patrick.net

Lashkar_i_Trumpi says

Price controls, esp. on ER, absolutely necessary. Should be kept in line with inflation. There is no international shortage of cotton, alcohol wipes, etc. and healthcare provider wage pressure is in line with general wage-earners (that is, not increasing rapidly at all).

There is a reason Health Care costs are exploding annually and it isn't aging population, see Japan

If the economic structures we used weren't so fucked up, health care like any technology would asymptotically decrease in cost to some fixed, low level.

jazz music says

It is urgent that we all fight for Medicare for all, to FIX OBAMACARE...

You don't seem to realize those are opposite goals, and the latter is the slogan of "The Resistance", an Orwellian subversion along the lines of Animal Farm.

Quigley says

One is assistance for paying for medical school for kids of not-wealthy families.

Mexico has a better solution: free medical/dental/vision school for interested students who show ability and potential and agree to work for a year for the government in an underserved area. It creates a plentiful supply of highly capable medical professionals, and thus low prices for excellent quality. It's the best place in North America to go for those services.

Means testing is a bad idea that keeps coming back, in Rin's comments also. Why should you care whether your doctor was born in a log cabin he built himself? "Oh, sorry he misdiagnosed your kid and blinded her for the rest of her life, but he had come from a dirt poor family so we gave him a scholarship, while dissuading better qualified candidates with $60k/year tuition." The idea comes back because it expands the market for expensive tuition: find a way to enable people who can't afford it. It's a lot like Obamneycare in that way: expand Medicaid so that hospital executives can monetize even indigent vagrants at $500k/year each. The idea comes back because marketing can easily distort the inherent sacrifices to look "fair" when in fact it's about maximizing their own power at the expense of everyone else.

The better solution is to reduce the cost. The Mexican system works because they produce so many talented graduates that even the professors can be hired at reasonable salaries. If we had NAFTA for medical/dental/vision, the price would equalize.

Also repeal the Rx requirement, because too many people are scheduling Dr visits for permission to buy junk they saw on TV. Let Darwin Awards take their course. If some schmuck wants to buy the toxic placebo he saw on TV, and wash it down with a can of Pepsi to deter police violence, so be it. You can't save people from themselves, so let people make their own decisions and the smart ones will check expert systems (e.g. RightDiagnosis.com, FKA WrongDiagnosis.com) that cost nothing.

Also, as noted above, emergency services need price controls. That should also be on a fee-for-diagnosis basis, not fee-for-service, which creates terribly perverse incentives. Ideally, emergency medical should be paid by government like Fire&Police, because there is no time for "market" comparisons.

American overpricing relative to other countries, and excess spending especially after age 65, practically began with Medicare's fee-for-service model driving over-utilization. Dan and others have posted a chart showing how American spending leaps above all others starting around Medicare age. Some have noticed the increase becomes most noticeable around age 60, and so they don't blame Medicare, which starts generally at age 65. They don't realize Medicare eligibility extends already to some people under age 65, and the pool expands enough by age 60 to affect the charts. Expanding current Medicare to all, while maintaining current supply restrictions and perverse incentives that increase demand, would increase spending even faster. Here is a chart comparing American medical costs to other countries; notice what happens when Americans become eligible for Medicare, whether due to age or disability (which correlates with age after around 60):

Ironman says

Strategist says

And if they still can't afford a 800 sq ft home, they should move to a 400 sq ft home.

Or a single wide.

Noooooooo. We deserve nice big houses in good neighborhoods. We need good quality cars with all the bells and whistles, and a sports car on the driveway. We need to be able to shop at nice department stores, go to good restaurants. And we need to have several vacations a year.
It's our right. So what if i'm not working.

3 of my siblings live with my mother in NJ. Ages 28 to 40.

GuiltyBattle says

3 of my siblings live with my mother in NJ. Ages 28 to 40.

I'm willing to bet those 3 losers voted for Obama.

Consider it selection of those unfit to breed in this competitive exonomy.

Ironman says

The Number 1 living arrangement today for Americans in the 18-to-34 age bracket, according to the Census Bureau, is to reside without a spouse in their parents’ home.

Great job, boomers!
Thank you so much.

I don't mind if my kids stay with the wife and I into thier 30s or more as long as they are productive. Everything is just a cycle and maybe its just going back to the way it use to be. Maybe this struggle will bring families closer which is has been on a decline for for a long time in the US.

We could have a two tier system, one for those that work and one for those that don't. Insurance companies need to go but we also need to talk about at what point do we not keep people alive without getting emotional about it. People should be able to die gracefully and not kept on life support or long term critical care after a certain age.

curious2 says

Mexico has a better solution: free medical/dental/vision school for interested students who show ability and potential and agree to work for a year for the government in an underserved area. It creates a plentiful supply of highly capable medical professionals, and thus low prices for excellent quality. It's the best place in North America to go for those services.

This is an excellent idea.

curious2 says

Means testing is a bad idea that keeps coming back, in Rin's comments also. Why should you care whether your doctor was born in a log cabin he built himself? "Oh, sorry he misdiagnosed your kid and blinded her for the rest of her life, but he had come from a dirt poor family so we gave him a scholarship, while dissuading better qualified candidates with $60k/year tuition."

Agreed. Talent, not poverty, should be the basis for such scholarships.

MMR says

Standard of living has gone down for long time

In Nixons America one breadwinner could support whole family, small house 2 cars maybe a boat.

Very few people can do that now.

Before boomers,
vs
After boomers.

It should be pointed out that during the last 40yrs, there's been migration into big cities. That partly explains the trend.

What do you mean "now"? Less than half a year after losing both Congress and WH to GOP? You absolutely sure this is a good time to push for lefty ideas?

Ironman says

Sounds like your parents didn't kick your ass and make you personally responsible for your actions.

You admit boomers didn't do a good parenting job, in addition to destroying the economy?

What the hell are they doing, waiting for Obama handouts?

What does it have to do with me? Who says I'm a millennial?
I'm just observing the facts laid in front of us: Boomers did a terrible parenting job in addition to destroying the economy.

Ironman says

rpanic01 says

I don't mind if my kids stay with the wife and I into thier 30s or more as long as they are productive.

Why would you want that? How can the kids learn, grow, mature and handle life's issues if they're living under your wing?

rpanic01 says

Everything is just a cycle and maybe its just going back to the way it use to be.

Kids use to live at home into their 30's in the past??? When was that?

Unless I move out of or my kids move out of California they might not have much of a choice, and as I said they would have to be productive no deadbeats.

Is it really that bad of a thing I had my dad live with me up until it became to difficult from his illness but my kids will always cherish the time with there grandfather that they would have not had otherwise. My one grandmother lived with my aunt and uncle, my great grandparents lived above my grandparents. Honestly I think something has really gone wrong with our society. A lot of older houses were built for multigenerational familys and have been turned into apartments or split up into separate housing.
http://www.nytimes.com/2010/03/19/us/19family.html

socal2 says

Unionized government bureacrauts don't have any accountability or incentive to save money and ferret out fraud.

That's why you privatize enforcement. Hey, privatization is always the answer. Let Private Firms pursue Medicare fraud and keep 25% of the haul. Lawyers' profit is a great motivator - and fear of it.

You know how many law firms would love to sue over $20 sprays of Lysol?

I believe the top 5 health insurance companies brought up $30B of their own stock in just two years, hardly suffering.

Whatever we're doing now doesn't work beyond any reasonable doubt, since our costs are astronomical but results mediocre.

Everybody, left and right agrees - only the stupid center of technocrats refuses to see the system they run and benefit from sucks and needed replacement two decades ago.
http://www.weeklystandard.com/insurers-profits-have-nearly-doubled-since-obama-was-elected/article/2005073
http://www.salon.com/2016/10/28/making-a-killing-under-obamacare-the-aca-gets-the-blame-for-rising-premiums-while-insurance-companies-are-reaping-massive-profits/

Whatever the solution, cost controls, at least for ER services, is a big starting point.

"Cost Controls don't work". Funny, works great in Japan. ~1% cost increases on medical care annually, while dealing with an incredibly aged population consisting of many lifelong smokers, and a smaller demographic behind it that has even fewer kids.

Ironman says

rpanic01 says

I don't mind if my kids stay with the wife and I into thier 30s or more as long as they are productive.

Why would you want that? How can the kids learn, grow, mature and handle life's issues if they're living under your wing?

Well, if they are productive, responsible and saving money it should be OK to live at home for some time. They will be able to save up for a down payment, and basically get an early boost towards financial prosperity.
But wait a minute......they are millennial. How can they be responsible?

Epitome of diplomacy right there. I always thought AF would be the finest ambassador America can produce.

You should see what Health Care CEOs and Senior Hospital Admins spend on Hookers and Blow.

Next on : Home Buyers California.

"What do you guys do?"

I'm a professional Feng Shui Consultant, and my wife is a part time Harpsicord tuner and Hamster trainer.

"Wow, a Harpsicord tuner?"

Oh, it runs in the family, Marv. My brother owns the West Coast's largest Hurdy Gurdy distribution center in Palo Alto.

"What's your budget?"

Uh, 1.5 Million is about what we'd like to pay.

"I think we might find some 1000-ish square feet, lower end, maybe fixer-uppers, in that price range."

FortWayne says

Epitome of diplomacy right there. I always thought AF would be the finest ambassador America can produce.

AF could make the perfect ambassador to N Korea. He would really intimidate that "crazy fat kid"
I think AF would make an even better ambassador to ISIS.

Ironman says

Strategist says

it should be OK to live at home for some time.

What's your definition of "some time"?

I guess it would be case by case.
If the kids are going for an MBA, PhD or Medical school, they have already shown themselves to be very responsible. They could leave at the appropriate time.
If the kids are school dropouts, lazy bums, and don't want to do anything, I would kick them out right away.
The rest are in between. It's a tug of war between letting them fend for themselves, and giving them every possible opportunity to excel in whatever they do in life.

APOCALYPSEFUCK_is_ADORABLE says

Kimfuck could be convinced to give up North Korea to the FREE! world for enough cigarettes and Big Macs.

That or a hooker going down on him with a razor blade in her mouth.

Lets go with the former. I like torturing dictators.

Lashkar_i_Trumpi says

I think we might find some 1000-ish square feet, lower end, maybe fixer-uppers, in that price range."

$1.5M in Palo Alto? Where?

BayArea says

Lashkar_i_Trumpi says

I think we might find some 1000-ish square feet, lower end, maybe fixer-uppers, in that price range."

$1.5M in Palo Alto? Where?

The landfill.

Lashkar_i_Trumpi says

You should see what Health Care CEOs and Senior Hospital Admins spend on Hookers and Blow.

They don't even have to steal the money, the free market shovels if into their bank accounts with a front end loader.

YesYNot says

bob2356 says

We need to decrease the costs of health care

Easier said than done. That was one goal of Obamacare. It should be a goal for a single payer system as well.

Reducing the cost of health care was never a goal of Obamacare. Getting the uninsured health insurance was the goal of Obamacare. There were a lot of smoke and mirrors budget tricks claiming ACA would save money, but they disappear quickly with an honest look at the program.

socal2 says

FP says

socal2, you seem to equate/confuse profit with expenses

Profits as a percent of revenue.

So do you think that the money health insurance companies spend on marketing polices, billing polices, collecting premiums, paying claims, political lobbying, campaign contributions, salaries, bonuses, legal work, setting rates, negotiating with doctors/hospitals, etc. etc, etc.all comes from the tooth fairy? It all is health care spending. So is the large amounts of money doctors and hospitals spend billing insurance companies. The insurance company profits are the least of it.

curious2 says

Dan and others have posted a chart showing how American spending leaps above all others starting around Medicare age. Some have noticed the increase becomes most noticeable around age 60, and so they don't blame Medicare, which starts generally at age 65.

You do know that ironbrains vaunted chart isn't anywhere close (like off by a factor of 3 or more) to medicare and HHS spending numbers don't you? I really think that medicare actually knows what they spent no matter what some random unknown source chart ironbrain came up with says. Its public record, go look it up. Here is Kaiser's numbers from 2011 since I still have it on my computer. Not anywhere close to ironbrains mystery chart.

bob2356 says

You do know that ironbrains vaunted chart isn't anywhere close (like off by a factor of 3 or more) to medicare and HHS spending numbers don't you? I really think that medicare actually knows what they spent no matter what some random unknown source chart ironbrain came up with says. Its public record, go look it up.

The chart I linked comes from Carnegie-Mellon via Forbes and elsewhere. It says annual per capita costs, not merely one or two federal components of those costs. I gave up looking up things for you because you remained the same: sarcastic, unappreciative, and toxoplasmotic. You don't even say what chart you're referring to, so maybe you meant a different one from the Carnegie-Mellon chart, and I am definitely not going to waste time trying to read your opiate- and opioid-addled mind. In your paranoia you used to accuse me of being MMR as an alias, which I found very flattering even though we are obviously different people, so who knows what chart you might be imagining now.

Update: I see you updated your comment to add a chart from the Kaiser's HMO empire showing a subset of Medicare spending that "excludes [enrollees] in Medicare Advantage." The Kaiser's chart also excludes Medicaid, other federal and state programs, private insurance, and individual payments. In other words, the Kaiser's chart presents only one subset of annual per capita costs, and thus does not refute the Carnegie-Mellon chart that I had linked.

curious2 says

The chart I linked comes from Forbes.

Ok I found the forbes link. Very interesting history of the numbers. It's a jumbled mess. A chart taken from of a local newspaper article about a 2010 study of a 2005 study with no peer review or data integrity of any kind done by researchers with no back round in medical. No data sets or methodology are given for either study for anyone to check on. That's very solid professional research.

curious2 says

It says annual per capita costs, not merely one or two federal components of those costs.

There are newspaper articles that say the moon landings are fake and there were WMD in Iraq. The original 2005 Kotlikoff and Hagist article that Fischbeck took his data from is titled Comparing Government Healthcare Costs in Ten OECD Countries. (note that only 5 made the Fischbeck study/chart, the US and the 4 lowest cost countries of the other 9) If you had looked you would have found It's a study of GOVERNMENT spending on health care (note that Fischbeck left out the government part in his study/chart). Want to comment on how much GOVERNMENT health care spending there is in the US before people start using medicare? Most health care in the US is private insurance before age 65, yet the US spending is top of the chart from birth on. The US numbers under 65 are government spending divided by the entire under 65 population, not just the medicaid eligible population making the chart even more distorted. The other 4 countries the population under 65 is almost all government spending. Just in case you didn't catch the implication it drives the US under 65 per capita cost on the chart down relative to the other 4 countries. A lot down.

Might want to give this a glance also before you genuflect before your chart again. http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/

The chart never made any sense to me, the numbers don't even come close to adding up. It seems like the it's true because I believe it should be true crew didn't do any thinking. Still want to stand on this hand or would you like to fold now?

curious2 says

a subset of Medicare spending that "excludes [enrollees] in Medicare Advantage." The Kaiser's chart also excludes Medicaid, other federal and state programs, private insurance, and individual payments.

Want to do the math and show how medicaid, other federal and state programs, private insurance, and individual payments can triple the per capita cost of basic medicare which takes care of most over 65s? Maybe ironman can help you out since he's so good at math.

bob2356 says

http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/

From that link: "UPDATE: Chart deemed bogus. See comments. Rest of post altered to reflect that fact, including a big red “X” through the chart." So, commenters on that particular site deemed that chart bogus. It remains at Forbes and elsewhere without retraction.

Nearly everyone who has looked honestly at the issue finds entrepreneurial over-utilization due to the Medicare fee-for-service payment model, including the New Yorker articles we both read and cited here on PatNet.

jazz music says

time to put forward a popular health care improvement. It shouldn't be too hard to do because the political base is broadened now.

By all means, write to your legislators and President, and I wish you luck with that. You are likely to find it very difficult to make progress because nearly every organization exists for the purpose of increasing its own revenue, and we have reached the point where they're basically butchering and poisoning people for power including revenue. The anecdotes are harrowing, flogging patients to the bitter end even when they've signed advance healthcare directives saying not to do that. The data are even worse. Please do try, but understand what you're up against. The patient population are brainwashed like hostages with Stockholm Syndrome, and the Congress represents the captors trying to maximize ransom. People are addicted to toxic placebos and the higher the price goes, the more "valued" they feel as "beneficiaries" of their insurance programs, which maximize cost-shifting and encourage patients to "get more" at the expense of their neighbors' kids. Well organized and highly educated professionals depend on that gravy train for their yachts, second houses, retirement plans, and fancy cars. Current law enables them to command literally infinite subsidies, and the revenue recipients will not give those up without a fight. You will be denounced as racist or whatever they can imagine to discredit you. And, remember, you're asking the Trump administration to behave nobly and altruistically rather than cutting a deal to make more money. But yes, please try.

bob2356 says

Want to do the math and show how medicaid, other federal and state programs, private insurance, and individual payments can triple the per capita cost of basic medicare which takes care of most over 65s?

You can do the math if you want to challenge the Carnegie-Mellon chart. Medicare spends over $10k/yr per enrollee, and Medicaid spends another $2k/yr per person over 65, so that's $12k/yr just for those two programs. Medi-gap, long term care insurance, and "personal resources" add a lot more.

bob2356 says

Reducing the cost of health care was never a goal of Obamacare. Getting the uninsured health insurance was the goal of Obamacare. There were a lot of smoke and mirrors budget tricks claiming ACA would save money, but they disappear quickly with an honest look at the program

Agreed that the primary purpose was to get more people covered by health insurance. A secondary goal, which was taken on in an effort to help finance the first goal was to make health care more efficient. Because there was a huge annual inflation of health care costs prior to Obamacare, you should judge the results by seeing how the annual increases changed under Obamacare. I cannot easily find charts to show this. If you have them, I'd be interested in seeing them.
Republicans primary goal is to lower taxes, particularly on the wealthy. They want to repeal Obamacare as well. This is really a secondary goal, which is there to help finance their primary goal. That doesn't mean that it's not a goal. The only reason that they cannot achieve it is that repealing without a replacement is unpopular, and they cannot agree on a replacement.

curious2 says

Nearly everyone who has looked honestly at the issue finds entrepreneurial over-utilization due to the Medicare fee-for-service payment model, i

I'd agree that fee for service is a major problem, especially when hospitals are run by corporations. People spend hundreds of thousands of dollars on treatments with little hope of any cure in the last 6 months of their lives. IMO, people want every chance that they can get, so they will go for it even when it's not worth it. It's not necessarily good for the patients even if a few people beat the odds.

Federal gov can't run anything right for all? Actually impossible, because too many people. How about Medicaid for all, run independently by each State.