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Post by thehightenor on Aug 13, 2017 12:14:35 GMT -6
PS - for the USA haters....warts and all, there's no place else I'd rather live. The best and most imitated music in the world gets made here. I feel that way about living and working as a creative in London. I guess there's no place like home ;-)
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Post by Tbone81 on Aug 13, 2017 12:16:55 GMT -6
The more medical care costs, the more money the insurance industry "earns." Healthcare in the United States is an utterly classic insurance job. One of the things that really bothers me too is that nothing is really being done to lessen the cost of providing medical care. All the proposed solutions (including nationalized healthcare) are really only ways of paying for the cost, or spreading it to a larger base. But There are plenty of things that could be done to actually lower the cost of healthcare.
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Post by drbill on Aug 13, 2017 12:30:18 GMT -6
PS - for the USA haters....warts and all, there's no place else I'd rather live. The best and most imitated music in the world gets made here. I feel that way about living and working as a creative in London. I guess there's no place like home ;-) <thumbsup>
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Post by Bob Olhsson on Aug 13, 2017 12:59:03 GMT -6
Actually a national system could easily lower the cost because the profit motive would be related to outcomes rather than increases in expense. This is why other countries have both significantly lower costs and longer life expectancies. It would need to be more like Medicaid than Medicare to really be effective. Taxes would go up but the cost would be considerably less than the combination of taxes and health insurance. When I visited Sweden with my parents, I discovered that they were into finding the cheapest possible solution as opposed to having a do-good "liberal" attitude. They understand that rich people can get deadly diseases from sick poor people.
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Post by johneppstein on Aug 13, 2017 13:27:29 GMT -6
When corporations and other government imposed limits on liability exist, there is no such thing as a free market because unlimited liability is what regulates it. By definition limited liability requires government regulation to replace the people's unlimited right to sue the owners. Most talk of a "free market" is utter BS that misleads people. Eric, I also worry that changes to healthcare are being way oversimplified on all sides. It has been a train wreck since the Reagan Administration forced Wall Street to take it over from the non-profits. We pay lots more while doctors and hospitals earn lots less. Unfortunately nobody seems to be talking about how we got here. Nobody is willing to talk about the fact that "Saint Ronnie" did far more harm than good on almost every front - and I'm not entirely certain about the "almost" part.
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Post by johneppstein on Aug 13, 2017 13:40:14 GMT -6
The insurance companies seem to contribute nothing but bureaucratic waste. Not to mention, maximizing profits inherently conflicts with maximizing health outcomes for those already sick, those with completely unexpected catastrophic illness, children with disorders or perinatal injuries, or the typical ravages of old age. This is why a public option that gives everyone an ounce of preventive care before costs spiral out of control (melanoma and colorectal cancers being prime examples) is a reasonable compromise proposal, because it preserves private insurance for "free market" worshippers, and leaves access to platinum umbrella healthcare for those that want it, while it increases risk pool to spread out cost per member and bring in healthy young people, and allows group negotiation of costs. Other big problem in line with tort reform is that a doctor will always order an expensive test like an MRI with anesthesia, even if he or she believes there is a less than .5% chance of it helping diagnosis and treatment approach. Anyone who has been admitted to a hospital knows that - aside from being awakened by a nurse every 4 hrs -- you are given a rotation of superfluous visitors, all charging an embedded hospital overhead on top of the usual professional fees. Similar to hospital mark up on over the counter pills like aspirin and medical devices. There is no such thing as a "compromise proposal" when it comes to health care. Either the vultures are getting rich by charging exorbitant prices or they're not, because they're required to provide treatment at regulated rates. The idfea of "preserving free market insurance" is somewhere between a bad joke and an outright lie, because anybody who could actually afford real "free market insurance" doesn't need it. Medical insurance is nothing but a sop to the insurance industry, granting them a monopoly so they can gouge people fort essential services they can't live without - and are usually priced so that people can't afford anything too serious anyway. The whole thing is a collossal scam to make huge profits providing a "service" that nobody really needs and only drives up prices while providing no added value.
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Post by johneppstein on Aug 13, 2017 13:48:25 GMT -6
Also the nurse and the tech can cut down & combine trips to your room but, I just say over the years I'll just apologize for screwing that up, for instance Sunday night my blood sugar went low and the Nurse had to stay with me till it was back to normal took 40min. where she was just in my room, now the solution would be more nurses but there already is a shortage. And how much of that charge for the nurse does the nurse actually see? 20%? 10%? Not much. The lions share goes to "administrative costs" in the hospital and profits to the insurance company. There is a shortage of nurses because nurses are underpaid. Nurses are underpaid because the bulk of the money charged for their services goes to leeches.
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Post by johneppstein on Aug 13, 2017 13:55:54 GMT -6
I'd like to add to your point Eric, if I may. I work in healthcare, it's my "other" profession and has been for 5 years now. There have been a lot of good points made here, by a lot of different people and I'd just like to say this: Healthcare is an incredibly complex system. There are hundreds of interlocking pieces. There is no one solution or one problem. It's not insurance premiums, or malpractice insurance or prescription drug prices...it's everything. There are FDA regulations, pharmaceutical interests, medical device manufacturers, insurance companies, hospital systems, kick backs and payolla, over regulation and under regulation (in different places), the education system, medical boards, unions and more. And that's just the tip of the iceberg. There's so much too it, and so many competing interests that few people are really qualified to come up with system wide solutions. I am not one of those people. I know just enough to realize I know very little. So what is the point of my post? I'm not sure, just food for thought. Just something everyone should think about in connection to this debate. Btw, we hate waking people at 4am too, but it's sometimes necessary. However, next time you're in the hospital ask your nurse to let you sleep, communicate that to the allied health folks taking care of you. Most of us are more than happy to skip less important tasks to let you sleep, and you do have the right to refuse treatment. There's really only ONE major factor - removal of corporate profit in healthcare. Making huge profits off the suffering and death of others is unconscionable. It's not a political question - it's a moral one. And those who turn it into a political ideology are crooks only interested in feathering their own nests. Follow the money.
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Post by johneppstein on Aug 13, 2017 14:08:26 GMT -6
The more medical care costs, the more money the insurance industry "earns." Healthcare in the United States is an utterly classic insurance job. Medical insurance companies don't actually "earn" anything. To "earn" you have to provide value. There are insurance industries that do this - fire, theft, disaster and auto insurance are the primary ones that come to mind. Life insurance too, I guess. Not medical.
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Post by johneppstein on Aug 13, 2017 14:11:00 GMT -6
The more medical care costs, the more money the insurance industry "earns." Healthcare in the United States is an utterly classic insurance job. One of the things that really bothers me too is that nothing is really being done to lessen the cost of providing medical care. All the proposed solutions (including nationalized healthcare) are really only ways of paying for the cost, or spreading it to a larger base. But There are plenty of things that could be done to actually lower the cost of healthcare. Of course there isn't, there's no money in it. No money for additional profits, no profits to fund bipartisan political contributions. EDIT: Sorry about all the posts, but this is a subject that really gets me riled up. I'm going to try to shut up now.
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Post by jcoutu1 on Aug 13, 2017 15:43:53 GMT -6
What a weird thread...
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Post by Tbone81 on Aug 13, 2017 15:46:36 GMT -6
Actually a national system could easily lower the cost because the profit motive would be related to outcomes rather than increases in expense. This is why other countries have both significantly lower costs and longer life expectancies. It would need to be more like Medicaid than Medicare to really be effective. Taxes would go up but the cost would be considerably less than the combination of taxes and health insurance. When I visited Sweden with my parents, I discovered that they were into finding the cheapest possible solution as opposed to having a do-good "liberal" attitude. They understand that rich people can get deadly diseases from sick poor people. Bob, I don't really disagree with you but that's a little bit of an over simplification. Partly because there are several major entities that all profit in different ways. For example, hospitals profits are already based on outcomes rather than rising expenses. Are you familiar with DRG's and how they effect hospital reimbursement? On the other hand pharmaceutical companies profit big time by increasing prices which become a rising expense to the rest of us. Nationalized healthcare might lower the "price" of healthcare, but by itself it doesn't lower the actual cost of providing that care. Which is why reform needs to happen on many levels. Many of those European countries have better laws when it comes to pharmaceuticals, medical equipment etc which helps them save a lot of money. Also, Americans tend to live very unhealthy lifestyles when compared to other industrialized nations which also contributes to our high prices. I'm not sure what is done for preventative care in other nations but we definitely need more of it here.
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Post by Bob Olhsson on Aug 13, 2017 16:24:50 GMT -6
When you can just walk in and get preventative care without spending any money, people do it. My understanding is that's where a lot of their savings comes from. It reduces the need for specialists and really expensive care. Doctors get paid less but the government pays for all medical school expenses. In Sweden doctors and school teachers earn the same wages. Doctors a bit less and teachers a whole lot more.
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Post by ragan on Aug 13, 2017 16:34:39 GMT -6
PS - for the USA haters....warts and all, there's no place else I'd rather live. The best and most imitated music in the world gets made here. Let's not go too crazy with any talk radio parrot phrases The urge to brand anyone with a critique a "hater" of the U.S. is something that various interests have spent hundreds of millions of dollars cultivating. And boy did it work. I reject it wholeheartedly. It was smart politics, extremely manipulative and effective, but it's bogus. No ideology has a patent on patriotism as I see it. I'm deeply grateful and glad to be an American. I don't see that as at odds with being honest about the things we haven't done a good job at (or being honest about and proud of the things we do well for that matter ). The right were strategically smart to try and claim a monopoly on patriotism and the left were dumb to cede it. Either way, it's a false distinction and it's been a gross and cynical operation that's done a lot of harm in my view. This is probably too far into politics and I'll have no hard feelings whatsoever if it's deleted. I just can't abide the "America hater" rhetorical trope that's used so often.
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Post by Tbone81 on Aug 13, 2017 16:40:12 GMT -6
When you can just walk in and get preventative care without spending any money, people do it. My understanding is that's where a lot of their savings comes from. It reduces the need for specialists and really expensive care. Doctors get paid less but the government pays for all medical school expenses. In Sweden doctors and school teachers earn the same wages. Doctors a bit less and teachers a whole lot more. I think you hit the nail on the head here. +1 for more prevention care. And you bring up a point about edu cost that people forget. Graduating med school $400k in debt and then having to spend the next 6 years of your life training 5-6 days a week, 12hrs a day, as a resident and then a fellow, is a huge sacrifice (even though tire getting paid for it). If you want to be a surgeon add another 4 years of training. That's one of the reasons we pay Drs so much money. And there's definitely room for improvement in that equation!
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Post by drbill on Aug 13, 2017 16:46:32 GMT -6
This is probably too far into politics indeed
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Post by joseph on Aug 13, 2017 17:04:45 GMT -6
The insurance companies seem to contribute nothing but bureaucratic waste. Not to mention, maximizing profits inherently conflicts with maximizing health outcomes for those already sick, those with completely unexpected catastrophic illness, children with disorders or perinatal injuries, or the typical ravages of old age. This is why a public option that gives everyone an ounce of preventive care before costs spiral out of control (melanoma and colorectal cancers being prime examples) is a reasonable compromise proposal, because it preserves private insurance for "free market" worshippers, and leaves access to platinum umbrella healthcare for those that want it, while it increases risk pool to spread out cost per member and bring in healthy young people, and allows group negotiation of costs. Other big problem in line with tort reform is that a doctor will always order an expensive test like an MRI with anesthesia, even if he or she believes there is a less than .5% chance of it helping diagnosis and treatment approach. Anyone who has been admitted to a hospital knows that - aside from being awakened by a nurse every 4 hrs -- you are given a rotation of superfluous visitors, all charging an embedded hospital overhead on top of the usual professional fees. Similar to hospital mark up on over the counter pills like aspirin and medical devices. There is no such thing as a "compromise proposal" when it comes to health care. Either the vultures are getting rich by charging exorbitant prices or they're not, because they're required to provide treatment at regulated rates. The idfea of "preserving free market insurance" is somewhere between a bad joke and an outright lie, because anybody who could actually afford real "free market insurance" doesn't need it. Medical insurance is nothing but a sop to the insurance industry, granting them a monopoly so they can gouge people fort essential services they can't live without - and are usually priced so that people can't afford anything too serious anyway. The whole thing is a collossal scam to make huge profits providing a "service" that nobody really needs and only drives up prices while providing no added value. I pretty much agree with you, but I just mean it could be easier to pass a public option and basically offer a big pool government insurance plan (perhaps even that certain states could opt out of to make it more palatable) rather than a medicare for all national single payer program, which is superior value. If it weren't for Joe Lieberman, a public option might have happened.
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Post by joseph on Aug 13, 2017 17:07:21 GMT -6
The more medical care costs, the more money the insurance industry "earns." Healthcare in the United States is an utterly classic insurance job. Medical insurance companies don't actually "earn" anything. To "earn" you have to provide value. Thare are isurance industries that do this -= fire, theft, disaster and auto insurance a re the primary onhes that come to mind. Life insurance too, I guess. Not medical. Exactly!
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Post by joseph on Aug 13, 2017 17:08:48 GMT -6
Actually a national system could easily lower the cost because the profit motive would be related to outcomes rather than increases in expense. This is why other countries have both significantly lower costs and longer life expectancies. It would need to be more like Medicaid than Medicare to really be effective. Taxes would go up but the cost would be considerably less than the combination of taxes and health insurance. When I visited Sweden with my parents, I discovered that they were into finding the cheapest possible solution as opposed to having a do-good "liberal" attitude. They understand that rich people can get deadly diseases from sick poor people. Yes, and it would also alleviate plan costs for most businesses and encourage free movement of labor.
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Post by Bob Olhsson on Aug 13, 2017 17:20:27 GMT -6
Many businesses oppose free movement of labor. The affordable care act allowed many skilled employees to quit and go into competition with their former employer. There was nothing in it that wasn't in most corporate plans. You just previously hadn't been able to buy things like pre-existing condition coverage in an individual plan.
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ericn
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Post by ericn on Aug 13, 2017 17:25:40 GMT -6
When you can just walk in and get preventative care without spending any money, people do it. My understanding is that's where a lot of their savings comes from. It reduces the need for specialists and really expensive care. Doctors get paid less but the government pays for all medical school expenses. In Sweden doctors and school teachers earn the same wages. Doctors a bit less and teachers a whole lot more. The one thing about DRs wages, you have to look at the time & expense of education, a Surgeon 4 years undergrad 4 years medschool residency 4-6 yrs fellowships 1-2years that' can be 16 years of education, yes residency and fellowships do pay a wage but most also spend med school, residency and fellowship in different places. Add in getting called in at all hours, I want the best and brightest operating on me to get that you have to pay! For every lazy MD I have seen I know 2 that go way above and beyond!
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ericn
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Post by ericn on Aug 13, 2017 17:40:33 GMT -6
Also the nurse and the tech can cut down & combine trips to your room but, I just say over the years I'll just apologize for screwing that up, for instance Sunday night my blood sugar went low and the Nurse had to stay with me till it was back to normal took 40min. where she was just in my room, now the solution would be more nurses but there already is a shortage. And how much of that charge for the nurse does the nurse actually see? 20%? 10%? Not much. The lions share goes to "administrative costs" in the hospital and profits to the insurance company. There is a shortage of nurses because nurses are underpaid. Nurses are underpaid because the bulk of the money charged for their services goes to leeches. OK I have marched with nurses for better wages and conditions because my presence would bring local media, but don't kid yourself most of the cost of nursing is nurses, yes there is always some administrative costs, but that's in any goods and services. One of the biggest expenses for nursing is the fact that hospitals are short of staff so hospitals pay a premium for Agency and Per diem nurses. Experienced nurses often find an agency will pay better than the facility they work at to work in the same place ! Agency adds it's cut nurse makes more you pay more! Nice racket but you have to have the nurses! Often when a hospital is "full" , it's got the physical beds and rooms it just doesn't have the nurses and ancillary staff ! Unlike MD's you need a high number of Nurses and ancillary staff 24/7! Some of these Ancillary non degree positions are dealing with what would gross out most! While they do pay better than most unskilled non degree jobs they offer excellent benefits but filling them with quality people is a challenge!
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Post by joseph on Aug 13, 2017 19:46:32 GMT -6
Many businesses oppose free movement of labor. The affordable care act allowed many skilled employees to quit and go into competition with their former employer. There was nothing in it that wasn't in most corporate plans. You just previously hadn't been able to buy things like pre-existing condition coverage in an individual plan. I'm reminded of the many articles on how ACA increased entrepreneurship and gig work, and benefited businesses with employees under 50. But as you say direct universal preventative coverage would lower economic costs in the long run, and I could see such a system benefiting businesses in the over 50 employee category.
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Post by johneppstein on Aug 14, 2017 0:50:15 GMT -6
When you can just walk in and get preventative care without spending any money, people do it. My understanding is that's where a lot of their savings comes from. It reduces the need for specialists and really expensive care. Doctors get paid less but the government pays for all medical school expenses. In Sweden doctors and school teachers earn the same wages. Doctors a bit less and teachers a whole lot more. The one thing about DRs wages, you have to look at the time & expense of education, a Surgeon 4 years undergrad 4 years medschool residency 4-6 yrs fellowships 1-2years that' can be 16 years of education, yes residency and fellowships do pay a wage but most also spend med school, residency and fellowship in different places. Add in getting called in at all hours, I want the best and brightest operating on me to get that you have to pay! For every lazy MD I have seen I know 2 that go way above and beyond! The thing that those pushing that rhetoric as a counter argument to a sane health care system always seem to overlopok (deliberately ignore) is that those who can afford it will always be able to get that "best and brightest" care on the open market for a premium. And the system will work to ensure that you get ONLY the real best and brightest for that premium because the rest won't be able to stay in business at that level. At the same time, those "best and brightest" will also be (at least semi) available to those who COULDN'T afford them through a requirement that they participate in the public system for X hours per month. This does, of course, assume that the law won't be written by idiots or outright saboteurs.
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Post by johneppstein on Aug 14, 2017 1:02:38 GMT -6
And how much of that charge for the nurse does the nurse actually see? 20%? 10%? Not much. The lions share goes to "administrative costs" in the hospital and profits to the insurance company. There is a shortage of nurses because nurses are underpaid. Nurses are underpaid because the bulk of the money charged for their services goes to leeches. OK I have marched with nurses for better wages and conditions because my presence would bring local media, but don't kid yourself most of the cost of nursing is nurses, yes there is always some administrative costs, but that's in any goods and services. One of the biggest expenses for nursing is the fact that hospitals are short of staff so hospitals pay a premium for Agency and Per diem nurses. Experienced nurses often find an agency will pay better than the facility they work at to work in the same place ! Agency adds it's cut nurse makes more you pay more! Nice racket but you have to have the nurses! Often when a hospital is "full" , it's got the physical beds and rooms it just doesn't have the nurses and ancillary staff ! Unlike MD's you need a high number of Nurses and ancillary staff 24/7! Some of these Ancillary non degree positions are dealing with what would gross out most! While they do pay better than most unskilled non degree jobs they offer excellent benefits but filling them with quality people is a challenge! And one adminmistrator pulls down enough to pay at least a dozen nurses, whith a good deal less training and expertise. And that's not even considering the level of insurance company leeches who do nothing whatsoever except make things more expensive. And I'm pretty damn sure that insurance brokers and execs are not figured into those "administrative costs." If they were you'd get into the ever upward spiraling Ouroboros of insurance companies adding the pay of their own execs to the "medical bills" they're covering and I'd be surprised if even insurance execs could get away with that blatant a level of thievery. Or maybe I'm naive and they could and do. I really hope not.
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