kept alive with the most aggressive treatments when they have cancer at at 80, they can pay more than someone who is happy to receive palliative care and die with dignity.
A parallel issue is retirement. In the 50's through the 80's everyone was promised a pension. The amount of the pension was set by a panel of experts who were subject to various political pressures. Because of the lack of personal accountability in the decision making, some incredibly bad decisions were made. For example, Detroit promising to let its fire fighters retire at age 45. Meanwhile life expectancy ballooned and they fudged their contribution numbers. Why would a Detroit politician in 1975 bother to push back on pension demands they don't know can be paid for in 2015? Their incentive was to get re-elected in November, not avoid disaster decades after they have left office. American city, state, and federal pension funds are underfunded cumulatively in the trillions because of this dynamic.
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> Lower savings rate, and buying instead of saving
> Increased borrowing, because of cheap interest, for buying things
> Increased pressure on stocks to perform extremely well, since that's now the new savings account
This is all compounded by the fact that pensions have slowly gone sway to be replaced by 401K accounts, which again puts pressure on companies to get more profits.
As Pogo observed, "Yep, son, we have met the enemy, and he is us."
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-> I am inclined to believe its capitalism at its finest, though would listen to an argument that it was craven greed on the part of the drug companies.
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They spent $150M !!! That could have all gone into nothingness; it was a huge gamble; there are plenty of drugs that were promising and effective, but failed miserably during trials or even afterwards. COX-2 comes to mind.
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It becomes a fixed cost no matter who pays for it, so why not use as much as we can. That's why there is a copay with insurance. To take a bite that should make most people think about how much health care costs.
Free medical help usually comes with a long line, because the wait is the cost (time is money).
Insurance companies have a vested interest in making as many drugs as possible non-percription. Drug makers have an incentive to develop new drugs because of the money they will make. Doctors get a kick back for perscribing the new drugs, which I think is wrong.
Yes in a perfect world medical care is free. But then again so is housing and food. The world isen't perfect, so we have to make of it the best that we can. And free, or apperently free isen't realistic. It increases demand, while decreasing supply. Basic economics.
What comes after the food police? Maybe the clothing police? Don't buy from China, Russia, etc. When the goverment does this it becomes a problem. If in a privite contract with an insurance company, you agree, then it's ok (never mind that your employer pays for half or more of this insurance).
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It can theoretically force specialists to make less.
It can theoretically force hospitals to become more efficient, since they will no longer be able to up their charges to cover slack in usage, i.e., the hospital has lots of fixed costs that are amortized over all of the patients treated, so if there are fewer patients, they will charge those patients more. This would be no different than factories that are underutilized and need to make changes to up the utilization rate.
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At one time I wondered why companies would change from in-sourcing to out-sourcing, and back to in-sourcing, and the truth is to shake out the dead wood. But when does goverment do this? Never, just look at the post office. Yes parasites happen at every level. but when you cap doctors ability to make money, you also cap the number of people who want to become doctors.
One issue is abortion, and I am not interested in the morality at this point, but if I have to pay for, or subsidize it then I become an enablier of irresponcable behavior, sort of like the food police above. We have done nothing but exchanged one type of bad behavior for another. How is that reducing medical costs? Where are the sex police?
In that 11% vs 17-18%, have you factored in the wait times, and the number of people suffering, or dead? Or the number of people that go else where and pay out of there own pocket?
To make medical costs lower, there should be a provision to pay for medical costs performed in other countries, and there isen't. Why?
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If you're not interested in the morality, why did you make that the whole point of your paragraph?
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% of Responses stating they could see a doctor the same/next day – Canada 41% (worst amongst OECD), US 43% (second worst), Germany 74% (best) (source)
Wait time for emergency case was 2 hours or more – Canada 48% (worst, 11th), US 28% (7th), UK 16% (2nd best) New Zealand 14% (best) (source)
% of people that did not get adequate care due to costs (fill prescription, visit doctor, get test, etc.) – US 37% (worst), Netherlands 22% (2nd worst), Canada 13%, UK 4% (best) (Source)
Number of annual deaths due to lack of insurance in the US – (2005 estimate, working age only) 44,789 (estimate according to this 2009 Harvard study)
2011 Health Expenditures/Capita – US $8,508 (worst, 11th), Canada $4,522 (6th), UK $3,405 (2nd) New Zealand $3,182 (best) (Source)
To claim that the solution to the current US healthcare issues is to move further away from what works in other countries (universal/socialized healthcare) flies in the face of facts and reason. Moving to a “free-market” healthcare system certainly does not address, and likely will make worse, the most crucial issue in the US medical system, equity. And if you don’t care about the fact that millions of disenfranchised people don’t have proper access to healthcare (and tens of thousands die as a result of that) in the “richest and most powerful” country in the world, well, that’s just sad (to put it as lightly as I can).
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I'm not a high consumer of healthcare either but based on my limited experience I've got to say considering how much more I seem to spend in the US, I don't get more for it - maybe less.
It's harder to find a primary care doctor here in the US, and a lot more time consuming to actually get to see them e.g. waiting several days or weeks to see 'your' primary care physician.
When I get to the office waiting for my scheduled appt, waiting times in the US are generally comparable to or maybe worse than in the UK. They game the system by having the nurse weigh you and stick you in an exam room fairly promptly (though I've been stuck waiting for this for a long time before now) but then you get stuck waiting in that room for 30+ minutes for the actual doctor to come see you.
When I have needed a non emergency X ray the service in the US was quicker - within the hour after being told I needed it V waiting a week or two for an appointment. However, I had to spend infinitely longer filling out extra paperwork each time (i.e. none in the UK, reams of it in the US).
My perception is that if you have the right insurance (and/or money) and live in a location with good clinics/hospitals etc. then you do get slightly better overall quality of care in the US. However, the value is not as good.
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Sex education is only valuable if morality is also tought. The (many) public schools don't teach morality, and some how believe free condoms is a subistute.
So is bad behavor of one type better than bad behavor of another? That's what I am hearing.
So if I have to pay for your medical care if you over eat, why is that a concern, when some one else is doing something risky, and you don't seem to care?
And if medical care is intended to be equal, why can't I have the presedent's plan? It's better than mine, and much better than what the homeless people's plan.
However it's not being offered under the Obama care options.
And if care is to be equal, how exactly do you intend to move doctors to where they don't want to live?
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Given all your complaining about the current system, why to you wish to continue what clearly isn't working for you?
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As to your direct concerns:
1) Wait times for essential procedures and emergency care are quite modest here unless you live in a remote location. Most of the people waiting 2hrs or more for "emergency care" here aren't in need of emergency care- they are taking advantage of the free access to the emergency room we get here 24/7, either deliberately or as a precaution (for a sick child etc.). They're having their needs triaged against those of others who truly do need emergency care. When someone dies in an emergency room here because they were inappropriately triaged, it is a HUGE deal and national news- it happened to a First Nations man in Winnipeg recently and there was a hue and cry from sea to sea about it. Deaths while waiting for care here are truly rare.
2) Virtually nobody pays out of pocket for anything other than procedures or services that are not covered, or non-emergency, or are elective. Yes there are "medical tourists" here, most of them getting hip or knee replacements where wait times are still a problem, or precautionary MRIs etc.. There are plenty of medical tourists from the US too, going to hospitals in eastern Europe or India etc.
3) Yes, someone here who needs a hip or knee replacement and is on a wait list, or who is worried about a condition they won't know about until an MRI can be scheduled, is suffering. But so too is anyone in the US who is out of a job and lets their medical insurance lapse because they can't afford the premiums- and then discovers that their wife has cancer, and can't get insurance now for any money because it's a "pre-existing condition"...that NEVER happens here. No employer here has to make a decision between healthcare coverage for their employees or hiring new staff, and nobody has to worry about whether or not their job offers coverage- the essentials that you cannot live without are provided as a right of citizenship (in fact, even as a right of permanent residency). The one exception is basic dental care.
4) The proof of the comparative number of parasites is in the COST NUMBERS, not in your ideology. Your private/public mess costs you far more of your GDP than our purely public system does- and in other countries they do it even cheaper still. Your system costs more- very substantially more. It costs you more by a proportion of your GDP which is much greater than the ENTIRE cost of your "national defense". So you, and most Americans, need to give your heads a shake on that one, because your ideology is leading you to a conclusion which is demonstrably FALSE.
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Typical clients are uber-wealthy folk from the middle east and South America
It is a dirty-little not-so secret that many hospitals, etc do this to subsidize their costs.
Domestic clients can't do this.
So, were the USA to adopt a Canada-like system completely, there will ALWAYS be a pay-for-use outlet SOMEWHERE for the wealthy to jump the queues or cherry-pick a superior doctor. It just may not be in your own country.
Meanwhile, the system will likely get better for most, in particular the lower income folk.
The only losers would be the accountants and lawyers charging 'rent' per Adam Smith on a process to which they add no real value.
RE: Health Insurance
Americans have a two-tiered education system. Public schools are funded via taxes and paid for by everyone to pays taxes. The system does not care if you have kids or not, you pay for it.
However, there exists a private school system for those that want to send their kids there. They pay for using this system. But they still fund the public system too. Please leave out the 'voucher debate' on this as it is a red herring to the discussion.
Generally, the private school system is high quality. It HAS to be, or they would have no customers.
The quality of the public system is mixed. In areas where voter apathy permits it, the system can be poor. In other areas, voter concern has created a decent system. There are large portions of the country where private schools have little traction because the public system is good enough that there is no market for the privates.
So, by offering a good easy-to-understand universal health care system without the hype, hysteria, and outright disinformation to everyone, you would create an incentive (via voter attention) for politicians to support it (or perish in the NEXT election). The wealthy will always have a Plan B.
The same thing happened here in Canada back in the day when Universal Health Care was created. Conservatives initially opposed it, Pundits slammed it and lied about it, but they went away once the results were clear.
RE: Health Insurance
RE: Health Insurance
The bigest problem with the VA issue is that any of these people could have gone around the VA and paid for the treatment themselves. They choose not to do that because the VA was free to them.
A dual system will ensure public hospitals keep up with standards, as they do have a competetor.
The problem here is any hospital, public, or privite, must take all patents no matter there ability to pay. But doctors don't, so if you don't have any money, you wait until it is an emergency to see the hospital for there basic needs.
So the emergency rooms are full of not so urgent people.
And the mandate states we must all pay for abortion and berth control, which I believe should be optional. The cost have been incerased, because of things we don't really need, due to goverment requirments.
Does Canada provide free abortions, and burth control? Tuba lessons for cruked teeth? Message theropy? etc. That's what passes for medical insurance costs here.
RE: Health Insurance
so , it is now proven that mechanical engs can spell better than electrical engs. Lets take that question off the list.
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
In my lifetime, medical researchers are going to achieve immortality, at a price.
A very expensive price.
So ... immortality for everyone? Who pays for that? Everyone else?
It's not argument-ad-absurdum when we're well on our way to having exactly that.
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RE: Health Insurance
And both you guys need to get over this idea that you can fix the problem by changing who shares the cost. "Single Payer" is just everyone buys Blue Cross Blue Shield, or everyone pays extra taxes and gets Medicare. It does not solve the problem. The problem is cost. See my numerous posts above.
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RE: Health Insurance
Who gets rationed, in there perspective? The poor, or the hard to justify?
If you can't pay doctors enough to attrect more into the profession, then those are the choices around single payer.
It's not all bad or all good, it's just not perfect.
RE: Health Insurance
Another fine example of how the “free market” sounds like a wonderful solution to your health care problems…let’s give these corporations MORE power and LESS regulations! That will solve the problem! I mean, thank goodness you didn’t get some commie-universal healthcare system, then your rates would have been…ahhh….well I don’t know but it would have been bad!
This implies that “public” hospitals (i.e. all hospitals in a universal health care system) offer poor quality care compared to private hospitals. That is false as demonstrated by the rank of quality of care in countries with universal healthcare.
This problem is NOT solved in a “free-market” system (and likely exacerbated) and is inherently solved in a universal healthcare system because going to the doctor is just as free as going to the hospital. This is one reason why costs are lower in universal healthcare systems – preventative and routine care are free and easily accessible, thus reducing the amount of emergencies required.
And where do these costs come from? All universal healthcare systems COST LESS PER CAPTIA than the US system. A sampling of the problem with costs in the US system, all of which are inherently solved by a universal healthcare system, are the following:
- Preventative and Routine care cost too much for the uninsured or underinsured, so they don’t do it. Then little (and inexpensive) problems, become big (and expensive) problems.
- Hospitals, insurance companies, etc. get to run as for-profit organizations. Their objective is to increase profits, pure and simple. If low cost, quality care is a by-product of that, great, but it doesn’t have to be and usually isn’t in the real world. In other words, they will keep costs as high as they can possibly get away with. (Even if there is some “fair” trade-off between quality care and inexpensive care, then are you suggesting that poor people should get bad care because that’s all they can afford?) Every step along the way is trying to skim profits off the customer and this will increase costs.
- A for-profit system has a negative incentive to promote healthy life-styles. They benefit off sick people. However, insurance companies lose profits on sick people and are therefore encouraged to deny coverage to unhealthy people (and they do whenever possible…the ACA tries to combat this slightly though). So when you have one half of the system that profits off sick people (hospitals) and the other half that wants to deny coverage to sick people (insurance companies), you get this messy inequitable, costly system. Whereas a non-profit system is intrinsically benefited by a healthy population.
- Because you have to deal with insurance companies, there is a lot of time spent dealing with paper work and disputes related to coverage which adds unnecessary overhead. Much of the doctors time is spent dealing with this paper work or themselves fighting the insurance companies so that patients can get needed medication/treatment blocked by coverage restrictions. Furthermore, the insurance company itself is an added cost to the system.
- Lawsuits due to malpractice are a huge issue in the US. It takes a lot of money to protect yourself against them, fight them when they arise and payout if you are found guilty. Like with any for-profit organization, this cost and risk is eventually passed onto the customer through higher rates.
None of these issues are solved by going to a “free-market”, insurance based system. If anything, they put more emphasis on the for-profit model and less control over providing proper care. All of these are solved by going to a universal, non-insurance based system. This is the reason why the real-life numbers demonstrate that universal healthcare systems are, across the board, less expensive than non-universal healthcare systems. So if cost is your only concern, then I think we have our winner.And this doesn’t even begin to touch on the issue of an equitable system, which is apparently a non-issue to “free-market” enthusiasts….
RE: Health Insurance
Sorry, but if you're going to condemn the ACA for not being what it could have been, just keep in mind that there were a lot more actors in this play than just the President and his people.
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RE: Health Insurance
RE: Health Insurance
Congress is SUPPOSED to draft the bills/laws
The Executive is SUPPOSED to bless or reject it.
Obama does NOT write the dang laws.
He also did not cause the BP oil spill or Hurricane Sandy.
Stop blaming him for these things.
RE: Health Insurance
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
Perhaps you read too many Newsweek articles or listened to too many FauxNews reports, but the facts were quite different. For example, here an excerpt from the linked item below:
"Almost no one is noting the extraordinary influence Republicans had on the healthcare reform bill crafted by the Senate, as it made its way through the committee process last year. The bill approved by Sen. Christopher Dodd’s Health, Education, Labor and Pensions committee, for instance, included 161 amendments authored by Republicans. Only 49 Republican amendments were rejected out of 210 considered. Yet the bill got zero Republican votes when it passed out of the committee."
And then there was this final recap:
"To recap: Senate Democrats have accepted at least 161 Republican amendments to their healthcare reform legislation, they’ve incorporated core GOP planks, and they’ve scuttled an aspect of the plan most popular with its base, the public option, because of opposition by Republicans as well as red state Democrats.
But they haven’t compromised with Republicans? It seems as though the GOP’s definition of compromise and collaboration involves the president and the Democrats dropping all of their ideas and passing the Republican platform. That’s OK; it’s their job to push their party line. But too much of the media seems to be falling for it."
For the complete article, go to:
http://www.salon.com/2010/02/23/hcr_amendments/
And here's another item that talks about the influence that the Heritage Foundation and previous Republican proposals had on the ACA:
http://www.politifact.com/punditfact/statements/20...
John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:
To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
I'm not going to type all the same crap all over again. Please re-read the posts made at the following dates/times in this thread by me. Bolded dates are posts that specifically discuss the source of our higher cost per capita, while non-bolded dates are posts that discuss how changing the methodology of cost sharing doesn't affect the problem.
21 Sep 14 20:47
23 Sep 14 7:36
23 Sep 14 15:30
25 Sep 14 15:37
8 Oct 14 11:39
17 Oct 14 15:39
19 Oct 14 17:19
21 Oct 14 12:57
21 Oct 14 16:07
21 Oct 14 21:21
28 Oct 14 11:17
30 Oct 14 15:04
Much more in the referenced posts. Quoting everything would have been burdensome.
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RE: Health Insurance
The issue is that many in congress and the president don't want to fix the system, as it provides a system of control over the people. That's the issue. The food police is just more of that control of it.
Now that the "operation strangle hold" has been open it is even deeper that most of us thought. Gun police, porn police, payday loans police, and what's next?
The medical issues in the US is nothing more that control of the people, and that's why costs are going up. You don't pay enough in taxes is the issue.
RE: Health Insurance
I fail to see how any of that supports a “free-market” system or provides a rational argument against a universal healthcare system.
Your first example (the ear ache) deals with Mexico, which has universal healthcare. Your second example (sprained knee) deals with Denmark, which has universal healthcare. You seem to be arguing that universal healthcare would be the better option, I don’t disagree.
Your third quote assumes that in a “shared pool” we have no incentive to keep costs down, so costs will be high. This is typical libertarian ideology and, equally typical, is not supported by the data. Universal healthcare is the epitome of a shared pool and yet, in the real world, the costs of operation are very low. Much lower than the US’s mixed system.
Furthermore, I have provided examples as to why the insurance aspect of the US system is where the majority of the increases in cost come from. In a universal healthcare system, these issues disappear as there are no private insurance companies to deal with. I don’t see anything that suggests otherwise from you.
A “free-market” system either has private insurance companies, and then is left with many of the existing issues plaguing the US system, or it doesn’t have private insurance companies (everyone pays out-of-pocket), and then the issues of inequity and lack of available healthcare for the poor become much worse. Correct me if I’m wrong but I don’t see a third option. The third option would be public “insurance” companies (i.e. the government) but that would defeat the purpose of a “free-market” system.
Your fourth quote seems to suggest that universal healthcare is simply everyone buying into Medicare. That’s a false assumption. You also state that the “payer is not the only difference between England and the USA”. That is a correct assumption. The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything. In true universal healthcare systems, the people don’t need to deal with insurance or “healthcare plans” for basic healthcare needs (and “basic healthcare needs” depends on the country but usually covers everything expect cosmetic surgery, dental, glasses, some physio, etc.). As a resident you get a healthcare card which you present when receiving “basic healthcare”. No plans that you have to update. No need to be screened for “pre-existing conditions”. Simply, resident = healthcare card = free basic healthcare. So the universal healthcare I, and others, are advocating for is more than simply forcing people to buy into Medicare. You need to get rid of the whole concept of applying for and acquiring insurance to receive basic healthcare. Your residency should entitle (yes, that dirty word for our libertarian friends) you to free basic healthcare. Just as you residency entitles you to other basic human rights.
RE: Health Insurance
Start by identifying the problem you're trying to solve. That's what we engineers do. First identify the problem.
Is the problem "lack of coverage?" Or is the problem "cost?"
If we identify "cost" as the problem, then examining cases of unnecessary cost in our system, as compared to all the other systems in the world, should be of paramount importance. If, upon examination, it becomes clear that the "publicness" or "privateness" of the cost sharing pool would not have affected the cost, then we rational engineers must turn our attentions to aspects other than "publicness/privateness" to find our solution.
You appear to be trying to claim that the "privateness" of our cost sharing pool is the source of our higher cost. This argument doesn't hold water, because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients. This is because when a medicare recipient strains their knee playing soccer, they go through the same highly expensive song and dance that a private insurance recipient goes through. The problem is not how the cost is shared. The problem is the song and dance itself. And we have all the evidence in the world that putting everyone on Medicare instead of private insurance would still mean the same song and dance, which means the same cost.
We already have vast, extensive test cases for "single payer" (Medicare) and for "single provider" (the VA) here in the US. We already know how they work here, within the rest of the system. Single payer does not make things cheaper. Single provider does, but at the cost of letting people die while they wait for treatment. Those facts are plain as day. Spending all day arguing about public vs private cost sharing is like trying to fix a broken car by repainting it over and over, and swapping out the hubcaps.
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RE: Health Insurance
That's not a valid comparison, since Medicare does not provide the health care itself; that care is still provided by the same people who provide the care to other insurance recipients. It's not a true single-payer system, since Medicare doesn't have sufficient clout to force costs down. In fact, there are lots of doctors that refuse Medicare and Medicaid because the reimbursements are too low. In a true single-payer system, Medicare would be the only game in town; to refuse their patients would then be tantamount to choosing another profession.
A more valid comparison would be the VA system, which administers both cost and providers: http://www.rand.org/blog/2012/08/socialized-or-not... Nevertheless, one should be cognizant of the fact that the VA's patients have an inherently different mix ailments compared to the general population.
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RE: Health Insurance
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RE: Health Insurance
Because their costs would pretty much double.
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RE: Health Insurance
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RE: Health Insurance
...is pretty much my point. It is the only valid comparison, since it is the only attempt on the planet to produce a single payer version of our system. Single payer in the USA is simply "everybody gets Medicare," in which case all our taxes go up to cover it, and the cost per capita doesn't really change. That's because the cost problem is not the payer, the cost problem is the system. If we could somehow wipe our system out and drop in Denmark's system in its place, with Denmark's doctors, Denmark's nurses, Denmark's lawyers, Denmark's tort law, Denmark's version of their AMA, and Denmark's citizens (which are healthier than ours) then single payer would work great with it. The reason why isn't the payer, it's because my primary care doctor would be sending me home with a bottle of advil and an ace bandage instead of sending me off to see a specialist before getting a needless MRI, seeing the specialist again, and going home with a prescription for something that's not fundamentally better than Advil and a brace that's not fundamentally better than an ace bandage.
Do you see?
The payer is not the problem. The system is a feedback loop of cost pressures.
In order to fix the thing, we need a way to prevent doctors from prescribing needless medicine. In Denmark, the doctors do that on their own because they're Danish and that's what the Danes do. In the USA, our doctors are like McDonalds front line clerks, asking "Would you like to upsize for an MRI and a large coke?" ..and they justify that by a blend of extreme hippocratic oath-taking and liability avoidance. Look no further than surgery rates. Can't remember whether this was linked above or not, but check out the abstract:
http://www.ncbi.nlm.nih.gov/pubmed/8073310
For back surgeries, the US had at least 40% higher rate per capita than anywhere else in the world. That's a cost. It gets shared. If the same stands for all other types of surgeries, then our per capita health cost rate is pretty easy to explain, and it has very little to do with whether the sharing pool is funded with taxes or earnings.
These are the sorts of things that engineers, focused on the actual problem, should be looking at when they struggle with fixing the health care problem here.
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RE: Health Insurance
No, it's not. 44 million people were covered by Medicare in 2010, which is only 17.3% of the total number of people covered by any sort of insurance. That's not enough of a market share to drive prices as low as they could go. Medicare costs are still climbing at about the same rate as the general insurance population. But, because of the low market share, this does not prove that a single-payer system in the US wouldn't work. That's not to say that there aren't other issues, but to continually bash doctors isn't exactly the answer. They respond to market forces; if a patient demands a certain drug or treatment and is refused, the doctor is likely to be complained against, which, while less than a malpractice suit, is still a nuisance, time consuming, and affects their standing relative to insurance payers.
A more valid comparison might be Walmart. They do have sufficient market share against their suppliers and are able to demand pretty much any sort of price control they want. The suppliers either find a way to make cost cuts, or basically go out of business. So we know that in the full-blown free-market, a single payer can and does command whatever price it wants.
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RE: Health Insurance
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RE: Health Insurance
In a universal healthcare system, where there are private or public non-profit hospital and a single public payer, this same profit-driven model inherently does not exist. Rather than profits, the right care for the right cost is paramount. This is why, in the real world, the cost of universal healthcare is much lower and the people are healthier.
Beyond that, the very existence of insurance companies and healthcare plans for basic healthcare is an unnecessary expense that does not exist in universal healthcare systems. As I just explained:
My response to you at 4 Dec 14 16:05 listed numerous reasons why insurance companies are culpable in US healthcare costs being the highest in the developed world. You (in your 23 Sep 14 9:32 post) state that your “perfect system” would be to have emergency services “handled on a single government payer model” but seem to imply that insurance would handle non-emergency care (correct me if I’m wrong). Would routine checkups be on insurance? What about treatment for chronic, non-emergency ailments? What about cancer treatments? You still have insurance companies involved in a very large portion of healthcare system and so the issues remain, specifically with the added costs of making preventative care inaccessible to many such that small things become large healthcare problems. The inaccessibility (due to cost/lack of coverage) of preventative care is a major reason why the US system is the worst in the developed world.
This leads into your asinine question - is the problem “lack of coverage” OR “costs”? As an engineer, if a design is BOTH unsafe and expensive, I don’t choose to fix one and ignore the other. There is no OR, BOTH are serious problems with the US healthcare system, as supported by the research. And, as supported by the research, BOTH appear to be much less of a problem in universal healthcare. No evidence has been brought forth to support a “free-market” system solving EITHER - most certainly not the former and, if you keep insurance companies as a middleman in everything, likely not the latter. So as an engineer, if I have one alternative that solves both problems and a second that MIGHT solve one problem but likely makes the other problem worse, I’d go with the first alternative. But that’s just me.
Regarding “single payer”/”single provider”, again you miss the point. Almost all other universal healthcare systems are not “single provider”, they allow private non-profit hospitals which bill the government (as long as they meet certain standards) and people are free to choose which doctor and which hospital they visit (which is actually untrue in an insurance based system). And as previously discussed (at least twice now), universal healthcare is NOT simply everyone buying into Medicare insurance as true universal healthcare is NOT an insurance based system when it comes to basic healthcare needs.
RE: Health Insurance
Agreed! All of which is solved by going to a universal healthcare system (note: most universal healthcare systems came with laws that limit the liability of doctors). None of which is solved by a “free-market” system.
Beej67, 95% of your posts are explaining the issues with the US system, that exist only because there isn’t universal healthcare, and why these issues don’t exist in countries with universal healthcare. The remaining 5% is concluding that the US shouldn’t adopt universal healthcare and should adopt a “free-market” system that doesn’t address any of the issues with the current US system (and likely makes them worse).
RE: Health Insurance
This is a talking point that the single-payer crowd loves to repeat, but the numbers simply don't back this up. Lets look at this graph again, which summarizes the problem:
We pay double what we should be paying per capita. If the profits were the problem, then 50% of the gross revenue in healthcare in this country would go towards profit. It does not. Most health insurance companies report profit margins at or below 5%:
http://abcnews.go.com/Business/health-insurance-pr...
If you switched everyone in our system to non-profit, you get a 5% savings, not a 50% savings.
It's not the profit that's the problem. It's the revenue that's the problem. The problem is over-use of the system. The problem, again, is this:
Now, on to the meat of the issue..
Please explain to me how switching from multi-payer to single-payer eliminates over-use of the system. "Single payer" is just "everyone gets Medicare." That's all it is. Explain to me how "everyone gets Medicare" eliminates over-use of the system. People on Medicare currently use the heck out of the system, at the recommendation of doctors, who are steered by their "at-all-costs" hippocratic oath and their desire to avoid lawsuit. How does "everyone gets Medicare" fix that, and why is that fix unique to the "everyone gets Medicare" solution?
In what seems like a thousand posts, you have failed to make that connection clear.
Please consider, when crafting your response, how Medicare in the United States is beholden to medical lobbyists trying to shoehorn every proprietary medicine into blanket coverage, to make their company more money. Also consider how modern medicare doctors actually over-prescribe procedures and tests on the presumption that they'll get paid enough on some of them to make their ends meet.
Changing the payer doesn't fix this. Hell, insurance companies have every incentive in the world to fight this, and do their very best to do so, and can barely keep it under control. And every attempt they make to keep this trend under control gets attacked from the AMA, because the insurance company is "interfering with the doctor's judgment." How would Medicare-for-everyone fix this, without interfering even more with the doctor's judgment?
That's the question. That's the thing that needs to get fixed. In the old days when we were paying cash, we customers opted out of the pointless MRI. Now that we're sharing costs, we customers are opting in for extra pointless MRIs. Fix that. Show me how "everyone gets Medicare" fixes that.
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RE: Health Insurance
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To an Engineer, the glass is twice as big as it needs to be.
RE: Health Insurance
One important reason that single payor systems are cheaper is that the entire profit motive is eliminated from the system. That's a hell of a lot more than 5% of the cost!
The other important reason is that single payor is more efficient, i.e. it costs less in administration cost to deliver services of the same value in terms of outcome. As I've noted before, I have friends who own a mobile medical imaging business- and 30% of their employees are associated merely with the process of BILLING for their services. That entire infrastructure is GONE from our single payor system.
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
Profit margins are mythical, just like the movies that gross $1B with a cost of $250M, and claim no profit exists. Moreover, profit is made through the additional and unnecessary procedures that you pointed out. For-profit company executives are not graded on just profit margin, but increased absolute profit, which requires increased absolute revenue. This is what their bonuses are based upon.
The graph shows that our health system's performance is quite pathetic, so I'm not sure why anyone would even imagine that the current system can be "fixed." It looks like we're actually spending more than 3x what we should be spending to get the results that we have. Given that the government insurance plans cover less than 1/5th of the US population, with the remainder being either covered with private insurance or none at all, what possible reason is there for maintaining that the current system is even plausible?
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RE: Health Insurance
After all who ever thought you could cure anything by sticking needles in your back?
The failure is the education system more than anything. Those costs keep going up, and I don't hear any commonalities with that.
RE: Health Insurance
Lack of hospitals & medical facilities I'm skeptical of being a national issue but don't have data to hand.
As regard cost of education, commonalities with what?
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
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RE: Health Insurance
If one of us refuses to acknowledge hard evidence, then yes, there is indeed no point in talking about this, or anything, further. The only way to reach logical consensus is to start with an agreement about the data, and then apply logic to that data. That goes for any discussion, of anything.
The data is out in the open. Google it. Insurance companies profit margins are around 5%, and have stayed that way, for a very long time. Insurance of all kinds is not a high margin business. They set their expectations of costs in a shared pool based on risk projections and apply a small markup. That's how insurance works. That's why it's as hard to become an actuary as it is to become an engineer. Very smart people project that risk, apply the small markup, and the insurance company moves on. That's the business model.
I don't even know what to say. Do you work? Are you, in fact, an engineer, that works for an engineering firm, that does engineering, for, you know, profit? Are your firm's profits "mythical?" Can you let me know who you work for, so I don't apply for a job there?
Noooo. Insurance is the very opposite of what you describe. If Insurance was raking a percentage of claims paid, then you'd be correct, but that's not at all what insurance is. Insurance gets paid up front, in premiums, and then strives to maximize profit by paying as few claims as possible. Every claim paid is lost profit. They have more incentive than anyone to not pay claims. In fact, my biggest gripe about insurance in general is that they are so stingy with paying claims.
That's what I'm getting at. Especially with such a ridiculously simple solution as "keep everything the same and bill Medicare," which is exactly what "single payer" is. If "single payer" alone would fix this, then doctors who worked purely off Medicare would be offering services at a third of the rates that private doctors are.
There's none. There's also no possible reason to think that shifting the population entirely to the payment method already used by 20% of us would reduce costs by a factor of 3. The source of the money is a red herring. To fix it, we need to look at the actual problem.
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RE: Health Insurance
The product is not the doctor, the product is the procedure. If the number, frequency, and cost of procedures per capita had stayed the same since the 1970s, you'd be correct.
It has not.
The number, frequency, and cost of procedures per capita in the US has skyrocketed, while the number of doctors per capita has stayed the same. That's the very core of the problem. Again, if you want to compare the US and UK, take a look at the relative number of procedures per capita. Data for back surgeries is posted above. I feel confident saying data for other surgeries is probably similar.
Just like my MRI example, when I go to a doctor in England for back pain, he sends me home with a hot pack, some advil, and instructions on how to do dead lifts. When I go to a doctor in the US for back pain, he jumps straight to the knife. Fix that somehow. Switching to "everyone gets Medicare" doesn't fix that.
To be absolutely clear, if the government offered a "everyone gets medicare" program that was optional, and paid for with taxes, and verified to be revenue neutral, and then they absolved individuals and businesses of all these unconstitutional insurance mandates, then I'd love it. I sure as heck wouldn't use it, but I'd love it. It would make businesses more lean, and remove one of the barriers to startups. But don't kid yourself that it would make a hill of beans difference in cost per capita. And cost per capita is the actual problem.
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RE: Health Insurance
Profit calculations are also very easily manipulated. As an example, apparently the Tolkien family were presented with statements which made out that the Lord of the Rings films, with a combined take of over a billion dollars, didn't actually make any money...There's a whole sub-class of parasites whose job it is to make companies appear to be poor- on paper- to the right people, generally the tax man.
The 30% of my friends' business spent to seek payment by their ~ 2,000 payors is a very real cost to your system that doesn't exist in a single payor system. And then on the side of the 2,000 payors, you have a similar infrastructure for processing those forms and paying those billings, or hopefully denying the payment of as many of them as possible. Then there's the legal costs associated with the arguments between people and their insurers, the costs to businesses in paying the insurers themselves, the cost on the part of all parties to lobby government etc....all those costs are added to your system BEFORE profit is taken. All are absent from our system.
The data that matters are there in front of your face: the costs of the Canadian system and your system are both there. The outcomes are similar. The difference is absolutely undeniably a result of two things: reduced costs to the single payor system as a result of the elimination of duplication and improvement in efficiency resulting from an elimination of the profit motive, and a complete elimination of profit. If there is a rationing of services that results in further savings, it is a rationing that doesn't result in a measurable decline in outcomes. And Canada isn't brought forward as a paragon of efficiency- merely as the closest possible comparison to your own system.
I'd argue that you're coming at this not from a data-based approach but from an ideological one, that makes you deny the logical explanation because it doesn't fit your world view. You can argue the same for me, but I have the data on my side on this one. And my point of view is simply this: government can be more efficient at delivering services we need rather than merely want. Goods and services we can choose to consume, or not? The private sector and the (regulated) free market are much better at providing those sorts of things.
RE: Health Insurance
That does not take in to account a few factors that unique to the US. Obesity rates are higher in the US. Being overweight is a significant factor in accelerating and exacerbating back injuries and pain. Another reason for high rates of back surgery in the US is the financial incentive it grants in a law suit. It is considered proof of an injury and can lead to higher financial rewards in accident and workplace injury cases. It is also likely to grant disability status to those looking for workman's comp claims.
RE: Health Insurance
The reported profits mythical. How else do companies like GE get away with paying little or no taxes? There are gigantic tax law loopholes for companies and 1-percenters to shield hide the true profits. There are lots of "expenses" that would have been profits, if not for loopholes. How is it that executives get large salaries and bonuses, if only to generate 5% profit? Aren't their bonuses actually profits? It's why actors with sway get percentage of gross, rather than percentage of profit, since there's almost never any film profits to report, and part of the reason is that the true profits are already skimmed off, so the reported profits are either nil or negative. And yet, the studios don't go bankrupt, mostly.
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RE: Health Insurance
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RE: Health Insurance
RE: Health Insurance
No, Moltenmetal. That's simply not true. Canadian doctors recommend fewer and less expensive procedures. That is the lions share of the difference. Medicare is a non-profit payer. Medicare doesn't spend kabillions of dollars on skyscrapers and on fancy accounting. If what you're saying was true, and the difference between our per-capita cost and the rest of the world's per-capita cost was the profit motive of the payer, then Medicare would be 3 times cheaper than insurance, and doctors working off of Medicare only patients would be able to provide healthcare three times cheaper.
That's. Just. Not. True.
It's a Blue talking point. It's not true. The source of the cost difference is not the payer. The source of the cost difference is that people in the USA are ten times more likely to have back surgery than most of the rest of the first world, and changing the source of the cost sharing pool doesn't fix that problem. The same sorts of trends apply to all surgeries. Don't get me started on C-Sections. In the USA, surgery is the preferred baby delivery method. Nowhere else in the world. And delivering a baby via surgery costs four or five times as much. How does switching to "everybody-gets-Medicare" fix that?
Australia is as obese as we are, yet their medical costs are much lower per capita, as are their rates of back surgery. Americans are fat, and some kind of anti-fat program would do the country some good, but you can't blame our triple-per-capita rates entirely on fatness.
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RE: Health Insurance
Focusing on, or ignoring any single significant aspect leads to misleading conclusions.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
True but, no other legal system in the world incentivizes back surgery like ours does. I am not saying that these surgeries are necessary. They clearly aren't. What I am trying to say is that the legal system rewards and incentivizes unnecessary back procedures by awarding significantly larger verdicts to plaintiffs who undergo them. My point is that if you want to talk about the US medical system as a whole you need to choose a procedure that is not influenced significantly by other factors.
RE: Health Insurance
Medicare limits lots of things, so C-sections would become an elective, non-reimbursable, operation, unless the life of the mother or baby is threatened. If the parents can afford to pay for the C-section, out of pocket, then everything is simple. This is, of course, unacceptable per Red talking points. So, what is the Red solution for this? How are they going to ration care without calling it rationing?
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RE: Health Insurance
And if medical treatment is less expencive in other countries, why does US insurance carriers refuse to pay for treatment in other countries?
The answer is goverment control. People in the goverment are attempting to choke the medical system to push people into demandig a govermentrun medical system. So stop whining because what ever the outcome the cost will go down afterwards.
Heads they win. Tails we loose.
RE: Health Insurance
RE: Health Insurance
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
The Graph – What’s the difference between the US and other western healthcare systems? The US works under a for-profit, private insurance healthcare system. The others work under a non-profit, universal healthcare system. The US costs are twice as high as the other western healthcare systems. So you wish to move further away from a universal healthcare system and further towards a for-profit, private, unregulated, insurance-based healthcare system. Smart.
Profits are “5%” – What molten said. Also, what IRstuff said. Also, this is the reported profit of insurance companies only. You have to tag on the profit of hospitals and inflated, unregulated rates of “specialists” as well. All of these profit streams are eliminated or minimized in a universal healthcare system. All of these profit streams are less regulated and have less over-sight in a “free-market” system. Furthermore, and to address your point about revenues, salaries are highly inflated in the US versus regulated salaries in universal healthcare systems.
How it works in the US
- The doctor makes much more money than in a regulated, universal healthcare system.
- The hospital has to pay doctors more money, so they charge more money and encourage unnecessary tests and take profit off the top of that.
- The insurance company has to pay the hospital for their services and take a profit off the top of that, so they increase rates or deny coverage. The existence of insurance companies adds another level of paper work and administrative costs. Some reports indicate doctors spend ~25% of their time dealing with insurance paper work, which inherently does not exist in a universal system.
- The people have to pay through the nose for higher rates and fight tooth and nail to be approved for care they paid to be insured for. Many aren’t covered/can’t afford routine and preventative care, so small things develop into big emergencies, increasing the cost of the system.
How it works in universal healthcare- The doctors rates are regulated to the point they still have highly competent doctors (which they do – UK was 1st in quality of care, the US was 5th)
- The hospital pays the doctor a decent wage and they charge a decent rate. No need for unnecessary tests or inflated charges because they are non-profit and regulated closely.
- The government pays the hospital bill and is highly motivated to ensure they keep costs low while provide good quality care (UK was 1st in quality and 40% the cost of the US)
- The people just show their healthcare and receive care. Because it’s free and available, they have primary care doctors which can properly diagnose and treat minor things during routine check-ups without the need for emergency visits. This decreases the cost of the system.
How it works in a “free-market” system- Free-market would have little to no regulation on the rates that doctors charge. Little would change from the current US system.
- Free-market would encourage private, for-profit hospitals. As in a free-market, there would be little regulation over the quality of care and they’d likely cut as many corners on cost as possible. However, being for-profit, they would still attempt to charge as much as possible to maximize profit. Little would change from the current US system and likely less regulation (as per a “free-market”) would decrease the assurance of fair and quality care.
- Private, for-profit insurance companies would still exist in a “free-market” system. They would still skim profits off the top. They would still be encouraged to get around the higher costs from the hospitals by increasing rates or denying coverage. Not much would changed.
- The people would be left with the same broken, expensive system, except now with less regulation and oversight on insurance companies and hospitals. Disenfranchised people would be flat out screwed and receive little to no care outside of emergencies (which would then become an increased burden on the cost of the system). Middle class people would have to be in a constant search and struggle for a lower/better plan (adding more strain and stress). Routine and preventative care would be a luxury and so many would skip it, allowing minor ailments to turn into emergencies. Upper class people would likely be able to find more deluxe care (more of the “supersized” treatments you spoke of) and would be very happy.
So how are rates lower in a non-insurance based, universal healthcare system:- Doctors rates are regulated and lower
- Legal liability of doctors is regulated and lower, so insurance is lower
- Legal liability of doctors is regulated and lower, so overzealous testing is less (however, the quality of care still remains higher than the US)
- Hospitals are non-profit and so don’t need to charge more to skim profit of the top
- Hospitals are non-profit and so they have no incentive to perform unnecessary tests (again, quality of care is higher than the US)
- Private, for-profit insurance companies do not exist for basic healthcare because basic healthcare is free
- The lack of private, for-profit insurance companies means no added overhead/administrative costs, much less paper work for doctors, no increase cost due to profit skimming, less legal battles regarding coverage, etc
- Free basic healthcare means that routine and preventative care is available to all citizens. This means less unnecessary trips to the emergency room and healthier lives.
- Oh ya and everyone gets free basic healthcare. You don’t have 45,000 people die a year in the “richest, most powerful country” because a lack of healthcare coverage. But apparently this mean absolutely nothing to you, as you only want to discuss costs.
That’s why every other modernized western nation has universal healthcare. That’s why every other modernized western nation has cheaper healthcare than the US. That’s why every other modernized western nation has more available, equitable healthcare than the US. That’s why every other modernized western nation laughs at the US when they argue against universal healthcare systems. That’s why every shred of real world evidence supports the benefits of a universal healthcare system.AND FOR THE LAST TIME, UNIVERSAL HEALTHCARE IS NOT SIMPLY SWITCHING EVERYONE TO MEDICARE. You need to scrap the whole insurance based system for basic care. You need to introduce regulations that limit liability of doctors. You need to introduce regulations on the quality and cost of care. You need to shift focus to primary care. That’s what makes universal healthcare successful everywhere else on the planet.
RE: Health Insurance
1) If doctors rates are regulated and lower, then what is their incentive to stay in the healthcare industry...the goodness of their heart? I'm not insinuating that doctors are heartless toward their patients, but just as we have entered the engineering industry for a career, for profit, so to have they.
2) Two words: Tort reform
3) I would rather a doctor be overzealous to figure out what is ailing me, then to be apathetic because he won't actually gain anything from helping me
4) The majority of US hospitals are already non-profit. There are actually more gov't operated hospitals in the US than for-profit hospitals.
5) Even though most US hospitals are already non-profit, again I would rather they be overzealous in finding a correct diagnosis than to be apathetic.
6 and the rest) BASIC HEALTHCARE IS NOT FREE...NO SERVICE IS FREE...PERIOD >>> Who then pays for this "free" health care, why you and me of course.
RE: Health Insurance
RE: Health Insurance
1) Right, that’s why all universal healthcare systems have no good doctors and the quality of care is poor…and then there’s reality. Quality of Care Rank: US – 5th out of 11, UK – 1st. (source)
2) And? Every nation that has universal healthcare went from non-universal to universal. Most of these transitions included limitations on liability. Difficult and impossible are two different things.
3) Right, that’s why all universal healthcare systems have poor quality of care…and then there’s reality (see above). (bonus points for using “apathetic” to describe universal healthcare while arguing for a system that lets millions go uninsured or underinsured for basic healthcare needs and ~45,000 die due to a lack of coverage.)
4) And? Are you saying it could be worse (all for-profit hospitals)? Ok. But that’s not an argument against universal healthcare. Furthermore, a true “free-market” system would have all private, for-profit hospitals. So it WOULD BE worse according to this argument.
5) Right,…never mind….just see 1 and 3 again. (and more bonus points!)
6) Right, that’s why all universal healthcare systems cost so much more than the US system…and then there’s reality. With a good portion of the medical system being paid out-of-pocket by the people (through insurance premiums or directly), the healthcare system still costs Americans much, much more than any other western nation with universal healthcare. Percentage of GDP that goes to healthcare: US – 17.7%, Canada – 11.2%, UK – 9.4%. And the per capita expenditures are even worse for the US (US - $8,508, Canada - $4,522, UK - $3,405). (source)
Ya know, facts and such.
RE: Health Insurance
That works when you are buying a car, where you have no compelling reason to buy now, or buy here. When you are sick or dying, it's a different thing altogether.
When my son is in the ICU for pneumonia, which he was, was I really going to pull him out to go to another, cheaper, hospital, or call a bunch of hospitals and get a lowest bid? Am I really going to try an negotiate a lower price right there for the MRI that he got? Seriously? Even the free-marketers will admit that getting treatment from a doctor is not the same as buying a car.
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RE: Health Insurance
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RE: Health Insurance
Oh I agree. The litigious nature of the US system is one of the biggest difference between our system and other systems, which leads to over medication, and is a huge burden. But A) simply switching to Medicare-For-All doesn't fix that, and B) there's no reason we can't fix that in a multi-payer system.
The how-we-share-costs issue and the litigation-breeds-over-medication issue are separate issues. Either can be changed without changing the other. To date, none of the Blue "single payer" proposals has touched tort. At least as far as I've seen. And tort is one of about ten things we seriously need to overhaul, that pushes us into over-proscribing procedures.
What, like pregnancy? Our C section rate in the US 30%, Belgium's is 15%. The reason why is we put everyone on an epidural, which slows contractions, then put them on pitocin, which causes contractions to be more violent, and then when the baby freaks out we cut it out with a knife. Birth by C section costs three times as much as vaginal delivery.
There's that X3 multiplier showing up again, and not due to a profit factor for the insurance company. They don't want to pay for C sections either.
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RE: Health Insurance
Lets talk GE. How does GE do it? I know quite a bit about how GE does it, because my brother in law is the chief alternative energy reporter for Bloomburg. GE does it by buying themselves tax breaks through carefully placed campaign donations, under the guise of things that Blue voters would support, to sneak them under the radar. Here's an example.
A few years ago, GE lobbied some language into one of the energy policy laws that was supposed to support 'green energy.' The language stated that any alternative energy project that got started that year, could be fully depreciated in that year, instead of along a normal depreciation schedule. Basically, instead of counting as an asset on their books, it was counted as an expense. So that year, if GE made 100 million in profits, they could start work on 100 million dollars worth of solar farms or wind farms or algae fuel laboratories or whatever, and fully depreciate them right then, and have no taxable income.
Neat trick, huh? How'd they get that trick off? They bought Washington.
They bought Washington.
And there, sirs, is one of the biggest difference between the USA and Denmark. You can't just knock off down to Copenhagen and buy yourself a tax break. But lobbyists don't just buy tax breaks. They also buy everything else, such as drug coverage and procedure coverage under Medicare. How on earth could you seriously support going to "Everyone Gets Medicare" as a solution, when the very things Medicare covers are up for sale, in the very same way that evil old GE's tax breaks are?
You cannot even engage the idea of putting all paying under one umbrella until you fix the umbrella. If our government worked as intended, then it might be conceivable. But it does not. It is purely a complex web of graft. Fix that first. I'm open to ideas how.
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RE: Health Insurance
No.
...which means they have more incentive than anyone to insure healthy people. They have every incentive in the world to pay for preventative care that shows an ROI. In many cases, they are flat out prevented from doing so by law. Insurance companies would love to structure coverage by BMI or percent body fat, for instance, but it's illegal. Who made it illegal? Lobbyists.
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RE: Health Insurance
I agree with all this, and this is one of the reasons I would totally support single payer emergency care. If you get in a car wreck, you do not have time to shop for your medical provider. Car wrecks should be like your house burning down, or like getting robbed. Emergency hospital care makes complete sense to cover with taxes. No marketplace can reasonably exist for it.
Colonoscopies, however, should be paid for out of pocket. Here's an interesting article:
http://www.nytimes.com/2013/06/02/health/colonosco...
There's lots of "evil profit seekers!" in that article, and a lot of it's legit, but there are two important things to take away from it:
1) In other countries with single payer systems, the administrators of those single payer systems can decide that colonoscopies really aren't needed if there are other tests that are cheaper. That wouldn't work here, because the AMA would lobby congress to have Medicare pay for the expensive treatment.
2) In other countries with an actual free market (which is NOT what we have here) where the patient is paying with cash, the patient is free to seek the most affordable screening option, which is typically not a colonoscopy or is a colonoscopy in a doctor's office instead of a surgical center. That doesn't work here, because we're going to pass the costs on to our shared pool anyway, so the doctors brew up a more expensive version of the same thing to sell to the shared pool.
We do not have a free market here. We do not have universal healthcare here. We have the worst, most insidious blend possible of the two.
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RE: Health Insurance
I think it is ironic that the "source" you cite is the Commonwealth Fund...whose president is an Obama appointee. Hmm, I guess that means they wouldn't be biased at all in this debate.
I won't disagree that "quality of care" is equal to or better in nations with universal healthcare; however, universal healthcare does not translate to access to healthcare. According to Britain's Dept. of Health, at any given time, there are 900,000 people waiting to be admitted to a NHS hospital and 50,000 canceled operations each year due to shortages. Woo-hoo! Please, put me on the next boat over so I can be on the wait list!
In Sweden, the wait list for heart surgery can be as long as 25 weeks! How many people will die during their wait time? Even the New England Journal of Medicine said in 2008 during the healthcare debate that "health insurance status was largely unrelated to quality of care."
Did you know that the CBO is estimiating that 31,000,000 US citizens will still not have health insurance by 2023. That is 10 years under the PPACA, and that is still 10% of the population uninsured.
You know, facts and such.
I won't argue with the % of GDP numbers, but I will argue that access to healthcare is not better under a universal system. It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?
I shall not post anymore because I have to go to work to pay my increased taxes and health care costs.
RE: Health Insurance
RE: Health Insurance
Color me unconvinced, while it was a frequent political hot potatoe back in Blighty I'm not sure it was any worse than here in the US.
In the single payer/single provider system I'm familiar with pretty much everyone got reasonable coverage for $X of GDP. There were issues such as long waiting lists at times for some procedures, some variability on quality of care geographically based on wealth distribution etc. however my experience with it - with admittedly limited need to take advantage of it wasn't bad.
In the US a few people get fantastic coverage, a lot of people get reasonable coverage, many more get mediocre coverage and a bunch get minimal - all for $2X GDP.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
I understand in the UK right now, politicians of both wings are falling over themselves to say how much they love the NIH, but they are also scared witless of their budget deficit. There is a lively political discussion as a result.
RE: Health Insurance
NIH? you mean NHS?
NHS is far from perfect, overall economics, political system... is far from perfect there too. I wasn't proposing blindly copying the NHS model in the US. However, I am not swayed by arguments that the NHS is overall worse than the US system and would argue that as a minimum it gives much better overall value for money.
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?
RE: Health Insurance
-> Maybe the answer is to break America up into smaller countries. How expensive does healthcare need to get before this makes sense?
RE: Health Insurance
Sources
The Commonwealth Fund study is not out-of-line with other studies. Furthermore, as cost appears to be your biggest issues, those numbers were not calculated by The Commonwealth Fund (listed in the study).
Meanwhile, you didn’t even bother linking your sources. No matter, I went to the trouble of trying to find them. Seems like your numbers came from the same paragraph in “Universal Healthcare’s Dirty Little Secrets” by Michael Tanner and Michael Cannon, of the CATO Institute! My favourite source for credible, unbiased, non-ideological driven information!
Regardless, it matters little. Let’s return to the matter at hand.
Wait Times
As you popped into this conversation about 450 replies in, I’m guessing you didn’t read my post highlighting the facts of wait times:
The difference in wait times is not huge, nor is the US the best. There appears to be little value for spending 2x more per capita. The only major area of difference is the wait times to see specialists for elective surgeries. As Beej67 has been arguing (as he's doing a better job arguing for universal healthcare than anything else), the availability of all these specialists comes with a cost/benefit ratio that appears slanted towards the cost side.
Also, see moltenmetal’s excellent post on the subject:
What you fail to mention (besides linking your source) is that the stats you list for the UK are for elective surgeries. As molten describes, waits can be long for non-essential aspects but overall timely, available access to healthcare in universal healthcare is on-par with the US (some are better, some are worse). You have one system that cancels 50,000 elective operations per year and another that lets 45,000 die due to lack of insurance. Still not buying that boat ticket?
Regarding the heart surgery wait times in Sweden, it again ignores the fact that cardiovascular surgery, along with all types of surgery, are tiered based on risk. Long wait times do not necessarily equate to more deaths. A study by Queen Elizabeth II Health Center concluded “prolonged waiting was not associated with worse surgical outcomes”. Another study, found that 0.48% of patients scheduled for heart surgery died while waiting for heart surgery. Certainly anything higher than 0% is non-ideal but the number does not indicate a severe issue and there is no indication that this number is sufficiently higher than the US, especially if you factor in the number of patients that died because they were not adequately covered for heart surgery. While these are Canadian studies, it does highlight that, for the most part, the prioritizing of surgery is done well for the most part.
Improvements to the system are needed and universal healthcare is not perfect. However, A 2009 Nanos Research poll found that 86.2% of Canadians support “public solutions to make our public health care stronger”. A 2008 Strategic Counsel survey found 91% of Canadians preferred their healthcare system over the US system. In addition, a 2003 Gallup Poll found only 25% of Americans were ‘very” or “somewhat” satisfied with “the availability of affordable healthcare in the nation”, compared to 50% in the UK and 57% in Canada.
CBO Estimate
What? The number of uninsured people in the US is still going to be high. How does that possibly support your point? That’s an argument FOR universal healthcare and re-emphasizes that the ACA is not universal healthcare, so it supports MY point. You, like beej67, are doing a better job arguing for universal healthcare than against it. What do you think that number would be in a “free-market” system? Greater than zero?
”It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?
…% of GDP is not the “up-front cost”. It’s the cost. And the US has the highest in the western world (by a long shot).
What is Canada really paying for healthcare? 11.2% of its GDP or $4,522 per capita
What is the UK really paying for healthcare? 9.4% of its GDP or $3,405 per capita
What is the US really paying for healthcare? 17.7% of its GDP or $8,508 per capita
Another interesting figure regarding the quality of healthcare in universal systems (with those "apathetic" doctors not giving you the care you need just to save money) versus the US:
RE: Health Insurance
A representative cannot be elected without obtaining and spending tens of millions of dollars in campaign funds, which are obtained from a few moneyed interests, who then obtain political favors ( at the 11th hour of an omnibus bill) which further their economic interests. Any legal challenge to individual instances of this formally permitted bribery is met with a stiff defense , since corporations are given all rights of a "person" under the law. In the case of the cash cow known as healthcare , the health insurance industry, pharmaceutical industry, AMA, medical products industry etc. can focus much more capital into "lobbying" (and other inducements) to obtain continued protection of their racket, to the detriment of the US public at large, as represented by the statistics provided earlier.
Restating statistics and facts apparently are not effective in changing US policy . IMO, either the legal system that allows moneyed interests to define policy needs to be amended, or a healthcare crisis would need to occur that can only be solved by a universal ,single payer healthcare system .
"Whom the gods would destroy, they first make mad "
RE: Health Insurance
RE: Health Insurance
RE: Health Insurance
So, not recession proof.
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RE: Health Insurance
Bingo.
And rconnor will also agree with that.
But then he will tell you that the solution is to have the (bought) government run everything. Which doesn't make a lot of sense. If our government was not bought, single payer healthcare would be a great way to go. He will continually bring up examples of other countries in which the government is not bought, which is like comparing a fresh apple to a rotten banana.
"Medicare For Everyone" is just putting a different skin on the rotten banana. It does not fix the rot.
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RE: Health Insurance
RE: Health Insurance
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RE: Health Insurance
But first a question, to help me understand your position more clearly. Which best describes your position:
1) Theoretically (ignoring the “money-in-government” problem), a “free-market” healthcare system is better than a universal healthcare system.
2) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would make it worse than a “free-market” system in practice.
3) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would prevent the transition to a universal healthcare system in the US. Therefore, the “free-market” system is the next best alternative.
If #1, then see all my previous posts. I really don’t want to go into the practical application of universal healthcare until after you agree that it is a superior system. If not, then we can continue to argue the merits of both systems.
If #2, then we can continue. We both agree that corporate influence on government is a major problem. This affects the healthcare system in the US greatly as, in the current system, healthcare is primarily ran by private, for-profit corporations. This gives them the incentive to lobby for their interests (i.e. more profits). If you take away the private, for-profit nature of the healthcare system you inherently solve that problem. There is no need for corporate corruption when there are no for-profit corporations. This is why universal healthcare works so nicely in other countries.
Your solution, the “free-market” system, minimizes or completely removes any ability for regulation. This too would remove the need for lobbyists, as corporations are allowed to do whatever they want but that is not a good thing. So you’ve identified the problem being corporate influence over government and your solution is to give all the power to the corporations and let the people fend for themselves.
If #3, then I agree with you much more than #1 or #2. However, I don’t feel it would be impossible. Difficult? Yes. Despite how bad the issue of money-in-politics is, if the voice of the people is loud enough, the government will listen. Remember that any candidate needs both money, which comes from corporations, and votes, which still comes from the people, to be in power. The first step is getting more people to understand the benefits of universal healthcare and squash some of the rumours. There is a lot of misinformation out there, usually stemming from the very lobby groups that you agree are the core of the problem. The more advocates you have for it, the more likely the government is willing to listen. Furthermore, even if a "free-market" system is in the best interest of the people and not corporations (which I completely disagree with), would it not face the exact same issues?
There is also a very interesting campaign that is attempting to develop a super-PAC to end all super-PACs. The Mayday Campaign is trying to raise money to fund candidates that are committed to push for reform to the way campaigns are financed.
RE: Health Insurance
4a) Free market principles don't work if you can't shop for stuff, so universal care makes complete sense for emergency services, in much the same way that it makes sense for fire protection and police protection. You will get no argument from me on that.
4b) The structure of the US health care system legacy, going all the way back, was one where health care providers made a solemn vow to "spare no expense," and their zeal was only counter balanced by the end recipient deciding to keep his own costs down, since they came out of his pocket.
4c) Shared cost pools, be they private or public, unravel that counter balance, leaving the legacy of our system to run wild. This is the seed of the rot. Sparing no expense is nice, and sharing costs is nice, but you mix those two together and the thing explodes.
4d) "Single Payer," as presented by the Blues, means nothing more than "Everyone Gets Medicare," or equivalently "Everyone shares their costs with taxes instead of premiums." It does not change the system, and the system is the problem. It is purely re-skinning the rotten banana.
Mr. Connor, you still, still, have not shown how re-skinning the banana gets rid of the rot. Now, lets punch through the rest of your post.
I think it's vastly superior for car wrecks, where I cannot shop for an ambulance. I think it's vastly inferior for headaches, where I can absolutely shop for Aspirin. I think blind zeal in one system being better for all types of healthcare over another is dangerous and not a particularly intelligent way to approach the problem.
Woah there buddy. The AMA is a lobby. Every little professional subgroup (The American Osteopathic College of Proctology, etc) is a lobby. Note how they, in the link above, recommend expensive procedures instead of cheap ones even though they're a "nonprofit?" Medicare coverage is affected by lobbyists. Device manufacturers are never going to be non-profit. Drug companies are never going to be non-profit. The "Band-Aid" company is never going to be a non-profit. You could turn all hospitals into nonprofits and not change the fundamental problem at all. They still have to hire doctors, who's artificial scarcity is effectively lobbied by the AMA.
Plus, your idea of what qualifies as 'nonprofit' doesn't really jive with reality. In reality, nonprofits lobby like heck. Teachers unions are nonprofit, and lobby like crazy. Churches are nonprofit, and lobby like crazy. The NCAA is nonprofit, and they fly around in private jets that would put the guys at Citibank and Blue Cross to shame.
Also, who exactly do you think you're going to convert 'nonprofit' as part of your solution? The MRI machine manufacturers? The MRI Technicians Of America lobby? The colleges who train the MRI technicians?
The primary reason why doctors can't compete with big corporations is because of the regulation. This is something that's fundamentally amiss with Blue thought. (There's plenty that's fundamentally amiss with Red thought too, btw, but that's not really the subject at hand) The Blues think "corporation bad" and then want to regulate the corporation, but what they fail to see is all they're doing is entrenching that corporation's market share. In a marketplace, I can choose the better solution for me. Regulation is about eliminating choice, and preventing innovation from displacing the market share of the big corporations.
I had a very close friend, an MD, who was so sick of the health care model in this country he decided he was going to quit his practice and start a direct doctor-to-patient company, predicated entirely on house calls. He'd show up with a van, to your house, do all your checkups, see you when you were sick, etc etc. The business model was flawless, because the doctors aren't actually making a lot of the money they're charging either - it all gets sucked up into the machine. But in order for his company to work, he had to charge cash. And nobody wanted to pay cash, because they had already paid their premium. They were on the shared pool, so they wanted him to get his pay from the shared pool. Which would have ruined his whole business model. "Everyone on Medicare" would do the same thing. The high efficiency system he brewed up would continue to be rubbed out in favor of the giant corporations that can figure out how the heck to be paid by Medicare.
I think the free market would work flawlessly for routine care, if people weren't paying premiums, because then they could take that money and shop for it. I think it would work flawlessly for your kids getting sick. I think it would work flawlessly for most of the things that we have now. Cash for services would be cheaper. Even up to and including things like broken bones and MRIs. The only thing it doesn't work well for is cancer and car wrecks. It flat sucks on car wrecks, and honestly when faced with "Chemo or die" choices, it doesn't really work then either.
My position is closest to (3) of yours above, but with the caveat that some stuff is absolutely cheaper if you're buying it with cash, in our country, where we have built everything from the ground up to work that way. And our problem is a cost problem.
If you want to make our system work:
1) get rid of all these "mandates"
2) single-payer the emergency hospitals,
3) up the HSA cap, and let people cover all their routine care, OTC medications, etc through it
4) let pharmacists issue prescriptions without a doctor, buyer-beware
5) Allow "limit of liability" clauses for all medical procedures
6) let all doctors self insure for malpractice insurance, by simply holding cash in escrow based on the volume of procedures they do per year, based on the liability limit
7) force all doctors, hospitals, etc, to publish their damn rates for procedures
That would give you de-facto tort reform without having to actually get into the details of it, would insulate us from the "oh god I got in a car wreck and now I'm bankrupt" factor, and it would restore the original cost controls that used to work in our system back into our system. It wouldn't be impossible to get there from here. The moment folks start trying to go to the sort of system you're talking about, rconnor, they'll be putting us all on the VA plan. And we know how single-provider healthcare works here in the USA. It kills Army vets.
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