The Government and Universal Healthcare

[editec]

That 45% or more that government provides along with the managed care and third party payors is what's driven health care up, not free markets.

I actually mostly agree with that premise, JR.

Now the fact that the government took on responsibility for paying for millions of us has GOT to be causing an increase in costs because that is one of those market forces that simple exists.

Additionally better HC (thanks to changes in medicine) are driving up costs.

Additionally the fact that Americans are getting older, is ALSO driving up the cost of health care, too.

I can go to a free market Doctor and pay $50 office visits, I can go to nurse practitioner clinics on nights and weekends for $40, the shots and tests are anywhere from $5 for a blood glucose test to $40 for more elaborate tests and shots, my hospital is covered for $70 a month, I can get my blood work done at a free market lab for $10-$50 so the free market clearly is very competitive. The free market is like any other, they strive to provide the best for the least cost where government payments give incentives to charge the most or any other type program where the consumer isn't responsible for the cost.

Here I'm afraid we have to disagree somewhat.

HC purchasing decisions is NOT like purchasing decisions in other markets.

Substitution or deciding that you can do without is not really something most people can do when it comes to HC.

And when you go into a store to buy most products, the salesman isn't the guy telling you what you MUST have, either. OTOH, you doctor most definitely IS the guy deciding what services you'll be buying, true?

Micro Economist after micro-economist has proven this to the satisfaction of everyone who studies the business of health care. My MBA was specialized in the BUSINESS of health care, so about this subject I know a little of what I speak.

Now that is NOT to say that market forces do not ALSO effect the cost of HC, but buying an apendectomy is not very much like deciding what TV to buy or what car to buy.

Actually, most people DO make substitutions and decide to do without when it comes to healthcare they're paying for. You never noticed, for example, your pharmacy offering you the generic brand instead of the name brand on your medications?

Yeah that's a good point. But in the grand scheme of HC that's not really significant. You're there to get meds because your MD told you you needed them.

You didn't know that people decide not to run to the doctor with every sniffle and cough when they have to foot the bill for the visit?

That is not driving up the cost of HC, amiga. There has always been the hypocondriacal patents. But the vast majoiryt of HC costs have nothing to do with people who are wasting the resources.

Shopping for health care would be just like shopping for any other important necessity in life if it were actually possible to treat it like just another commodity.

I'm sorry if I cannot explain this to you to your satisfaction, but HC is not just like every other commodity.

HC is not even close to being like other commodities in terms of supply and demand, actually.

 

[johnrocks]

Resources are being wasted, in 1960, consumers paid appox. half of their HC costs and that has dwindled down to appox. 13% now, it is a direct correlation between that and costs, I would eat Steak everyday if government was buying it for me and not even do comparison shopping.

 

[sealybobo]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

 

[Meister]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

Are you talking about quality healthcare or, just like what Europe, and Canada have??? You know, if you make statements like you did, you have to be precise in what kind of healthcare you want. Because if you want real good healthcare from our government...your not going to get it.

 

[Andrew2382]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

 

[Meister]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

point taken...thanks

 

[DiamondDave]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

Even more of a moron than I though.. as I see when others quote posts by him where he is in some attempt to argue/converse with me in a post... and has not figured out that he is on my ignore list.. even though it clearly states it in my sig line



Meister.. the key is to ignore that fruitcake assclown... the more people that will ignore and not reply, the more his little attention seeking raving will convince his tiny brain that he needs to go elsewhere with his trolling

 

[Andrew2382]

you know Dave, I think you are right....I never liked ignoring people because I like proving their stupidity like I do with Sealy over and over...however the trolling does get to a point.

You know he types what he types just to agitate people no tbecause it's what he thinks.

I may have to join you on the ignore wagon

 

[Meister]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

Even more of a moron than I though.. as I see when others quote posts by him where he is in some attempt to argue/converse with me in a post... and has not figured out that he is on my ignore list.. even though it clearly states it in my sig line



Meister.. the key is to ignore that fruitcake assclown... the more people that will ignore and not reply, the more his little attention seeking raving will convince his tiny brain that he needs to go elsewhere with his trolling

Thanks, Dave...I'm still learning the ropes.

 

[sealybobo]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

Are you talking about quality healthcare or, just like what Europe, and Canada have??? You know, if you make statements like you did, you have to be precise in what kind of healthcare you want. Because if you want real good healthcare from our government...your not going to get it.

Well don't you think rich people will still get better healthcare than you and me?

Then I suspect you will probably have the ability to get some kind of premium healthcare.

I don't know what the exact solution is going to be. You're just assuming this new government we have is going to be as bad/corrupt/inept as the last one was.

This is something we could never accomplish if the GOP were in control of any of the three houses. They would protect the health care corporate giants who have fucked up that system just as bad as the oil guys fucked up, the energy guys, the banker guys and the housing market guys. Give corporate greed too much power and this is what you get.

The GOP didn't offer any solutions on this in 8 years. Instead, your cost went up 199% from 2000-today. That's great if you own a pharmacutical company, or have a lot of stock in one, but not if you need healthcare.

And finally we can take this off the companies plate. This will make them more competitive with the rest of the world.

We can have better healthcare, for less, and cover everyone.

Or we can continue with what we have now, which sure aint much.

I suspect if you are an average joe, the quality of your healthcare will stay the same.

Now bring on the next scare tactic, about how modernizing the system might violate someone's privacy, etc.

PS. Fuck excluding anyone for a pre existing condition. Suck it up! You cover the best and the worst of us. It's called spreading the risk. Works just like life insurance. The more people that are covered, the more we spread the risk around, the cheaper the cost.


PPS. All we want is the same healthcare John McCain gets. Have you seen the Senate healthcare plan? Very nice!!!

 

[Andrew2382]

ahh this is so nice..THANKS DAVE

This message is hidden because sealybobo is on your ignore list.

 

[sealybobo]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

Even more of a moron than I though.. as I see when others quote posts by him where he is in some attempt to argue/converse with me in a post... and has not figured out that he is on my ignore list.. even though it clearly states it in my sig line



Meister.. the key is to ignore that fruitcake assclown... the more people that will ignore and not reply, the more his little attention seeking raving will convince his tiny brain that he needs to go elsewhere with his trolling

Thanks, Dave...I'm still learning the ropes.

Dave's a jackass.

 

[DiamondDave]

ahh this is so nice..THANKS DAVE

This message is hidden because sealybobo is on your ignore list.

Any time

And people just have to start remembering not to quote the assclown.. that's the only time you actually see his posts... hell, even PM's are blocked/flagged like that with ones on the ignore list...

Now if others would start doing all this, the board would certainly start becoming a better place

 

[editec]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

Are you talking about quality healthcare or, just like what Europe, and Canada have??? You know, if you make statements like you did, you have to be precise in what kind of healthcare you want. Because if you want real good healthcare from our government...your not going to get it.

If you could actually PROVE that Canada or most of Europes HC systems were inferior you would.

I defy you to do that.

You cannot because I KNOW the morbitity and mortality statistics prove eexactly the opposite of what you believe.

Do feel free to do your own research to refute my claims.

I'll wait...forever...because you won't be able to refute my claims.

 

[editec]

ignore Sealy

He is a fucking moron and never brings up any points in his comments

ACtually in this case, Andrew it is you looking moronic.

And I have to tell you, on you it doesn't look good.

Do some research.

 

[Andrew2382]

Your opinion means everything to me ed

 

[Meister]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

Are you talking about quality healthcare or, just like what Europe, and Canada have??? You know, if you make statements like you did, you have to be precise in what kind of healthcare you want. Because if you want real good healthcare from our government...your not going to get it.

If you could actually PROVE that Canada or most of Europes HC systems were inferior you would.

I defy you to do that.

You cannot because I KNOW the morbitity and mortality statistics prove eexactly the opposite of what you believe.

Do feel free to do your own research to refute my claims.

I'll wait...forever...because you won't be able to refute my claims.

Can you answer why Canadians and Europeans come to this country for treatment?? I bet it's because they have such superior healthcare over ours...huh?
Can you answer why private clinics in Canada are starting to open their doors to private healthcare?? I bet it's because they have superior healthcare over ours...huh?
Mortatality has nothing to do with healthcare, It's more like our lifestyle that creates it. You do your fucking reasearch and refute my claims. Geeze, kind of pompous aren't you? Don't let the facts get in the way of a good story, OK?

 

[DiamondDave]

The American people, including myself, don't understand just how much money we all spend on healthcare. It is a no brainer that we should all have at least what our grandparents get.

And with single payer, it should cost us all less!!!!

And EVERYONE will be covered!!!

No brainer.

Now bring on the corporate beasts who will tell us why we can't.

Are you talking about quality healthcare or, just like what Europe, and Canada have??? You know, if you make statements like you did, you have to be precise in what kind of healthcare you want. Because if you want real good healthcare from our government...your not going to get it.

If you could actually PROVE that Canada or most of Europes HC systems were inferior you would.

I defy you to do that.

You cannot because I KNOW the morbitity and mortality statistics prove eexactly the opposite of what you believe.

Do feel free to do your own research to refute my claims.

I'll wait...forever...because you won't be able to refute my claims.

It is like when people use the "WHO" rankings as their "proof".. we the FACT is that in terms of the amount of care, medical advancements, availability of facilities, quality of facilities, etc the US actually is the top of the bunch...

Age mortality rates are NOT only impacted by the quality of the 'healthcare' system or the available healthcare.... not to mention it has been shown numerous times that the 'data' provided from wonderful shitholes like Cuba (who claim a better 'system' of care) is put into SEVERE question...

Other healtchare 'systems' can say they 'cover' everyone or whatever they want... but when it comes down to it, what hospitals, doctors, types of services, etc that we have here DWARFS anything that is available in any other cuntry... we have the top rated hospitals in terms of quality.. we have the top doctors.. we have the top medical training.. we have the top research...

We just do not have a system where people are just handed healthcare for simply existing, all at the expense of someone else.. nor should we have that... your personal care is not someone else's responsibility.. you body is not like a road and the public domain of the country and all citizens of the country... your body and your health and your upkeep is your concern and your responsibility, not that of others

Should there be improvements with us on ability to be in a group plan, etc? Yep... I think there is much to be improved there, when about the only time you can join a group plan is thru your employer... if you had a choice between a group plan thru your community, thru your employer, thru a club you belong to (Elks or the NRA or PETA or whatever), I believe the problems of price and availability and choice would be greatly improved.. you could shop available plans, coverage, price, etc thru all the group plans you have access to...

 

[LiveUninhibited]

What amazes me most is there are still people who argue there is no problem with American healthcare, or that it can be fixed with tax credits, but they are underinformed. America spends over 15% of its GDP on healthcare, which is the highest in the world, and this value is expected to reach 20% in the next decade. Medical bills are also the most common reason for personal bankruptcy. These drawbacks might be tolerated if America also had the best health in the world, but according to organizations like the World Health Organization, America is in the middle of the pack of all nations, and near the bottom when compared to other developed nations. Basically, we don’t get what we pay for, but many wonder why.

The issue of healthcare reform wouldn’t simply be fixed by making it government-funded. But effective, comprehensive reform would have to involve moving to a quasi-single-payer system.

Healthcare needs to be socialized, but I wouldn't extend that to all of the economy. See healthcare is different from other sectors of the economy. How much are people willing to pay for a procedure that will save their lives? There is no upper limit. The answer is whatever it takes or whatever they can come up with. Thus the traditional rules of supply and demand do not work for healthcare. Without a single payer, the cost goes to the highest bidder as doctors are not exactly in a desperate situation.

There is also a much, much higher than usual asymmetry of knowledge. There's some asymmetry when a sleazy car salesman tells you that the crappy looking car runs great. But even if you're not a car expert, you can test his claims to some extent. Effective healthcare requires so much specialized knowledge that very few consumers have any basis to second guess what their doctor says. If their treatment is ineffective they can simply claim they did all they could or you would have been worse off if not for them. Most doctors are honorable, but some consciously or subconsciously recommend expensive procedures in questionable circumstances. Again, regulation under a single-payer system could help here.

Finally, need is very unpredictable for most people. Where need is predictable, private insurance will treat you like a hot potato. You can guess how much food you’re going to need next week and about how much it will cost. You don’t know if you’re going to need an emergency surgery in the next year or even within your lifetime, or if it will cost a few thousand or hundreds of thousands of dollars. This necessitates some kind of insurance for pooling of risk, but then when the private insurance company sees that bill they often find it cheaper to use their mercenary army of lawyers to deny you coverage.

Healthcare throughout the world is facing a challenge because of aging populations. America has done worse than the other industrialized or post-industrial nations (except South Africa, which also relies on the private sector) on most measures, despite the fact that we spend dramatically more.

Whatever virtues you might wish the free market has, it will reliably push towards one goal: profit - not health. I would argue that the quest for profit doesn't always lead to bad outcomes, as Adam Smith argued, but in this case it does. This worked better, if not ideally, when our main source of mortality/morbidity was with acute infections and diseases as at the turn of the 20th century. The interventionist ideology that is emphasized in America more than elsewhere developed not only because some doctors and insurance companies are greedy, but also because it was effective versus these infectious diseases that used to kill people most. With these problems mostly dealt with in industrialized nations, we are now being killed by chronic conditions like diabetes, cancer, and heart disease. The way to deal with these is not acute intervention, as medicine in America is set up to do, but rather long-term prevention. A penny of prevention can literally be worth a dollar of intervention when you consider how expensive surgery can be. Furthermore, the private sector has demonstrated its incapability of effectively adapting to new times except for the purpose of making profit at the expense of patients. It is time for the government to take a bigger and smarter role.

It would be okay for the free market to handle healthcare if profit and effective healthcare were not incompatible. Unfortunately they are because, from the provider's perspective, prevention is not something to encourage because it is a lot less profitable than intervention (usu. surgery). Why would they want to get 1,000 dollars from a decade of doctor's visits when they could gain 100,000 dollars or more from the one surgery the patient needs without preventive care?

From a coverage perspective, preventive care is not something private insurance companies emphasize because it is unreliable whether or not they will see the benefit: the person covered often switches insurance companies. Then when somebody does have a health crisis, it is in their interest to deny them coverage and let them die if they can possibly legally do so. Hence their favorite phrase: Pre-existing condition. Sorry sir, you've been dying since the day you were born.

A single payer system, whether it be administered by states with federal matching funds or just an overall federal system, would definitely help us with this problem and others. I don't expect it to be amazingly efficient, but it would be easy for it to do better than the private sector has and with effective leadership could do very well. I am not convinced my state is competent enough to do this. However if it is done we will need to seek guidance from our own VHA, which made a dramatic and sustained improvement 10 years ago, as well as other countries like the Japanese and French. Since the government's goal would not be profit but rather breaking even and working within a budget, this could promote a movement towards evidence-based medicine, preventive care, and overall healthcare with the purpose of improving health, not profit.

Here is a list of the reforms I would suggest:

1. National health insurance with income-adjusted copays for interventionist tx, and free prevention-based care. Another consideration for copays is whether there is evidence to support the clinical effectiveness of the tx. The government can use its leverage through a quasi-single-payer system to bring costs down. (Quasi since supplemental insurance would be allowed, but probably not necessary)

2. More general practitioners, with an emphasis on prevention-based care and patient education. This could be facilitated with state or federally funded tuition forgiveness programs for doctors who choose to go into general practice. People need to learn to see their GP regularly to avoid crises, rather than wait until a crisis occurs.

3. Salaried doctors with bonuses for outcomes (pay for performance = P4P), P4P on the hospital level too. Greatly reduce hospital/clinic level reimbursements for interventions; modestly increase hospital/clinic reimbursements for prevention.

4. Electronic medical records and software like VistA. These help to coordinate care.

5. Evidence-based medicine.

6. Revise malpractice law in (at least) two ways:
a. Put a cap on pain and suffering damages that can be awarded, limit lawyer contingency fees, but still award full amounts for medical costs incurred as a result of a medical error.
b. Allow informed patient choice in addition to informed consent so that doctors/hospitals can provide unbiased decision-aids when a patient is considering undergoing an invasive procedure so that they can weigh the risks against their own priorities.

7. Provide better regulation of the pharmaceutical industry.
a. Require “new” drugs to be compared to both the existing treatment and a placebo at comparable doses if possible. In order to be approved the drug must show some kind of significant improvement over existing tx in some situation. (currently only placebo comparison is required, so we get a lot of copycat or “me-too” drugs).
b. The FDA needs more funding, and must be made independent of the industry it regulations, e.g. repeal “user fees.” Drug companies can currently legally pay money to expedite the approval process.
c. There should be no way to extend a drug’s patent, e.g. by suing generic manufacturers or testing the drug in children, but the patent time should not begin to be used until the drug hits the market.
d. The government should be able to negotiate for better drug prices (one major problem with medicare is they can’t by law).
e. Pharmacies should not be allowed to sell the prescribing patterns of individual doctors to pharmaceutical companies.
f. Drug companies should not provide continuing medical education to doctors.
g. Ban DTC ads.
h. Drug companies should be required to disclose and make publicly available basic financial information about R+D, marketing, and other costs vs. profits.

8. Eliminate the way special interests control politicians in America:

Scores of members of Congress, for example, accepted contributions from the same pharmaceutical companies that reaped millions of dollars of additional profit from the provision in Medicare Part D legislation that prevented the government from negotiating discount prescription prices for beneficiaries.

http://www.nytimes.com/2008/07/06/business/06view.html

 

[DiamondDave]

Jesus Christ.. another WHO parrot



Try looking at the fucking criteria the WHO used.. it did NOT even deal with the services available.. level of procedure advancements... types and numbers of procedures available...

The WHO report is a fucking joke