patrick.net

CBOEtrader says

 

Dan8267 says

Because of economies of scale, reduced waste and needless competition, better coordination, and elimination of redundancies, socialized

This is the promise of every socialized program. Its an evil lie.

It's not like we don't have proof. Look at all the countries that don't practice, "oh, you want to continue living ? How much will you willing to pay for that ?"

Good incomes for services provided have a place in health care, but not the profit motive to the degree it does. It's a service, and those providing it should be paid very well becasue of the amount of training involved. Big pharma ? Providing cheap drugs to Canada ? What's up with that ?

I wonder how much drug research is heavily subsidized by the govt at the University level. Then when they're hot and on the verge of a breakthrough, they go to work for a drug company.

I've worked in the healthcare industry for years. I think a bunch of you are making valid points. Here is my research and conclusions up to this point:

- Our population is fatter, unhealthier, larger and more diverse than most every other developed nation, so you can't compare healthcare administration costs as apples to apples.
- We have a lot of poor, illegal immigrants who use our healthcare system because we don't really check citizenship and have IDs like other countries do.
- The US produces the most medical innovation than any other country in the world by far. We end up subsidizing the generics and copy-cats deployed elsewhere. If the US innovation didn't exist, our healthcare options would be much more antiquated. Leftists, be careful what you wish for if you do "too much" price fixing; will get to this later. The HepC cure may have never even existed had it not been for capitalism.

What Do We Do? (my opinion only obviously)
- WE HAVE TO FIX OUR ILLEGAL IMMIGRATION PROBLEM.
- If a life-saving drug is invented, we can't let capitalism reign. We must have some level of price fixing to allow Gilead, for example, to make money but not let people die. I'm not saying this will be easy, but an independent third party (i.e., government) would need to facilitate price-setting.
- I don't think we should get rid of gov't-paid healthcare for the poor and elderly. However, Medicare/Medicaid should be 1970s level of healthcare. In other words, procedures paid for by the government shouldn't be cutting edge or uber expensive.
- Most healthcare costs come from a small percentage of the population, and from the elderly in the last years of life. That small percentage needs to pay more via cost sharing than they are today. For the elderly, we need to make more forceful decisions about providing quality of life in the their last years, vs extending their life unnaturally.
- The Right will hate this, but we need more price fixing, period. There's too much subsidy by those who pay, vs those you can't, so you end up with people paying $1500 for stitches. HOWEVER, I don't think single payer is the answer because gov't is so fucking inefficient and corrupt. Just set price ranges for procedures and drugs (by region) and let the free market deal with out claims are adjudicated, etc., and technology and automation will drive down the cost of administration. Medical device companies will have to change their cost/pricing structures to match the cost of procedures.

So, I see this as a CAREFUL balance of free market and gov't intervention. If we lose too much free market, we lose innovation and increase gov't corruption and inefficiency. If we allow too much free market, we get outrageous pricing and certain portions of the population left out to die.

just any guy says

- Our population is fatter, unhealthier, larger and more diverse than most every other developed nation, so you can't compare healthcare administration costs as apples to apples.

- We have a lot of poor, illegal immigrants who use our healthcare system because we don't really check citizenship and have IDs like other countries do.

- The US produces the most medical innovation than any other country in the world by far. We end up subsidizing the generics and copy-cats deployed elsewhere. If the US innovation didn't exist, our healthcare options would be much more antiquated. Leftists, be careful what you wish for if you do "too much" price fixing; will get to this later. The HepC cure may have never even existed had it not been for capitalism.

just any guy says

What Do We Do? (my opinion only obviously)

- WE HAVE TO FIX OUR ILLEGAL IMMIGRATION PROBLEM.

A brilliant observation and one that could tantalizingly get enough bipartisanship support.

I have trouble believing that illegal immigration is causing the burdensome and exorbitant healthcare costs. The people that crowd the parking lot at all the health campuses every day all day doing who knows what, are all regular white fat Americans. And tons of old people causing traffic on the roads just to go to their daily appointments that yield virtually no benefit. I don't participate in any of that bullshit.

People with kids in sports should pay a butt load more as well. Twenty five years ago, none of that existed and we seemed to do better with the injuries. Now there's a med express on every corner with a queue around the block. I don't think anyone would be any worse off if all of those just disappeared

errc says

I have trouble believing that illegal immigration is causing the burdensome and exorbitant healthcare costs. The people that crowd the parking lot at all the health campuses every day all day doing who knows what, are all regular white fat Americans. And tons of old people causing traffic on the roads just to go to their daily appointments that yield virtually no benefit. I don't participate in any of that bullshit.

People with kids in sports should pay a butt load more as well. Twenty five years ago, none of that existed and we seemed to do better with the injuries. Now there's a med express on every corner with a queue around the block. I don't think anyone would be any worse off if all of those just disappeared

Think the Illegal issue is more of an issue with certain states. I had a Doctor friend that worked ER in an area that got flooded with illegals after another hospital in a Hispanic area had to shut down the ER, he suddenly started having tons of people with no insurance and no way to collect.

The illegal immigrant issue is a significant problem. I've seen it first hand over and over and over. The Left has politicized this issue so much that there's a great level of cognitive dissonance. This is why I've been banging the drum on this issue here on Pat.net for so long. It's a no-brainer

One more thing to add what I stated above. We have to have the individual mandate for this to work. However, we need to ensure we provide catastrophic options for healthy individuals so that they're not subsidizing the sick too much, but that we're not "directly" on the hook for when catastrophe strikes a seemingly healthy individual...it's baked into the actuarial model. And, we need to ensure cost-sharing with each plan assigned to an individual or family. If there's no cost-sharing, there's no skin in the game and services will be over-used.

I notice that programs that make the kids sit in groups and work on problems together are really popular with teachers. hahaha

CBOEtrader says

Regardless, a tiny country with one dominant civilized culture group that shares a strong patriotic loyalty to each other can do a lot of things that our 500 million multi-cultural society cant...like enact socialized health care system that doesn't degrade into a venezuelan nightmare.

You can't compare the us to Switzerland.

If you cannot compare the U.S. to Switzerland, then you cannot compare the U.S. to Venezuela either, and so any attempt to show failures of socializing in other nations are not applicable to attempts at socialization in the U.S. That principle goes both ways.

It's funny how one side of the argument over basic economic strategies loves to point out the failures of bad implementations of socialist policies by governments with many other problems, but hate it when competent governments demonstrate successful socialist policies.

In actuality, it makes far more sense to compare the U.S. to Switzerland than to Venezuela. The former two are rich countries with politically and socially stability and are highly developed. The latter meets none of those conditions. Consequentially, socialist policies implemented in the U.S. would be more like those in Switzerland than Venezuela. Anti-socialists don't like this because it's clear evidence that socialism, when used wisely, works.

Furthermore, it would be utterly impossible to run a society without socialism. You could have no military, no police, no streets, no sewer system, no electric grid, no lighthouses. Your society would be a third-world hell hole with para-military gangs constantly waging wars on the streets.

just any guy says

The illegal immigrant issue is a significant problem. I've seen it first hand over and over and over. The Left has politicized this issue so much that there's a great level of cognitive dissonance.

I don't really care if CA or any of the other border states want to kick Mexicans out. But if this was the main issue, you would expect everything to be working smoothly in the non-border states where immigration isn't a big issue. That's not really the case, so I doubt that fixing the immigration issue will solve much.

just any guy says

- Our population is fatter, unhealthier, larger and more diverse than most every other developed nation, so you can't compare healthcare administration costs as apples to apples.

Weight is a part of health care. A lot of people in the US think that doctors will just fix them if they get sick and that getting sick is just a genetic crap shoot. They don't realize that their own lifestyle will have a tremendous impact on how healthy they are. They also don't realize that doctors can't really 'fix' heart disease, cancer, etc. With heart disease, they can save your life if you are lucky. But they cannot reverse the disease. With Cancer, they can prolong your life with some of the less aggressive types. But the more aggressive ones will probably just kill you 'pretty quickly' regardless of what a doctor does.

Also, with regard to Obesity, 34% of Americans were obese in 2014. This is compared to 28-29% of people in the UK, Canada, New Zealand, Australia, and Mexico. That's not a huge difference - pun intended.

It's hard to believe that diversity of genetic backgrounds complicates the work of doctors all that much. Diversity of genetic material probably helps an individual, but I may be wrong on that. Correct me if you know something about that.

YesYNot says

But if this was the main issue

I never said it was the main issue. Healthcare is a very complex issue to solve with numerous factors to consider. Illegal immigrants using our healthcare system without paying for services is a problem...period.

I know your ideology says otherwise, but it's mistaken. I have first-hand experience with this.

It's hopeless. People muddle the issue with irrelevant details instead of looking at the big pucture.

How can removing the middle man, streamlining and simplifying the administration, removing the for-profit element, improving preventive care, and regulating services and costs does not make health care better and more affordable?

http://content.healthaffairs.org/content/31/8/1803.full.pdf+html

Or how about this? US compared to EU countries is an apples to oranges comparison. You are literally comparing white people with healthy lifestyles to obese black people. Im assuming facts are acceptable since this is thunderdome.

FP says

It's hopeless. People muddle the issue with irrelevant details instead of looking at the big pucture.

How can removing the middle man, streamlining and simplifying the administration, removing the for-profit element, improving preventive care, and regulating services and costs does not make health care better and more affordable?

A monkey could take a dump on our current system and it would be more affordable.

just any guy says

I know your ideology says otherwise, but it's mistaken. I have first-hand experience with this.

Having seen a few illegals going to the ER does not mean you know how significant a burden on the system they are.

FP says

Having seen a few illegals going to the ER does not mean you know how significant a burden on the system they are.

You're wrong. Having worked as an executive in the health plan for one of the largest health systems in the nation, I know what the burden was based on actual payor data as well as interacting with hospitals and physicians in 6 different states. Don't tell me my business.

CBOEtrader says

http://content.healthaffairs.org/content/31/8/1803.full.pdf+html

Or how about this? US compared to EU countries is an apples to oranges comparison. You are literally comparing white people with healthy lifestyles to obese black people. Im assuming facts are acceptable since this is thunderdome.

Why did you ignore the hispanics? They are as many as the blacks?

We have a problem of cultural choices. We choose to eat too many ho-ho's and shoot each other.

FP says

It's hopeless. People muddle the issue with irrelevant details instead of looking at the big pucture.

How can removing the middle man, streamlining and simplifying the administration, removing the for-profit element, improving preventive care, and regulating services and costs does not make health care better and more affordable?

In the words of Trump, healthcare is A LOT hard to solve than you think. If it were as trivial as you make it out to be, it would've been solved by now.

just any guy says

FP says

Having seen a few illegals going to the ER does not mean you know how significant a burden on the system they are.

You're wrong. Having worked as an executive in the health plan for one of the largest health systems in the nation, I know what the burden was based on actual payor data as well as interacting with hospitals and physicians in 6 different states. Don't tell me my business.

Give me the numbers then, don't just blablabla me.

FP says

just any guy says

FP says

Having seen a few illegals going to the ER does not mean you know how significant a burden on the system they are.

You're wrong. Having worked as an executive in the health plan for one of the largest health systems in the nation, I know what the burden was based on actual payor data as well as interacting with hospitals and physicians in 6 different states. Don't tell me my business.

Give me the numbers then, don't just blablabla me.

Roughly 15% of the uninsured were illegal immigrants. It was obviously worse in CA (upward of 25%) vs other states, but consider that a rough average. It's not just about the cost, but it's also about the experience that other legal and/or insured patients go through as it pertains to wait times.

FP says

Why did you ignore the hispanics? They are as many as the blacks?

Stats suggest the hispanic population does not harbor the same cultural plague as our black communities, and are therefore not as noteworthy.

FP says

Give me the numbers then, don't just blablabla me.

Gave you the numbers. Now are you just gonna blablabla me back like you have been?

Let me also add that the uninsured tend to use the ER because they have to be admitted. The ER, on average, costs 5x that of a normal doctor visit.

just any guy says

Gave you the numbers. Now are you just gonna blablabla me back like you have been?

Now I'm going to tell you that the number you gave me is meaningless by itslef. The question was what burden are the illigas on the system. You tell me they are 15% of the uninsured. So if the uninsured are 150 people?

Try again Mr. executive. But this time think more before writing.

just any guy says

Let me also add that the uninsured tend to use the ER because they have to be admitted. The ER, on average, costs 5x that of a normal doctor visit.

That was a big driver that was expected to lost costs when the aca lowered the number of uninsured. Common sense tells you that the benefit is long term, while the cost is front loaded. That's too much nuance for a national debate though.

YesYNot says

just any guy says

Let me also add that the uninsured tend to use the ER because they have to be admitted. The ER, on average, costs 5x that of a normal doctor visit.

That was a big driver that was expected to lost costs when the aca lowered the number of uninsured. Common sense tells you that the benefit is long term, while the cost is front loaded. That's too much nuance for a national debate though.

Yep, I agreed with some of the things that ACA tried to do and its objectives. Healthcare is the hardest thing for our country to figure out. I give it to Obama for trying.

FP says

just any guy says

Gave you the numbers. Now are you just gonna blablabla me back like you have been?

Now I'm going to tell you that the number you gave me is meaningless by itslef. The question was what burden are the illigas on the system. You tell me they are 15% of the uninsured. So if the uninsured are 150 people?

Try again Mr. executive. But this time think more before writing.

Done with you bro. You give back nothing in return except insecurity and animosity for sound logic that shakes your ideology. It's like debating a religious zealot...your mind is made up.

just any guy says

You give back nothing in return except insecurity and animosity for sound logic that shakes your ideology.

What a fucking idiot. I just exposed your lack of logic.

CBOEtrader says

Stats suggest the hispanic population does not harbor the same cultural plague as our black communities, and are therefore not as noteworthy.

I though you posted that figure to show that the average American longevity is lowered because the blacks. But it also shows that the hispanics compensate for the blacks.

marcus says

Good incomes for services provided have a place in health care, but not the profit motive to the degree it does.

If it's business, the only motivation is profit. Everything else is secondary.

FP says

CBOEtrader says

Stats suggest the hispanic population does not harbor the same cultural plague as our black communities, and are therefore not as noteworthy.

I though you posted that figure to show that the average American longevity is lowered because the blacks. But it also shows that the hispanics compensate for the blacks.

No, the hispanics show how our cultural decisions fail us. Hispanics in the US live longer despite being poor and not having the best healthcare BECAUSE they eat healthier than the average american white person. Fruits, veggies, rice, beans, and chicken.

This is still a story about personal decisions.

just any guy says

So, I see this as a CAREFUL balance of free market and gov't intervention. If we lose too much free market, we lose innovation and increase gov't corruption and inefficiency. If we allow too much free market, we get outrageous pricing and certain portions of the population left out to die.

Makes a lot of sense. I believe single payer, administered and regulated well could accomplish this. IT already does for the senior that use most of the health care services already.

Ironman says

So you really think Medicare is administered and regulated well and is very cost efficient?

It's more cost efficient than private insurance is.

joeyjojojunior says

Ironman says

So you really think Medicare is administered and regulated well and is very cost efficient?

It's more cost efficient than private insurance is.

This is an interesting analysis because comparing administrative overhead of Medicare vs private health plans is apples and oranges. For example with integrated health systems, they handle most of the claims processing and adjudication overhead...not Medicare or Medicaid. So, it is hard to compare.

If you ask independent providers who is easier to work with, most will likely say private insurers because the paperwork and guidelines for Medicare is outrageous. From what I've seen, this is a symptom of how government operates...with far too much bureaucracy and overhead.

Look at auto insurers. If we have private companies in a commodity business like insurance competing against each other, a huge portion of their success will be derived from automation and process improvement. In contrast, the government has no motivation to streamline administrative processes as evidenced by how Medicare/Medicaid is today because they know they'll get funding from the taxpayer and not go out of business. Government, by nature, breeds corruption because it's more driven by politics, getting reelected, and getting the biggest budgets possible, so that's why I'm against single payer. No competition.

FortWayne says

If it's business, the only motivation is profit. Everything else is secondary.

...including lives, which is why capitalism does not work for health care.

just any guy says

In contrast, the government has no motivation to streamline administrative processes as evidenced by how Medicare/Medicaid is today because they know they'll get funding from the taxpayer and not go out of business

Other countries manage.

HEalth Care costs are so high now, that if we implemented single payer, the administrators would have no choice but to figure out how to streamline the processes and also use their negotiating power to hold prices and costs down.

Dan8267 says

FortWayne says

If it's business, the only motivation is profit. Everything else is secondary.

...including lives, which is why capitalism does not work for health care.

Capitalism works fine, if it wasn't for capitalism we'd be all dying off left and right from our unhealthy lifestyle choices.

FortWayne says

Capitalism works fine, if it wasn't for capitalism we'd be all dying off left and right from our unhealthy lifestyle choices.

If it wasn't for the socialistic military we'd all be speaking German now.

Capitalism works great as long as certain conditions are met, one of which is elastic demand. Unfortunately, healthcare demand is highly inelastic. Which is why healthcare costs can rise at such high rates year after year.

FortWayne says

Capitalism works fine, if it wasn't for capitalism we'd be all dying off left and right from our unhealthy lifestyle choices.

www.youtube.com/embed/zkYCf4h5XgE