patrick.net

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.

Here in Southern California, out of all the people I know my age (40) and younger, only one guy has bought a house without help from the parents. And he lived with his mom for like five years to save up the down payment himself.
I came here with no family support, built a family, and saved the money to get into a massively overpriced house as a team with my wife. It only took a dozen years...

I'm sure the hard noses out there think that is working as intended, but I suspect establishing a household here was far too difficult for the grand fucking majority of young people to manage. Everyone else with a house either inherited it or got hundreds of thousands from parents to help buy.

Quigley says

Here in Southern California, out of all the people I know my age (40) and younger, only one guy has bought a house without help from the parents. And he lived with his mom for like five years to save up the down payment himself.

Well, indirectly he did receive help from his mom.
It's almost impossible for a young first timer to buy a home in California without help from parents.

Quigley says

Here in Southern California, out of all the people I know my age (40) and younger, only one guy has bought a house without help from the parents. And he lived with his mom for like five years to save up the down payment himself.

I came here with no family support, built a family, and saved the money to get into a massively overpriced house as a team with my wife. It only took a dozen years...

I'm sure the hard noses out there think that is working as intended, but I suspect establishing a household here was far too difficult for the grand fucking majority of young people to manage. Everyone else with a house either inherited it or got hundreds of thousands from parents to help buy.

Dead on, same boat here. Even when I bought at the bottom it was a struggle, now its back to insane. I have many friends in 30s-40s that are completely priced out and will eventually have to leave CA unless there is another major crash. Timing is what got my family our house on our own, even with our income up 30% from 6 years ago we could never afford our current house in this market without being completely house poor.

These slackers are valuing staying in place over moving to a lower cost area to start a family. They are not the type you'd want to start families.

Ironman says

You do know that there are 49 other states to live in, right?? Isn't it YOUR choice to live in Southern CA?

You like to tell other people who to live with. Then, when they point out valid reasons for those living situations, you tell them that they could / should just live somewhere else. Nice guy. Do you spy on your neighbors with binoculars and then bitch about how they spend their time?

I have seen some positive examples of millenials living at home. Some were perfectly productive people saving some coin. A couple of these have moved out and one is still living with her mom and driving a beater although she works for a big consulting firm.
OTOH, another can't seem to get her head out of her ass and is very unproductive. She works, but never gets ahead due to various personality issues. Some tough love would either help her or create another homeless individual.

The overwhelming majority of my friends under 40 who bought a house in the Bay Area did so with parental financial assistance (downpayment money). With the rental prices here, saving $200k or $300k for a DP is extremely rare unless you are an income outlier.

Buying in the Bay Area totally on your own without any family aid is extremely rare from what I have seen.

Ironman says

You do know that there are 49 other states to live in, right?? Isn't it YOUR choice to live in Southern CA?

Yes it is. ''Tis my misfortune to have a profession that may only be practiced at a large port. Those only exist in metropolitan areas, which have high real estate prices. Of all the places to work outdoors, this was the best. So here I came and stayed. Now that the house thing is figured out, I can sort of relax. I have a very nice house five miles from the beach in a good school disctrict where my kids can walk to school for twelve years. My wife has a job at the local college. We are set, but we are extreme outliers.
Most people here who are established have money from other means than working for it. So to pretend that those who are unestablished are lazy slackers is disingenuous.
Most middle class Americans today were elevated here by hardworking lower class parents.
Pretending that the same opportunities exist as did for your generation is prevarication.

Ironman says

Nobody seemed to notice in the chart I posted above. Look which states have the largest percentages (hint: most are BLUE states). What a surprise... (not)..

Nailed it

I just visited DailyKos for a few minutes.

All the problems with Obamneycare apparently began late January, 2017. They alternately bash "Trumpcare", while laughing it didn't pass, while blaming the huge premium and deductible increases (yet again, year after year with Obamneycare) on Ryan's plan that didn't pass.

The compounding failures of Obamacare are now laid at Trump's feet.

Alternate Reality.

jazz music says

Straw Man says

What do you mean "now"?

Now, after the republican failure to repeal or replace, is not the time to gloat but the time to put forward a popular health care improvement.

With what army?

YesYNot says

IMO, people want every chance that they can get, so they will go for it even when it's not worth it.

I've seen multiple studies showing people make cheaper decisions when allowed to decide for themselves. It's mainly the hospital executives and other institutional pressures that drive the big ticket over-utilization, while entrepreneurial doctors (including kickbacks from diagnostic labs and other services) drive the routine over-utilization. Religious hospital corporations refuse to follow advance healthcare directives, saying their religion commands them to keep the patient "alive" as long as possible; some hospitals even involve the local police, removing patients involuntarily from their homes and inflicting treatments that the patients had specifically refused. It's a dynamic of cognitive dissonance and conflicts of interest: given a choice among many imperfect options, the natural and institutional tendency is to resolve uncertainty and ambiguity in the direction of self-interest. Institutions that maximize ROI get rewarded, and institutions that fail to maximize ROI get taken over as part of industry consolidation. Reducing hospital infections, for example, can end up costing medical staff their jobs, because the hospital's revenue falls and staff get laid off. Self-interested hospital executives make sure to focus on bringing in the business (I get constant direct mail brochures touting local hospitals), and maximizing the revenue from each sucker that walks in the door.

If you like books, I recommend The Good Nurse. It reports in depth the story of a serial killer who was convicted of murdering dozens of patients. He had probably murdered hundreds, and injured thousands. Hospital executives lied to police in order to cover up his crimes, and enabled him to move on to other hospitals and murder more people. The pattern echoed the Vatican covering up priests who molest children, moving them on to another parish to molest more children. Every single hospital executive who figured out they had a serial killer murdering patients chose to enable him to continue rather than stopping him, and zero hospital executives were ever punished for that. The book notes other, similar stories of serial killers working in hospitals, with murders eventually proved beyond a reasonable doubt. These were not "mercy killings," but actual malicious murders, including patients who had recovered and were about to be discharged to go home to normal lives. I've mentioned this book before, and some defenders of Obamneycare try to fight the example rather than considering the pattern. I don't know what percentage of iatrogenic fatalities result from intentional murder, but the point is the mentality: these instutitions are run by people who would (and did) literally enable a serial killer, even lying to police, for the purpose of protecting and maximizing institutional revenues and thus their own salaries.

curious2 says

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.

What facts about the problems of the two studies are wrong? Nice shuffle and jive. What happened to

curious2 says

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

It says per capita costs because Fischbeck skipped putting the word government in his study anywhere. And cherry picked his countries. and came up with numbers that aren't even close to what is in the public record. The real question is who paid for Fischbeck 's study and what were the results they wanted to see. This is the part where you say I fucked up. The chart really is only the government costs.

I never saw a retraction for the fake moon landing stories.

I added the address from the original post as my first item on https://whatdidyoubid.com:

https://whatdidyoubid.com/address/4/383-60th-street-piedmont-ca-94618

Site needs a ton of work and more features, but it's alive!

curious2 says

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.

Meaning you can't begin to come up with anything that supports your claims. You are really saying that the two sources of over 2/3's of the health care spending for over 65's come up to 12k a year and the other third manages to triple that? You really want to try and sell that? Nursing home care last year was 150 billion out of 3.2 trillion. Hell of a big tail wagging that dog. You really do need ironbrain to help you with math.

It's not the Carnegie-Mellon chart. It's a Carnigie-Melllon professor of social sciences chart. He freely admits he did it totally on his own with his own database. It's not like it's some kind of official peer reviewed Carnegie-Mellon research no matter how many times you meaninglessly throw around the school name.

I am not familiar with the first five states but I am with Hawaii and California. You think housing prices are crazy here relative to incomes go try Hawaii. Biggest industry is tourism and there's no way a valet attendant and a front desk worker are able to afford $600k + homes.

I'm willing to bet Hawaii should be above California on this list. I know so many people there living with parents or in multi generation homes it's crazy. I always wondered how people can afford new cars/trucks on hourly wages then I realized they aren't paying shit for rent or living expenses, in fact many don't even buy food for the house and expect mom to still cook for them.

It's a societal norm over there so lots of people don't look down on it.

YesYNot says

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.

Insurance companies are a big part of the cost of health care. Adding more people to the system doesn't make it cheaper. That's like adding water to drain the swamp.

@Patrick , good candidate property to start. Although the link isn't working for me.

BayArea says

$1.5M in Palo Alto? Where?

The couple isn't looking in Palo Alto; the Brother of the wife has a Hurdy Gurdy Warehouse in Palo Alto. Right next to Spatula City.

BayArea says

Patrick , good candidate property to start. Although the link isn't working for me.

How about now? Please hit https://whatdidyoubid.com/address/4/383-60th-street-piedmont-ca-94618 and let me know if that works.

Thanks!

APOCALYPSEFUCK_is_ADORABLE says

How about Charles Manson?

Today he'd qualify as a mainstream Republican, virtually indistinguishable from O'Reilly.

No good. He's not as prone to violent outbreaks as O'Reilly.

APOCALYPSEFUCK_is_ADORABLE says

Who Will Replace Obscene Phone Caller Bill O'Reilly on Fox?  

What about Shia LaBeouf? No wait, he looks too much like a Muslim with the beard. Fox News audience will never accept him with that foreign sounding name anyway.

Ironman says

Yes, you normally do... Now how do you explain this chart?

Our system is the most privately run, most non-transparent, and shittiest in the world. It has all of the problems of capitalism and few of the benefits.

www.youtube.com/embed/LQdObqEWscU

Sign in to make your opinion count. Sign in 14 Loading... Loading... Loading... Rating is available when the video has been rented. This feature is not available right now. Please try again later. Published on May 30, 2015Really the most intense ever Category Comedy License Standard YouTube License Suggested by DHX Media Shopkins Taco Terrie Easter Egg Hunt Shopkins Videos BEST Easter Play Adventure RaInBoW PoP 7 Show more Show less Loading... Autoplay When autoplay is enabled, a suggested video will automatically play next. Up next

bob2356 says

It says per capita costs because Fischbeck skipped putting the word government in his study anywhere.

According to YOUR LINK, he "used total medical expenditures for each country using OECD data."

As for cherry-picking, YOUR LINK says he omitted some of the countries where spending was "in between", meaning they were irrelevant to demonstrating the range of costs. If you can recall math, you might remember that the high and low extremes define the range. Whatever is "in between" does not change the range.

Some of the commenters in YOUR LINK defended the chart, including one who posted anecdotal observation similar to what I've seen among my own neighbors: people becoming eligible for Medicare and then getting surgery that makes them worse off, when their original complaints had been minor. Nobody at your link produced a better chart or better comprehensive data, and meanwhile we see an abundance of reports documenting entrepreneurial over-utilization that makes patients worse off.

Bob, you might feel better simply arguing with yourself. Create a second User account, and switch between accounts each day. You can harangue yourself all day long. At least you would have a better chance of winning. Meanwhile, you're fighting against a chart, without presenting a better one. American per capita spending remains the highest in the world, and at least a third of it (I'd say most) goes to waste, fraud, and abuse, including widely documented entrepreneurial over-utilization to maximize revenue. In California, we see Medicare HMO corporations suing each other like cattle ranchers fighting about poaching cattle, and the battles between them give a glimpse of the enormous revenues at stake. If you don't like the chart that Forbes and others published, then produce a better chart, but remember to use "total medical expenditures for each country" as YOUR LINK says Fischbeck did.

curious2 says

I don't know what percentage of iatrogenic fatalities result

I read the linked study in full, and can appreciate most of the points. I think that like unwinding Social Security, unwinding Medicare would be very difficult for the same reason. People have paid into the system and are owed huge benefits. To cut off medicare for them would require buying them out in some way, which is essentially paying for the 'unfunded liabilities' today rather than when the bill comes due. I also think that where the rubber meets the road (defining what is catastrophic rather than a predictable expense) is the hard part. Nevertheless, I agree that lack of cost transparency and responsibility takes away any incentive of the customer for reducing costs. This is the major problem with the system. I gave Trump credit for making comments about cost transparency during the election. But, this is an obvious problem without an easy solution. I'll give him or anyone else credit if they can get that implemented.

APOCALYPSEFUCK_is_ADORABLE says

Really? I can't remember the events, but why do you think that is?

I believe that he is a Eunuch. Even if he tries to harass women, they can just piss in his face and call it a day. What's he going to do about it? I read that his show keeps getting bumped up to take the place of various people who left or got the boot.

I hope that was good therapy for the snowflake that made it. I'm sure Donald got a good chuckle out of it, I know I did.

YesYNot says

People have paid into the system and are owed huge benefits

A big theoretical difference is the actual benefits don't need to cost nearly so much. With already more than a third going to waste, fraud, and abuse (I still say more than 50%), a more efficient system should deliver better results at lower cost.

The problem in the medical sector is not the people who have paid in and are owed benefits. The problem is the pigs at the trough who maximize the cost, including unnecessary and injurious "benefits," and lobby for more of the same. To the extent the two problems are related, it's because patients have become like hostages with Stockholm Syndrome, taking on the perspective of their captors. Patients demand more subsidies rather than lower costs, because that's what their captors/providers tell them is best.

I love that new wife smell.

curious2 says

Patients demand more subsidies rather than lower costs, because that's what their captors/providers tell them is best.

This.

This is not a violent meme.

I am going to miss mean old O'Reilly beating liberals to a pulp with his Jesus statue.

It's going to be hard to find somebody with the same aura of grandiose, prickish self righteousness. Many are called, but few can pull it off.

It's a revolt of the fading beauty leg-crossers!

jazz music says

Straw Man says

With what army?

Heheh the army of people that have their eyes opened to looking at no access to health care they can afford because the system is all about maximizing speculator passive gains for doing nothing, ohhh yeaaaaahhhhh.

You don't have said army at your disposal judging from the results of the last election. So there is nothing to "push" with. Try again after winning. Want me to remind you when the next election is? Hint: it's not "now". Your timing is waaay off.