Welcome to the MacNN Forums.

If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below.

You are here: MacNN Forums > Community > MacNN Lounge > Political/War Lounge > Repeal of Obamacare

Repeal of Obamacare (Page 11)
Thread Tools
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 02:10 PM
 
Originally Posted by Laminar View Post
I said "cost," not "price." Insurance companies currently pay whatever "price" they manage to negotiate.
Precisely. Price is a function of cost. Our problem is high costs, which leads to high prices. How does single payer fix this?
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 22, 2017, 02:28 PM
 
Originally Posted by Snow-i View Post
Precisely. Price is a function of cost.
This is absolutely 100% untrue.

Price is a function of what people are willing to pay. Cost has VERY LITTLE impact on price.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 22, 2017, 02:29 PM
 
Originally Posted by subego View Post
Doesn't the entire EU have single payer?

I can dig up the master WHO rankings of healthcare systems if you want, but if you're willing to take my word, we do better than a big hunk of Eastern Europe.
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 02:33 PM
 
Originally Posted by Laminar View Post
Well then let me ask you this (you may have already answered it so sorry if I'm making you repeat yourself): How does every nation with single payer achieve A) lower costs per capita and B) better outcomes. The question has two parts, and sources must be cited.
Because the costs in general are lower in those countries. Costs such as:

-Medical Wages
-Medical schools
-Medical facility construction
-Insurance for said facilities
-Property
-transportation
-emergency services such as helicopters and ambulances.
-infrastructure to support the emergency services.
-medical equipment (manufacturing to delivery)


Those things all cost considerably more in the US - single payer won't do anything to address those costs. I could cite numbers for all the above, but we'll start here (and I definitely can't be accused of bias with this source):

http://www.motherjones.com/kevin-dru...ther-countries

Single payer will not address any of the problems with costs. Our problem is costs. If you want prices to go down, you need to cut the costs. The margin is already under 3%, meaning there's nothing else really to cut besides costs. No one can connect the dots on how single payer would do a damn thing for any of these costs, aside overhead (which again, is not exactly something the government is good at AND would have no motive to keep under control). If you think that the government would come in and be more efficient than the profit motivated companies today in reducing overhead costs, well, I don't even have words for that - just a facepalm. The government has never been good at cutting costs, nor would this time be any different.

Simply dedicating less money to these things will absolutely 100% reduce the quality of care. No one has been able to connect the dots on how single payer would reduce these costs.


Your options for cutting costs are:
1. Pay less in wages and deal with the subsequent dearth of medical staff quality and quantity. Who would pay half a mil & a decade of their life to go to medical school when there is just no financial incentive to do so? You'll get what you pay for here.
2. Pay less for facilities, infrastructure. This will adversely impact the quality of care as you'll get what you pay for.
3. Pay less for medical schools - you'll get what you pay for here, and no, it won't be better care.
4. Pay less for equipment - at the same time no one will invest in developing new technologies as there is just no more ROI here. You'll see investment bottom out and the industry will not deploy new technologies as it will simply be too expensive/risky with no prospect of an ROI.



I need someone to connect the dots on how single payer can significantly reduce [i]costs[.i] in the industry. Not the price, the cost. In the US, where costs in general are higher. Hint: it won't - it'll either artificially reduce prices (which will result in quality of care/access falling to the level that the costs support), or it'll continually run at a steep deficit leading to insolvency. You can also forget about new technologies and/or cheaper treatments, since no one will invest in new tech since there is no ROI and absolutely no reason to take the risk that comes with developing new technologies.

If you want to go single payer, you've got to get costs under control. The correlation between single payer countries and lower costs is NOT causative - infact it's the reverse - lower costs all around allow for the viability of single payer.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 02:50 PM
 
Originally Posted by Laminar View Post
This is absolutely 100% untrue.

Price is a function of what people are willing to pay. Cost has VERY LITTLE impact on price.
What? You're saying cost has little impact on price? Really? The margins are under 3%, so you're saying that the costs, which are 97%+ of the price, have very little to do with the price? What are you smoking dude.? Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Healthcare is not a collectors market. The demand is more less constant (with a slight increase year over year). Supply is not being artificially or otherwise constrained, so unless you plan on the government somehow increasing the supply of medical goods and services (somehow by paying less money for it?), I'm really not sure how you came to the conclusion this would reduce prices.

It's an equation that sums to 0, so pick where you want to take from to make both sides even out. There really isn't anything to take from margin, sooo

Edited to add:

Price = Cost + Margin (<3% in this context)
( Last edited by Snow-i; May 22, 2017 at 03:09 PM. )
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 22, 2017, 02:54 PM
 
Originally Posted by subego View Post
Doesn't the entire EU have single payer?

I can dig up the master WHO rankings of healthcare systems if you want, but if you're willing to take my word, we do better than a big hunk of Eastern Europe.
You mean all the satellite states that were behind the iron curtain until 25 years ago?
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Online
Reply With Quote
May 22, 2017, 03:09 PM
 
Originally Posted by Laminar View Post
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
This is a fair point, but then it circles back to whether comparing the U.S. to the paragons of Western Europe is apples to apples.

Which gets us the same old list of primary differences.

Geography
Population density
Ethnically non-homogeneous
Defense spending
Old infrastructure
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 03:18 PM
 
Originally Posted by subego View Post
This is a fair point, but then it circles back to whether comparing the U.S. to the paragons of Western Europe is apples to apples.

Which gets us the same old list of primary differences.

Geography
Population density
Ethnically non-homogeneous
Defense spending
Old infrastructure
Don't forget much lower costs of living, and costs for all the ingredients that make up healthcare
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Online
Reply With Quote
May 22, 2017, 03:21 PM
 
Originally Posted by The Final Dakar View Post
You mean all the satellite states that were behind the iron curtain until 25 years ago?
Yes.

And moreso than I thought because it looks like the paper's from 1997. My bad.

http://www.who.int/healthinfo/paper30.pdf

List is on page 18.

Though we do (did) manage to be a stone's throw from Denmark, and make New Zealand look bad.
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Online
Reply With Quote
May 22, 2017, 03:22 PM
 
Originally Posted by Laminar View Post
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
Turns out my source was from 1997, so my argument takes a hit here.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 22, 2017, 03:45 PM
 
Originally Posted by Snow-i View Post
What? You're saying cost has little impact on price? Really? The margins are under 3%, so you're saying that the costs, which are 97%+ of the price, have very little to do with the price? What are you smoking dude.?
You broke the rule about citing sources.

Whose margins? The margins of the insurance companies that don't need to exist? The margins of employees whose job it is to negotiate prices between a hundred companies and a thousand providers? The billing departments of each and every hospital, clinic, and doctor's office that spend countless hours going back and forth with patients and providers trying to figure out who owes whom what percentage of what made up price? Surely you recognize the inefficiency there.

[quote]Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Take Business 101, if you're charging less than someone is willing to pay, you're undervaluing your product and missing out on money.

Why do you think the cash price that providers list are always so much cheaper than the "negotiated" insurance price? Because they will charge exactly how much the insurance company is willing to pay, and not a penny less. They'd be idiots to accept less.

Price = Cost + Margin (<3% in this context)
Waiting on that margin source and your comments on the cost of insurance overhead.

I'm beginning to see where you're coming from - you think an MRI actually costs a provider $1500 (-3%), and you'll rationalize it by assuming there's some cost of equipment and R&D and pharmaceutical research and some other stuff, without realizing that an MRI costs $1500 because insurers will pay $1500 for an MRI. Walk in and pay cash and it will run you $400.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 22, 2017, 03:52 PM
 
Originally Posted by Snow-i View Post
Because the costs in general are lower in those countries. Costs such as:

-Medical Wages
-Medical schools
You cited those, but those are easy. Let's get to citations on these:

-Medical facility construction
-Insurance for said facilities
-Property
-transportation
-emergency services such as helicopters and ambulances.
-infrastructure to support the emergency services.
-medical equipment (manufacturing to delivery)
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 03:55 PM
 
Originally Posted by Laminar View Post
You broke the rule about citing sources.
To be clear, are you arguing for single payer, or are you just trying to nitpick my argument while ignoring it's main points?
Whose margins? The margins of the insurance companies that don't need to exist?
Yes - they are under 3% today. Is your argument ideological or are we trying to come up with a solution?


The margins of employees whose job it is to negotiate prices between a hundred companies and a thousand providers?
No, the margins of the insurance providers (who single provider would be replacing).

The billing departments of each and every hospital, clinic, and doctor's office that spend countless hours going back and forth with patients and providers trying to figure out who owes whom what percentage of what made up price? Surely you recognize the inefficiency there.
Nothing like a government bureaucracy to fix that

Hows the post office doing?

Lets make getting critical medicine like going to the DMV! Brilliant!
Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Take Business 101, if you're charging less than someone is willing to pay, you're undervaluing your product and missing out on money.
Are you arguing that the sub 3 percent margins are too high? Or that they should be higher? I'm really not sure - but your argument seems ideological and not grounded in how to fix the market.

Also, that someone is willing to pay the cheapest price for the same service. I.e. if someone else offers the same thing (or roughly) for cheaper, they will pick that 10/10 times. What you're describing is a monopoly, like if there were only one entity pay....wait a second!


Why do you think the cash price that providers list are always so much cheaper than the "negotiated" insurance price? Because they will charge exactly how much the insurance company is willing to pay, and not a penny less. They'd be idiots to accept less.
Yes, and at 3% margins, I'm not sure this is where the problem lies. Do you?


Waiting on that margin source and your comments on the cost of insurance overhead.
https://www.forbes.com/sites/theapot.../#6653194f3c3a

Margins for US insurance (which is what single payer would replace).

I'm beginning to see where you're coming from - you think an MRI actually costs someone $1500, and you'll rationalize it by assuming there's some cost of equipment and R&D and pharmaceutical research and some other stuff, without realizing that an MRI costs $1500 because insurers will pay $1500 for an MRI. Walk in and pay cash and it will run you $400.
\
The margins for those paying less than 3%, so it actually costs the payer $1455- if no one's looking at how much it costs, no one is going to care how much it costs. But if you are arguing for single payer, you need to describe how the MRI would be less than that $1455 something everyone else is failing to connect the dots on. Again, the margins are less than 3% - the other 97% making up costs, so you can't take anything from the margin.
( Last edited by Snow-i; May 22, 2017 at 04:10 PM. )
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 22, 2017, 04:10 PM
 
Wait, what's so bad about the post office?
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 04:14 PM
 
Originally Posted by The Final Dakar View Post
Wait, what's so bad about the post office?
https://about.usps.com/news/national...6/pr16_092.htm

2016 - net loss 5.6 billion. Income, 610 million. It's insolvent.

https://lawstreetmedia.com/issues/bu...is-whats-plan/

http://www.cnsnews.com/commentary/do...-enormous-debt
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 04:19 PM
 
Originally Posted by Laminar View Post
You cited those, but those are easy. Let's get to citations on these:
Well, how do you reconcile the first two? We can move down the list, but only if you participate.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 22, 2017, 05:48 PM
 
Originally Posted by Snow-i View Post
To be clear, are you arguing for single payer, or are you just trying to nitpick my argument while ignoring it's main points?
I'm not nitpicking your argument because there are no fine points to nitpick. "Single payer will never work in the US because the US is extra special." is the entirety of your argument.

Yes - they are under 3% today. Is your argument ideological or are we trying to come up with a solution?
The ACA implemented an 80/20 rule where 80% of insurance premiums had to go to to payouts and other value-added expenses. Why should I care about 3% profits when 20 or more percent of my premiums is going to overhead?

The margins for those paying less than 3%, so it actually costs the payer $1455- if no one's looking at how much it costs, no one is going to care how much it costs. But if you are arguing for single payer, you need to describe how the MRI would be less than that $1455 something everyone else is failing to connect the dots on. Again, the margins are less than 3% - the other 97% making up costs, so you can't take anything from the margin.
You're really fixated on that 3% value, so much so that I think you're getting some tunnel vision and can't see the big picture. You seem to have conveniently ignored my cash price example.

The MRI does not cost $1500 (-3%). I guarantee you the clinic is not taking a loss by charging $350 cash. The clinic knows what it costs them to do an MRI. They're able to charge $1500 because that's what the insurance company will pay. That doesn't mean the insurance company or the provider is making some giant gross profit margin, it means that a thousand dollars is wrapped up in billing, negotiations, collections, and other overhead. If a single entity always paid the cash price, how would that not save money?

Nothing like a government bureaucracy to fix that
Yet somehow every other developed nation has figured out how to spend less per capita on health care and provide better outcomes. What is so wrong with the US government that it's so far behind other nations?
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 11:26 PM
 
Originally Posted by Laminar View Post
I'm not nitpicking your argument because there are no fine points to nitpick. "Single payer will never work in the US because the US is extra special." is the entirety of your argument.
Sigh. How many times do I have to ask?

How does single payer address the costs of medical services in the United States?

You keep trying to generalize my argument, when I'm trying to look at the particulars.

Also, way to dodge yet again.


The ACA implemented an 80/20 rule where 80% of insurance premiums had to go to to payouts and other value-added expenses. Why should I care about 3% profits when 20 or more percent of my premiums is going to overhead?
How does single payer address this?

Does the government run without overhead?
Is it better than the private sector at managing overhead?

The answer to both those questions is a resounding no.

You're really fixated on that 3% value, so much so that I think you're getting some tunnel vision and can't see the big picture. You seem to have conveniently ignored my cash price example.
What bigger picture? I've asked repeatedly for you and others to spell out exactly how it works, yet you continually fail to do so. Don't blame me for being unconvinced by arguments that lack substance.

The MRI does not cost $1500 (-3%). I guarantee you the clinic is not taking a loss by charging $350 cash. The clinic knows what it costs them to do an MRI. They're able to charge $1500 because that's what the insurance company will pay. That doesn't mean the insurance company or the provider is making some giant gross profit margin, it means that a thousand dollars is wrapped up in billing, negotiations, collections, and other overhead. If a single entity always paid the cash price, how would that not save money?
How would that single entity, yet alone the government, manage to do so without a profit motive?

Are you arguing economies of scale would reduce overhead? What do the overhead numbers look like in the countries you keep referring to? It's time for you to shit or get off the pot, and make your counter argument. I'm not looking for your gut feeling here, and I'm not just going to take your guarantee as support especially when my arguments include those citations.


Yet somehow every other developed nation has figured out how to spend less per capita on health care and provide better outcomes. What is so wrong with the US government that it's so far behind other nations?
That the costs per capita on the ingredients of healthcare are far higher in the US - a fact I've already cited which you've still to address. I'm asking you how the government paying would reduce those costs, again, for like the 14th time, and you still haven't articulated a response. I'm not going to spend an hour digging up all the numbers we both know would support my argument, when you'll do the usual and just ignore the parts of my argument that directly contradict yours.
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 22, 2017, 11:44 PM
 
Anyone checked to see if the Atlas Medical model can be replicated on a large scale?
http://www.bizjournals.com/wichita/n...s-program.html


https://atlas.md

Umbehr said direct primary care provides real solutions that could be enacted to help Americans and drive down health care costs.

“We don’t take insurance,” Umbehr said on the program.” “We don’t need insurance for the common things.”

At Atlas, patients pay a monthly membership fee — from $10 to $100 per month. Members have access to doctors in person, by phone or through social media channels.

Patients don’t pay co-pays and aren’t charged extra for office visits. Medications typically cost “pennies on the pill,” Umbehr told Hannity.

Imaging often is done at a lower cost through the Atlas model as well.

Umbehr said an X-ray, for example, might cost an Atlas member $20 to $40 including radiology reads versus $100 or so at other clinics. Similar services might cost $500 to $1,000 through a hospital emergency room, Umbehr said.

Hannity, who long has been a supporter of Umbehr and his business, said the doctor is a person whom everyone in Congress should know.

Umbehr has told the Wichita Business Journal on multiple occasions the direct care movement has generated some momentum in recent years, and the goal is to continue to push that in the weeks and months ahead.

He founded the Wichita direct-care medical practice more than six years ago as a way to bypass insurance companies. He advocates for health insurance to cover catastrophic events, however.

He told Hannity Tuesday the model can help employers save money on their health insurance plans, making that type of coverage more affordable.

He cited Allied National Inc. in Overland Park as an example of an insurance company whose profit margins have increased by incorporating the Atlas model.

The WBJ has recognized Umbehr for his work on multiple occasions, including the 2016 Health Care Heroes awards.
"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 22, 2017, 11:53 PM
 
Also, administrative costs would plummet if the companies were allowed to sell across state lines and didn't have to have 50 different processes for 50 different sets of regulations, 50 sets of lawyers, and 50 different processes for payment.
     
OAW
Addicted to MacNN
Join Date: May 2001
Status: Offline
Reply With Quote
May 23, 2017, 12:01 AM
 
Originally Posted by Snow-i View Post
Also, administrative costs would plummet if the companies were allowed to sell across state lines and didn't have to have 50 different processes for 50 different sets of regulations, 50 sets of lawyers, and 50 different processes for payment.
Sounds like a sound argument for "single-payer".

OAW
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 23, 2017, 12:03 AM
 
One more note before I hit the sack

*Timeout*
Please forgive my frustrations. My passion for my arguments doesn't always come out in the most constructive of ways, but I do greatly appreciate your time & respect the discussions we are having. I would not be here otherwise.
*Ok, round 4, FIGHT!*
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 23, 2017, 12:03 AM
 
Originally Posted by OAW View Post
Sounds like a sound argument for "single-payer".

OAW
Or you know, just a single set of regulations. Payment has nothing to do with it. Single payer would suffer the same set backs if the regulatory schemes are not redone under a nationwide market.
     
reader50
Administrator
Join Date: Jun 2000
Location: California
Status: Offline
Reply With Quote
May 23, 2017, 01:08 AM
 
Insurance works best with large risk pools. It makes claim rates more predictable, and should simplify customer support and overhead. So I agree that health insurance should be national. Other insurance types (like auto and renters) should be national too. Homeowners -- I'm not sure on this one. Home codes do vary by state, sometimes by county too.

I don't want the ACA repealed because I believe the current Congress will replace it with nothing, or something worse than the ACA. Causing people to lose insurance, face higher premiums, and ultimately have more people hit with life-changing medical bills. If Congress could be trusted to make improvements, that would be a different story. But they just seem intent on repeal, and let the people formerly-covered sink or swim.

In my observations, this is a continuation of "punish the poor" policies. Basically, if you can charge the poor heavily, make them miserable enough, they'll get tired of being poor and start having decent incomes. Likewise the homeless - charge them, lock them up, drive them out of town. Enough misery and they'll get tired of being homeless.

What would actually break the poverty cycle would be education and insurance. But the administration wants to kill education debt lifelines, and Congress wants to curtail the ACA. Punish people enough, and they'll get tired of being poor.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 01:23 AM
 
You've been hoodwinked, friend. The USPS is a profitable venture, but thanks to Congress enacting a regulatory burden no private company must deal with, they are look like a fiscal mess.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 01:24 AM
 
Originally Posted by Snow-i View Post
Ehh considering blue cross blue shield is quasigovernmental and was a government sponsored monopoly for most of that time, this isn't exactly accurate to portray the government "just standing by". Their meddling got us into this situation in the first place, much as single payer would to a larger degree 30 years down the line.
Please explain.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 01:27 AM
 
Originally Posted by Laminar View Post
The ACA implemented an 80/20 rule where 80% of insurance premiums had to go to to payouts and other value-added expenses. Why should I care about 3% profits when 20 or more percent of my premiums is going to overhead?
Jesus, I was wondering why that 3% seemed unbelievable. But the question is, how much of that 20% overhead goes to, say, lavish executive pay and bonuses?


----


I found this surprising
http://thehill.com/policy/healthcare...lthcare-report
“Single-payer, I think we should have that debate as a nation,” Mark Bertolini reportedly said after being asked about the possibility of the GOP’s ObamaCare repeal plan paving the way for a single-payer system.
Of course, I have to think he's merely open to the idea of socializing the losses, rather than having to deal with the sick and poor, or people complaining they should be covered.
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 23, 2017, 08:47 AM
 
One of my leftie cousins posted this on Facebook after the first attempt was postponed. . She doesn't realize this was the plan to begin with. Enact Obamacare, but it's so F'ed up people will want single payer.
"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 09:55 AM
 
Originally Posted by Chongo View Post
One of my leftie cousins posted this on Facebook after the first attempt was postponed. . She doesn't realize this was the plan to begin with. Enact Obamacare, but it's so F'ed up people will want single payer.
Yes, conspiracy theory man, it was always the plan for the ACA to be a trap door into single payer, mostly by having Lieberman **** over the public option at the last second. Who leaked the Democrats devious plans?!
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 23, 2017, 10:24 AM
 
Originally Posted by The Final Dakar View Post
Yes, conspiracy theory man, it was always the plan for the ACA to be a trap door into single payer, mostly by having Lieberman **** over the public option at the last second. Who leaked the Democrats devious plans?!
Must Resist Posting Meme. Ahhhhhhhh

"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 10:31 AM
 
Originally Posted by Chongo View Post
Must Resist Posting Meme. Ahhhhhhhh

Makes sense that Satan would be on the GOP side
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Offline
Reply With Quote
May 23, 2017, 10:39 AM
 
Originally Posted by Snow-i View Post
One more note before I hit the sack

*Timeout*
Please forgive my frustrations. My passion for my arguments doesn't always come out in the most constructive of ways, but I do greatly appreciate your time & respect the discussions we are having. I would not be here otherwise.
*Ok, round 4, FIGHT!*


There's no malice here, and I realize that internet arguments in the back and forth quote for quote text form can often seem more heated and angry than they actually are. I appreciate this forum as a place where I can have my positions, beliefs, and rationalizations challenged and honed.


Originally Posted by Snow-i View Post
Sigh. How many times do I have to ask?

How does single payer address the costs of medical services in the United States?
You haven't yet explained why it's more expensive. We agreed that doctor compensation is higher in the US, but that's easy to fix. My wife is in the industry, I personally know of a bunch of extremely highly-paid physicians that had to have their salaries market-adjusted down by 30% because of an unsustainable compensation plan put in place by previous management. Guess how many of them quit being interventional cardiologists? None. Because they can live just fine on "only" $550,000 per year instead of what they were making before.

You made a list of unsubstantiated claims and then refused to cite the ones that would be hard to cite.

You keep trying to generalize my argument, when I'm trying to look at the particulars.
"My cable bill is far too expensive," he says as his house burns down.

Also, way to dodge yet again.
Pot and kettle here, no?

How does single payer address this?
Because single payer creates a monopoly where a single entity decides what it is going to pay. If the clinic refuses to work with the single entity, they can't just turn to accepting the other 400 insurers out there.

That the costs per capita on the ingredients of healthcare are far higher in the US - a fact I've already cited which you've still to address.
No no no no no. You linked an article about physician compensation being higher. You've proven nothing about
-Medical facility construction
-Insurance for said facilities
-Property
-transportation
-emergency services such as helicopters and ambulances.
-infrastructure to support the emergency services.
-medical equipment (manufacturing to delivery)
I'm asking you how the government paying would reduce those costs, again, for like the 14th time, and you still haven't articulated a response. I'm not going to spend an hour digging up all the numbers we both know would support my argument, when you'll do the usual and just ignore the parts of my argument that directly contradict yours.
"I don't have to cite my sources because we both know that I'm right."

That's now how this works.

Originally Posted by Chongo View Post
Anyone checked to see if the Atlas Medical model can be replicated on a large scale?
http://www.bizjournals.com/wichita/n...s-program.html
The Atlas system:

- Pay a fixed monthly fee
- Pay a per-procedure fee that's less than the actual cost of the procedure
- Pay a per-prescription fee that's less than the actual cost of the medication
- Works at very limited number of locations
- Provides no emergency or catastrophic care.

The health insurance system:

- Pay a fixed monthly fee
- Pay a per-procedure fee that's less than the actual cost of the procedure
- Pay a per-prescription fee that's less than the actual cost of the medication
- Works at lots of locations
- Typically provides emergency and catastrophic care

You've discovered health insurance, but kind of worse because you still need health insurance.
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 23, 2017, 10:51 AM
 
Originally Posted by The Final Dakar View Post
Makes sense that Satan would be on the GOP side
Actually, he's a card carrying progressive. DNC chair Tom Perez is one of his minions.
http://www.huffingtonpost.com/entry/...b018a9ce5b351d
"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 23, 2017, 11:08 AM
 
Originally Posted by Laminar View Post
Atlas system:

- Pay a fixed monthly fee
- Pay a per-procedure fee that's less than the actual cost of the procedure
- Pay a per-prescription fee that's less than the actual cost of the medication
- Works at very limited number of locations
- Provides no emergency or catastrophic care.

The health insurance system:

- Pay a fixed monthly fee
- Pay a per-procedure fee that's less than the actual cost of the procedure
- Pay a per-prescription fee that's less than the actual cost of the medication
- Works at lots of locations
- Typically provides emergency and catastrophic care

You've discovered health insurance, but kind of worse because you still need health insurance.
I'll let the good Dr explain.


Audio interview.
https://blog.atlas.md/tag/the-sean-hannity-show/
"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
OreoCookie
Moderator
Join Date: May 2001
Location: Hilbert space
Status: Online
Reply With Quote
May 23, 2017, 11:19 AM
 
Originally Posted by Snow-i View Post
Right, and you think changing who's paying is going to affect how much is paid for those services? You need to explain the mechanism.

[citation needed]
I had already gave evidence in my first reply to you:
Originally Posted by OreoCookie View Post
The US does abysmal in comparison: health care spending accounts for 16.9 % of GDP in 2015 as compared to 12 % for the next country (the Netherlands) and 10.8 % for the average of other comparable countries. Single payer significantly outperforms the US system. In absolute numbers, the US does even worse (as the GDP per capita varies from country to country): the US spends $9,451 per person and year on average compared to the comparable country average $4,908. If you think the US has better health outcomes, also there you'll be disappointed.
Just look at the raw data, independently of what you think a better system is, you have to grapple with the reality that the US health care system is underperforming by a large margin.
Originally Posted by OreoCookie View Post
Are the government dollars worth more than the private industry? How does the government paying reduce the costs of medical wages, facilities, equipment, etc?
Because other health care systems cap the costs of procedures.
Originally Posted by OreoCookie View Post
Because the goods and services there are cheaper. I'm not sure how single payer does anything to address this, and you continually state your conclusion without stating the mechanism.
It's not a conclusion, it is based on data: the same procedures cost significantly more in the US than in other countries.


On the other hand, other, comparable countries still have better health outcomes.
Originally Posted by Snow-i View Post
It's still 3%, and the same aggregate market.
No, it's not 3 %, because it is compounding. If you have three different layers, each needs a 3 % margin, then there is a cost increase: (103 %)^3 - 103 % = 6.3 %. Again, that is why in some situations having a vertically integrated approach is more efficient and better.
Originally Posted by Snow-i View Post
Performance? Actually performance is an arms race to the top, thanks to the competition between Apple, Samsung, TMSC, etc. Imagine if the government bought everyone an iPhone, do you really think we'd have the same speeds and efficiency gains over the last 5 years?
The government does not enter into the smartphone side of the analogy. TMSC is a fab and does not compete with Apple or Samsung. Samsung both has a fab business and makes its own SoCs. But Apple has had Samsung fab its SoCs in the past. But look at who is at the top of the smartphone market today, arguably it is Apple and Samsung, the most vertically integrated players. Point being that the lack of vertical integration in the US health care system is a competitive disadvantage.
Originally Posted by Snow-i View Post
Until you can articulate the mechanism for how changing who pays is going to affect how much medical services cost, you simply cannot make those comparisons.
You don't need to understand the mechanism to contrast and compare different health care systems based on objective criteria such as the absolute or relative cost per person (in US$ or as a percentage of GDP) or health outcomes.
Originally Posted by Snow-i View Post
Healthcare is cheaper in those nations, regardless of who pays. Infact, it's this disparity in costs that is exactly why single payer is viable in the first place.
You are reversing cause and effect: these systems are cheaper, because they work differently. The onus is on those who claim that a “market-based approach” (whatever that means) can even be competitive in terms of cost and quality of care.
Originally Posted by Snow-i View Post
Your correlation does not factor in that the US costs considerably more in general, especially in wages for medical staff. You need to tell me how single payer would reduce those costs, not just "it works over there! trust me!"
You don't need to trust me, just have a look at the data I provided.
Originally Posted by Snow-i View Post
So medical staff getting paid less under single payer are going to provide better care? The money for it has to come from somewhere. If that''s how you want to reduce costs, there will be consequences to it.
Of course there will be consequences if you shift 5~10 % of GDP from the health care industry to another. But the people will be better off.
Originally Posted by Snow-i View Post
Uhh, the costs aren't going to reduce themselves simply because the government negotiates that. If they artificially set the prices too low, the quality of care and treatments will naturally fall to that level in short order. This is not ideal.
Except that health outcomes are still better on average.
Originally Posted by Snow-i View Post
Negotiatons - more competition is lower prices. Less negotiators means higher prices. Your argument would have the exact opposite effect.
No, it doesn't mean that, it depends on the relative positions on the players. Walmart and Amazon have huge leverage to lower prices precisely because there is no competition. If you don't sell your goods on Amazon, you will lose a significant share of business. So you have to accept their terms.
I don't suffer from insanity, I enjoy every minute of it.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 11:26 AM
 
Originally Posted by Chongo View Post
Actually, he's a card carrying progressive. DNC chair Tom Perez is one of his minions.
http://www.huffingtonpost.com/entry/...b018a9ce5b351d
When you have to do damage control on a poorly thought out meme post
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 23, 2017, 02:01 PM
 
Originally Posted by The Final Dakar View Post
Officially passed.

The guy who single handedly resurrected the bill has resigned the moderate Tuesday group. I don't think they appreciated the position he put them in.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 24, 2017, 04:50 PM
 
Originally Posted by The Final Dakar View Post
CBO says 14 million uninsured from AHCA. That's like almost all of ACAs coverage numbers, isn't it?
New score is out. Still uninsures 14 million.
     
 
Thread Tools
 
Forum Links
Forum Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Top
Privacy Policy
All times are GMT -4. The time now is 10:13 PM.
All contents of these forums © 1995-2015 MacNN. All rights reserved.
Branding + Design: www.gesamtbild.com
vBulletin v.3.8.8 © 2000-2015, Jelsoft Enterprises Ltd.,