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 9)
Thread Tools
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Offline
Reply With Quote
May 13, 2017, 02:53 PM
 
My self-serving, knee-jerk guess?

The same reason most first world countries spend money which would go into the military on social programs... they're getting their military subsidized by the U.S.

The results other countries get are built on U.S. pharmaceutical and medtech research.

Repeating, this is a self-serving, knee-jerk guess.
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 13, 2017, 03:09 PM
 
I looked up the top ten Pharma companies by revenue, and only four are US based.

Novartis - Switzerland
Pfizer - USA
Roche - Switzerland
Sanofi - France
Merck - USA
Johnson & Johnson - USA
GlaxoSmithKline - UK
AstraZeneca - Sweden
Gilead Sciences - USA
Takeda - Japan

So it seems like the money we spend is primarily benefiting other countries economies- not funding US based research.
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Offline
Reply With Quote
May 13, 2017, 03:51 PM
 
In the top ten we have four.

Next best is two.

Every other country on the list has one.

Doesn't this sorta prove my point? We're the world leader.
     
Cap'n Tightpants
Addicted to MacNN
Join Date: Oct 2014
Location: Shaddim's sock drawer
Status: Offline
Reply With Quote
May 13, 2017, 07:04 PM
 
Pretty sure that's the definition of world leader.
"I have a dream, that my four little children will one day live in a
nation where they will not be judged by the color of their skin,
but by the content of their character." - M.L.King Jr
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 13, 2017, 08:32 PM
 
Regarding scalability, perhaps Japan could be a model when it comes to health care. No, the population is obviously not the same, but friends of mine living and working in Japan have reported nothing but positive reports.
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Offline
Reply With Quote
May 13, 2017, 09:24 PM
 
Is there something about that model which lends itself to adaptation to the U.S.?
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 13, 2017, 09:26 PM
 
Originally Posted by subego View Post
Is there something about that model which lends itself to adaptation to the U.S.?
I don't know, but for starters I think it would help if Americans were generally open to entertaining these possibilities without being overly dismissive or knee-jerky.
     
Waragainstsleep
Addicted to MacNN
Join Date: Mar 2004
Location: UK
Status: Offline
Reply With Quote
May 13, 2017, 09:40 PM
 
Pharma companies are going to have the same issues repatriating overseas profits that Apple have, albeit not quite on the same scale.
Don't most drugs have to be rectified independently in different countries? FDA approval won't get you onto European shelves. Essentially different geographic departments might as well be completely different companies barring some of the basic research paperwork which can likely be re-submitted in multiple regions.
I have plenty of more important things to do, if only I could bring myself to do them....
     
reader50
Administrator
Join Date: Jun 2000
Location: California
Status: Offline
Reply With Quote
May 13, 2017, 11:14 PM
 
I expect not only basic research, but clinical trial results can be submitted in every jurisdiction. The research should only need doing once. Just pay the filing fees with each government, and of course, cross the right palms with silver.
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 13, 2017, 11:47 PM
 
Originally Posted by subego View Post
In the top ten we have four.

Next best is two.

Every other country on the list has one.

Doesn't this sorta prove my point? We're the world leader.
Not remotely to same level that the US in the world leader in defence spending- it's magnitudes of difference.

Add to that, the revenues of those companies based within the European Single Market exceed those of the US based companies.

Beyond all of that, the massive US spending of defence buys us the most effective military in the world. Our massive spending on health care buys us, at best, mediocrity.

So perhaps we can add defence spending to consumer tech and entertainment as things health care is different from?
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Offline
Reply With Quote
May 15, 2017, 02:12 AM
 
Here's my back of the napkin math.

Google says the U.K. health budget is £116 billion.

The U.S. has five times the population, so that would be £580 billion. There'd hopefully be some economy of scale knocking that down a touch. I'll address that later.

£580 billion exchanges to $748 billion.

Let's say economy of scale knocks off $98 billion, so it's an even $650 billion.

Why did I pick that number? $650 billion just happens to be the cost of the best military in the world. Also known as about 50% of your tax dollars.


To be clear, this isn't me saying "so **** off", I'm trying to lay out the scope of the problem, which I argue defies easy solutions. I agree if we spent $650 billion on Federal Healthcare, the system would probably work. Lest it look like I'm cooking the books to make a point, let's say $600 billion. Let's even say $500 billion. This would work fine.

IOW, a swell idea once we jump the half-trillion hurdles.
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 15, 2017, 05:04 AM
 
Originally Posted by subego View Post
IOW, a swell idea once we jump the half-trillion hurdles.
I don't think I am seeing the numbers so differently because of ideology.

I will say flat out that my numbers are lacking some accuracy, because I am comparing healthcare per capita from 2015 and population from 2017, but the US already spends far more than the UK adjusting for population and currency. I was asserting that the US could save money and gain batter outcomes with a different system.

If the US spent the same on health care per capita as the UK it would save ~$1.788 Trillion. That would buy a lot of bombs.

The problem isn't the level of spending, but the system.
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 15, 2017, 05:11 AM
 
As an aside, I wouldn't necessarily put the UK forward as the best model- we can argue why the UK trails the rest of the EU in outcomes (my vote is that it has been hampered by creeping privatisation by both the Torries and Labour), so let's take Germany. If they US spent as much per capita as Germany, it would still save the economy ~$1.365 Trillion and Germany has MUCH better outcomes.
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 15, 2017, 08:45 AM
 
Originally Posted by subego View Post
Here's my back of the napkin math.

Google says the U.K. health budget is £116 billion.

The U.S. has five times the population, so that would be £580 billion. There'd hopefully be some economy of scale knocking that down a touch. I'll address that later.

£580 billion exchanges to $748 billion.

Let's say economy of scale knocks off $98 billion, so it's an even $650 billion.

Why did I pick that number? $650 billion just happens to be the cost of the best military in the world. Also known as about 50% of your tax dollars.


To be clear, this isn't me saying "so **** off", I'm trying to lay out the scope of the problem, which I argue defies easy solutions. I agree if we spent $650 billion on Federal Healthcare, the system would probably work. Lest it look like I'm cooking the books to make a point, let's say $600 billion. Let's even say $500 billion. This would work fine.

IOW, a swell idea once we jump the half-trillion hurdles.


From here:

https://en.wikipedia.org/wiki/Medicare_(United_States)

Medicare contracts with regional insurance companies to process over one billion fee-for-service claims per year. In 2008, Medicare accounted for 13% ($386 billion) of the federal budget. In 2016 it is projected to account for close to 15% ($683 billion) of the total expenditures. For the decade 2010–2019 Medicare is projected to cost 6.4 trillion dollars.[53]
Looks like we are already spending $683 billion just for Medicare - without much cost control.
     
OreoCookie
Moderator
Join Date: May 2001
Location: Hilbert space
Status: Offline
Reply With Quote
May 15, 2017, 11:57 AM
 
Originally Posted by subego View Post
Here's my back of the napkin math.
The math is incomplete and hides the main point: you should look at the numbers as percentages of GDP: in 2013 numbers the UK spends 8.8 % of GDP on health care while the US spends 17.1 %. This combines spending by the state, insurances and by the individuals. This is the number you want to decrease.

If you plot the per capita health care spending with respect to GDP per capita, you see that most countries lie close to a line:



The only two outliers are the US (in a very negative way) and Norway (in a positive way).

It would be cheaper, not more expensive, for the US to adopt universal health care, the US “market-based” approach doesn't work for anyone but the health care industry.
I don't suffer from insanity, I enjoy every minute of it.
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 15, 2017, 02:15 PM
 
Originally Posted by Paco500 View Post
As an aside, I wouldn't necessarily put the UK forward as the best model- we can argue why the UK trails the rest of the EU in outcomes (my vote is that it has been hampered by creeping privatisation by both the Torries and Labour), so let's take Germany. If they US spent as much per capita as Germany, it would still save the economy ~$1.365 Trillion and Germany has MUCH better outcomes.
What is the economic benefit to Germany of the presence of US military bases?
https://en.m.wikipedia.org/wiki/List...ns_in_Germany#

"The blood of the martyrs is the seed of the church" Saint Tertullian, 197 AD
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Online
Reply With Quote
May 15, 2017, 03:13 PM
 
Originally Posted by Chongo View Post
What is the economic benefit to Germany of the presence of US military bases?
What does that have to do with the US spending more per capita on health care? If the US spent less per capita on health care, the US could afford to double its military bases in Germany!
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 03:59 PM
 
Originally Posted by OreoCookie View Post
The math is incomplete and hides the main point: you should look at the numbers as percentages of GDP: in 2013 numbers the UK spends 8.8 % of GDP on health care while the US spends 17.1 %. This combines spending by the state, insurances and by the individuals. This is the number you want to decrease.

If you plot the per capita health care spending with respect to GDP per capita, you see that most countries lie close to a line:



The only two outliers are the US (in a very negative way) and Norway (in a positive way).

It would be cheaper, not more expensive, for the US to adopt universal health care, the US “market-based” approach doesn't work for anyone but the health care industry.
This has been my point all along, and the foundation for my opposition to the ACA.

Everyone is so fixated on who's paying when the real problem is how much. The ACA only addressed the former, as would single-payer. I've outlined several low-hanging-fruit solutions that would reduce the costs. #1? Medical tort reform.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Online
Reply With Quote
May 15, 2017, 04:40 PM
 
Originally Posted by Snow-i View Post
This has been my point all along, and the foundation for my opposition to the ACA.

Everyone is so fixated on who's paying when the real problem is how much. The ACA only addressed the former, as would single-payer. I've outlined several low-hanging-fruit solutions that would reduce the costs. #1? Medical tort reform.
The ACA prevented insurance companies from denying coverage for bullshit reasons. That seems like it should be a given in any modern first world country, but given the last few weeks' events, apparently it's not.

How do you feel about the attempt to remove protection of preexisting conditions?
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 04:51 PM
 
Originally Posted by Laminar View Post
The ACA prevented insurance companies from denying coverage for bullshit reasons. That seems like it should be a given in any modern first world country, but given the last few weeks' events, apparently it's not.
The ACA was promised to "reduce costs". I have demonstrated it did not (simply shifted who was paying).

How do you feel about the attempt to remove protection of preexisting conditions?
Which measure in particular? None that I had heard removed this protection. Also, my thoughts can easily be summed up here:
http://forums.macnn.com/newreply.php...eply&p=4380518

Anything that does not aim to address the root problem of high costs, I will not support. All the other issues will become far more easily managed without the crippling realized costs we experience today (and no, shifting who pays does not count as reducing costs).
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 15, 2017, 04:58 PM
 
Originally Posted by Snow-i View Post
I've outlined several low-hanging-fruit solutions that would reduce the costs. #1? Medical tort reform.
Is this really anything more than a red herring? Do you have any data that demonstrates that medical tort reform would bring health care costs inline with the rest of the first world? The high-end of estimates I've been able to find put the cost of 'Medical Malpractice' at 10% of the total cost to our health care system. That includes not only payouts on lawsuits- but all associated costs.

This link cites a number of studies on the subject- most of which put the costs far lower than 10%.

Add to this, other countries have costs associated with medical malpractice as well- likely not as high as the US, but certainly not zero.

But for the sake of argument, let's say it is as high as 10%, and the other countries on the chart are 0%. The impact in total dollars may be a Very Big Number, but in comparative terms with the rest of the world on per capita spending, it's not really moving the needle.

As a side note, the status quo in the US is not, in my mind, acceptable- for lots of reasons, not just economic. This is not an argument for not addressing this problem, it's an argument against it being a meaningful solution to the larger problem.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 05:13 PM
 
Originally Posted by Paco500 View Post
Is this really anything more than a red herring? Do you have any data that demonstrates that medical tort reform would bring health care costs inline with the rest of the first world? The high-end of estimates I've been able to find put the cost of 'Medical Malpractice' at 10% of the total cost to our health care system. That includes not only payouts on lawsuits- but all associated costs.
Do your figures include malpractice insurance?

According to a quick google that would be $320 billion. I would say 320 billion is not a red herring. I think alot of people could access alot of care for 320 billion dollars - infact $1000 a year for every single person in the US. That would far exceed my expectations. What do you think?

Originally Posted by google
U.S. health care spending grew 5.8 percent in 2015, reaching $3.2 trillion or $9,990 per person.Dec 6, 2016
Also:
https://www.hsph.harvard.edu/news/pr...lity-costs-us/

Originally Posted by harvard
$55.6 Billion Price Tag Large, But Not a Key Driver of Total Health Care Spending
It would be a start. That 55.6 billion was also a 2010 number, likely higher now.

Do you have an argument against tort reform? Do you think it's just not worth considering?


This link cites a number of studies on the subject- most of which put the costs far lower than 10%.

Add to this, other countries have costs associated with medical malpractice as well- likely not as high as the US, but certainly not zero.
Of course there will be costs, but lets say we get that down by half. You don't think a 5% reduction across the board on medical costs wouldn't have a massive and appreciable influence on the industry today? 5% would be yuuuuuuuuge.

Would it solve all of our problems? No. but it would be a huge step in the right direction. It would be 5% more efficient. 5% more people could get care for the same cost or $500 bucks back in the pocket of every taxpayer.

That's like, taking a a whole month (and then some) of premiums and saying "you don't have to pay it, because we don't have to pay our lawyers as much). All for the same level of care. On the plus side - less lawyers, so expect to get some efficiencies out of that side benefit too.


But for the sake of argument, let's say it is as high as 10%, and the other countries on the chart are 0%. The impact in total dollars may be a Very Big Number, but in comparative terms with the rest of the world on per capita spending, it's not really moving the needle.
Who cares about measuring dicks? If the impact in total dollars was massive, that would mean that extra massive pile of money could be used to actually care for the sick/put the money back in their wallets. Using your high end figure, an extra 320 billion would be a huge deal. Even at a third of that, $120 billion in cost saving would be extremely beneficial to the market in terms of costs.

Also, it would move the number by 10%. That's alot.


As a side note, the status quo in the US is not, in my mind, acceptable- for lots of reasons, not just economic. This is not an argument for not addressing this problem, it's an argument against it being a meaningful solution to the larger problem.
It's not an end-all be all solution, but if our aim is to reduce costs, what arguments against tort reform could be made?

Also, follow the link. I outlined other cost saving measures that together could make a dent in the high-costs issue we face today.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Online
Reply With Quote
May 15, 2017, 05:20 PM
 
Originally Posted by Paco500 View Post
Is this really anything more than a red herring? Do you have any data that demonstrates that medical tort reform would bring health care costs inline with the rest of the first world? The high-end of estimates I've been able to find put the cost of 'Medical Malpractice' at 10% of the total cost to our health care system. That includes not only payouts on lawsuits- but all associated costs.
http://truecostofhealthcare.net/malpractice/

This is just one guy, but he's putting numbers to words.

By 2014 the difference was somewhat more pronounced. The States that had active tort reform laws had dropped by 31% versus only a 20% overall change in medical malpractice costs from 2003-2014 seen in States that didn’t have tort reform laws. Again, the States with stricter tort reform laws like a $500,000 non economic damage cap saw bigger drops in medial malpractice costs over the twelve years.

So tort reform laws appear to have had some impact on the cost of medical malpractice in the US, but the effect is modest at best and they’re obviously not the only factor in reducing these costs. Also, even very strict laws aimed at reducing medical malpractice costs appear to be ineffective in certain States (e.g. Massachusetts, Louisiana). But most importantly, a 27% drop in medical malpractice costs in the US has coincided with a 64% rise in overall health care costs. Clearly, tort reform laws have done nothing to reduce overall health care costs and are only partly responsible for reducing medical malpractice costs in the US.
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Online
Reply With Quote
May 15, 2017, 05:29 PM
 
Originally Posted by Snow-i View Post
The ACA was promised to "reduce costs".
I...don't care? I wasn't talking about that, I'm not sure why you brought it up. Keeping your doctor/plan and lower premiums were certainly huge lies used to gain support. And what do you make of the claim that Obamacare slowed the rise of medical costs?

But that's not what I was talking about.

Which measure in particular? None that I had heard removed this protection.
AHCA allows insurers to charge more for preexisting conditions in some circumstances (which wasn't allowed under Obamacare), potentially making the cost of insurance high enough as to become unaffordable. I have little faith in insurance companies to keep rates low out of the goodness of their hearts - if they can legally charge more, they will.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 05:37 PM
 
Originally Posted by Laminar View Post
I...don't care? I wasn't talking about that, I'm not sure why you brought it up.
Because it was central to my point.

Keeping your doctor/plan and lower premiums were certainly huge lies used to gain support. And what do you make of the claim that Obamacare slowed the rise of medical costs?
That they are still rising unsustainably, and unless you got a time machine handy it is neither here nor there.

But that's not what I was talking about.
Fair enough. I don't want us to talk past each other....

AHCA allows insurers to charge more for preexisting conditions in some circumstances (which wasn't allowed under Obamacare), potentially making the cost of insurance high enough as to become unaffordable. I have little faith in insurance companies to keep rates low out of the goodness of their hearts - if they can legally charge more, they will.
I am certainly not arguing in favor of the republican mess as it is today. It does nothing to address the fundamental problems with the market today. Infact, it's aimed at undoing something else that was not aimed at the fundamental problems the market has today, so by default is not worthy of my support.

To level set, I will support measures that reduce health care costs overall (not shift them, actually reduce the realized cost of care). I will not support measures that have the opposite effect. To me, it's the biggest problem we face where all the others would be far easier to manage if they didn't have such a high price tag associated with them.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 05:46 PM
 
Originally Posted by Laminar View Post
http://truecostofhealthcare.net/malpractice/

This is just one guy, but he's putting numbers to words.
That same guy also argues against "defensive medicine" or running tests that might not be necessary (but you can't really tell until you run the test). To add to that point, how much in unrecognizable cost is there when a doctor is more worried about lawsuits and doing the CYA stuff vs you know, actually being a doctor? I'm not arguing against the defensive medicine itself, just the environment that necessitates it (and what other impacts that environment has on a doctor's decision making process).

He also quotes the total malpractice costs for all (insurance, legal costs, etc) to be around $10 billion in 2010, and argues that it is likely lower today. I call bullshit on that number. Forbes, in 2010, puts the number at 5.5x that.

https://www.forbes.com/sites/rickung.../#1b4f55572ff5



Regardless of which numbers you use, whether they be on the low end, the middle, or the high end - there's room for improvement here and I can't see much of a downside in reducing costs in this manner. Again, it won't solve all our problems, but at least we'd be moving in the right direction and can consider other measures simultaneously.

What is the downside?
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 15, 2017, 05:47 PM
 
I'm not going to go through the quote and response thing. A few points.

1. Yes the 10% percent (which again, is the highest estimate I found- most have it pegged at less than 5%) includes malpractice insurance costs.

2. Even if is 10% today, Medical Tort reform will not make that cost go to 0. One estimate I saw puts the estimated savings of tort reform as .05% of total costs, but let's be unrealistic and say tort reform gives us a 50% reduction in medical malpractice costs- so we have now saved 5% overall. Again, taking the whole system into account, this makes for Very Big Number. Per Capita, not really.

3. 10% is almost certainly an over-estimate- the article you linked to pegs it as 2.4%. 50% savings on that gives us 1.2% savings, which gives us a per capita savings (according to this) of $113/yr. This is not dramatic on an individual level.

4. Comparing the costs to other countries is not about dick measuring, it's about pointing out that we spend more per capita than the rest of the developed world, but still manage to have, for the most part, poorer outcomes. I think it's worth considering that there is a systemic issue with the way we provision health care in the US, and it's pretty clear that malpractice costs are, at best, a minor contributor.

5. As I said in my original post, there are many good reasons to institute medical tort reform beyond economics, the primary, in my mind, is that doctors not operating in fear of law suits could very well provide better and more caring treatment. I've got no issues at all at pursuing tort reform, I just don't believe it will have meaningful impact on the out of control costs of our health care system. Do you have anything to convince me otherwise?
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 06:13 PM
 
Originally Posted by Paco500 View Post
I'm not going to go through the quote and response thing. A few points.

1. Yes the 10% percent (which again, is the highest estimate I found- most have it pegged at less than 5%) includes malpractice insurance costs.
Noted
2. Even if is 10% today, Medical Tort reform will not make that cost go to 0. One estimate I saw puts the estimated savings of tort reform as .05% of total costs, but let's be unrealistic and say tort reform gives us a 50% reduction in medical malpractice costs- so we have now saved 5% overall. Again, taking the whole system into account, this makes for Very Big Number. Per Capita, not really.
True, but some savings are better than none in a vacuum, right?
3. 10% is almost certainly an over-estimate- the article you linked to pegs it as 2.4%. 50% savings on that gives us 1.2% savings, which gives us a per capita savings (according to this) of $113/yr. This is not dramatic on an individual level.
But aggregately, would still be an appreciable difference. For low-end ACA plans, that's about a months worth of premium, and could come in quite handy to the cash strapped among us.

4. Comparing the costs to other countries is not about dick measuring, it's about pointing out that we spend more per capita than the rest of the developed world, but still manage to have, for the most part, poorer outcomes. I think it's worth considering that there is a systemic issue with the way we provision health care in the US, and it's pretty clear that malpractice costs are, at best, a minor contributor.
I agree with you here. I'd also say that many of the issues we face are minor contributors, and if we can address them individually we can undo the death by a thousand paper cuts. Those minor costs still aggregate to the massive costs we see as a whole.

5. As I said in my original post, there are many good reasons to institute medical tort reform beyond economics, the primary, in my mind, is that doctors not operating in fear of law suits could very well provide better and more caring treatment. I've got no issues at all at pursuing tort reform, I just don't believe it will have meaningful impact on the out of control costs of our health care system. Do you have anything to convince me otherwise?
Nope I'm with you here. I don't expect it to fix everything. I would be satisfied even with minor progress (it's better than none, right?) However, if we can get some savings here, some over there, and a bit more here - Before you know it our costs look a lot more reasonable and we'll have more money to budget towards fixing some of the other problems in the industry. That's all I'm trying to get to. Technology should in theory make a lot of these procedures less costly over time - we just need to keep it sustainable and accessible long enough for those benefits to become pervasive.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 15, 2017, 06:15 PM
 
I fully admit I don't remember how much my insurance costs because, well, I gotta have it. Trump on the other hand...
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 06:17 PM
 
Originally Posted by The Final Dakar View Post
I fully admit I don't remember how much my insurance costs because, well, I gotta have it. Trump on the other hand...
Mine is ~$500 a month - my company pays 75% of that.
     
The Final Dakar
Games Meister
Join Date: Aug 2009
Location: Eternity
Status: Offline
Reply With Quote
May 15, 2017, 06:23 PM
 
Originally Posted by Snow-i View Post
Everyone is so fixated on who's paying when the real problem is how much.
The problem was worse before Obamacare. No one cared how much until we started taxing the rich to pay. So I'm glad Obamacare has given them some motivation. Unfortunately, so far congress has found out its legislatively much easier to change the first back than try to solve the second. And they may just do that.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 15, 2017, 06:54 PM
 
Originally Posted by The Final Dakar View Post
The problem was worse before Obamacare. No one cared how much until we started taxing the rich to pay. So I'm glad Obamacare has given them some motivation. Unfortunately, so far congress has found out its legislatively much easier to change the first back than try to solve the second. And they may just do that.
The problem was talked about quote a bit - infact that's what prompted the ACA in the first place. It's just that the ACA didn't solve the problem it was advertised to solve - it just punted the problem down the road and hid the immediate costs for the first decade or so.

My only issue there is the definition of "rich". 100k/yr doesn't go near as far as it used to (and for the record, I'm nowhere near that myself - certainly could not afford to have a kid right now).
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 15, 2017, 07:20 PM
 
Originally Posted by Snow-i View Post
True, but some savings are better than none in a vacuum, right?
Not always- and to illustrate this I'm going to tell a (true, if not completely relevant) story.

We had some family friends growing up, and the father/sole breadwinner was a minor political mover in Republican circles. He did pretty well in the Bush (HW) administration, and clearly believed the money would keep flowing and they overextended financially. When Clinton won, he was out of a job and they were financially screwed.

Soon after I was talking to the daughter, who was a few years older than me, and she said they were in danger of losing the house and they were really cutting back. I asked her what they were doing to save money, and she told me they 'were making their own mayonnaise.'

Hand to God, true story.

The concern I would have by focusing on minor, peripheral savings rather than addressing the systemic issues is that it creates the illusion that actual progress is being made. Tort reform, selling insurance across state lines, and other minor tweaks may have the impact of saving some cost- maybe even Very Large Amounts, but probably will not do much to address the balance of cost per capita vs. mediocre outcomes.

There does not seem to be any evidence globally that the foundations on which we have built our health care system (private sector, competition, profit, market forces) is compatible with controlling costs or quality care.

Fiddling around the edges is like putting a K&N filter and a soup can exhaust on a Toyota Yaris and expecting to get a performance car.
     
Chongo
Addicted to MacNN
Join Date: Aug 2007
Location: Phoenix, Arizona
Status: Offline
Reply With Quote
May 15, 2017, 08:54 PM
 
Originally Posted by The Final Dakar View Post
I fully admit I don't remember how much my insurance costs because, well, I gotta have it. Trump on the other hand...
Originally Posted by Snow-i View Post
Mine is ~$500 a month - my company pays 75% of that.
Is Trump talking about putting money into a health savings account? Is this the HSA he was saying would not be the "use it or lose it" type, that rolled over at the end of the year, earned interest, and you could give to your kids?
"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 15, 2017, 09:01 PM
 
We need to find out waht this doctor is doing and replicate it.
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
     
Laminar
Posting Junkie
Join Date: Apr 2007
Location: Iowa, how long can this be? Does it really ruin the left column spacing?
Status: Online
Reply With Quote
May 16, 2017, 09:38 AM
 
Originally Posted by Snow-i View Post
I am certainly not arguing in favor of the republican mess as it is today. It does nothing to address the fundamental problems with the market today. Infact, it's aimed at undoing something else that was not aimed at the fundamental problems the market has today, so by default is not worthy of my support.

To level set, I will support measures that reduce health care costs overall (not shift them, actually reduce the realized cost of care). I will not support measures that have the opposite effect. To me, it's the biggest problem we face where all the others would be far easier to manage if they didn't have such a high price tag associated with them.
Here's what I think it boils down to.

Your core value is that health care should cost the country less than it does now. Every decision and piece of legislation you see, you evaluate based on that core value. If someone were to get cancer and lose their job and wasn't able to afford health care at any cost, that doesn't matter as long as health care costs less than it does now. Those details can be worked out later.

My core value is that everyone should have health care. It doesn't matter what the short term costs are or if it pushes up the deficit or insurance companies or malpractice lawyers are making bank. The sooner everyone has easy access to care and especially preventative medicine, the less we'll need emergency medicine, emergency care, or more serious procedures because things are being taken care of right away before they balloon into something large. We'll work on cost, too, through whatever method we can, but that's secondary.

Is this a valid summary?
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 10:30 AM
 
Originally Posted by Laminar View Post
Here's what I think it boils down to.

Your core value is that health care should cost the country less than it does now. Every decision and piece of legislation you see, you evaluate based on that core value. If someone were to get cancer and lose their job and wasn't able to afford health care at any cost, that doesn't matter as long as health care costs less than it does now. Those details can be worked out later.

My core value is that everyone should have health care. It doesn't matter what the short term costs are or if it pushes up the deficit or insurance companies or malpractice lawyers are making bank. The sooner everyone has easy access to care and especially preventative medicine, the less we'll need emergency medicine, emergency care, or more serious procedures because things are being taken care of right away before they balloon into something large. We'll work on cost, too, through whatever method we can, but that's secondary.

Is this a valid summary?

Not to bud into your conversation with Snow-i, but this does sound like a good reflection of some differences of PoV if not his, and I'd like to add that there is no doubt a ton of indirect financial benefit to universal health care that is hard to debate because it is hard to measure. It certainly seems logical to imagine benefits of old people not having to save up as much for emergency unexpected health care procedures, fewer medical bankruptcies, more job mobility, etc.
     
Paco500
Professional Poster
Join Date: Apr 2000
Location: Berkshire, UK
Status: Offline
Reply With Quote
May 16, 2017, 10:46 AM
 
Originally Posted by besson3c View Post
Not to bud into your conversation with Snow-i, but this does sound like a good reflection of some differences of PoV if not his, and I'd like to add that there is no doubt a ton of indirect financial benefit to universal health care that is hard to debate because it is hard to measure. It certainly seems logical to imagine benefits of old people not having to save up as much for emergency unexpected health care procedures, fewer medical bankruptcies, more job mobility, etc.
This is huge for me. After moving to the UK, I was surprised how much more willing people were to start their own business, take extended absences from the workforce for education, etc. The security of knowing that you and your family are covered from a healthcare perspective regardless of employment status is a boon for entrepreneurs.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 11:46 AM
 
Originally Posted by Paco500 View Post
Not always- and to illustrate this I'm going to tell a (true, if not completely relevant) story.

We had some family friends growing up, and the father/sole breadwinner was a minor political mover in Republican circles. He did pretty well in the Bush (HW) administration, and clearly believed the money would keep flowing and they overextended financially. When Clinton won, he was out of a job and they were financially screwed.

Soon after I was talking to the daughter, who was a few years older than me, and she said they were in danger of losing the house and they were really cutting back. I asked her what they were doing to save money, and she told me they 'were making their own mayonnaise.'

Hand to God, true story.
Thank you for sharing

I wouldn't even know how to make mayonnaise (not that I would want to).
The concern I would have by focusing on minor, peripheral savings rather than addressing the systemic issues is that it creates the illusion that actual progress is being made. Tort reform, selling insurance across state lines, and other minor tweaks may have the impact of saving some cost- maybe even Very Large Amounts, but probably will not do much to address the balance of cost per capita vs. mediocre outcomes.
I don't see why we can't do both. If there's cost out there to be saved without other adverse impacts, IMO we ought to be focusing on it to make a long term systemic change more viable.

There does not seem to be any evidence globally that the foundations on which we have built our health care system (private sector, competition, profit, market forces) is compatible with controlling costs or quality care.

Fiddling around the edges is like putting a K&N filter and a soup can exhaust on a Toyota Yaris and expecting to get a performance car.
I'm thinking its more like getting the injectors cleaned, which after a few decades of attrition should give us a modest boost to performance and MPG with no real downside. It isn't turning it into a GTR, but all else the same will streamline the performance and clean some of the gunk out of the engine. GTR's are expensive.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 11:59 AM
 
Originally Posted by Laminar View Post
Here's what I think it boils down to.

Your core value is that health care should cost the country less than it does now. Every decision and piece of legislation you see, you evaluate based on that core value. If someone were to get cancer and lose their job and wasn't able to afford health care at any cost, that doesn't matter as long as health care costs less than it does now. Those details can be worked out later.
Ehhh close. I've articulated that safety nets are certainly necessary, no matter the cost. We just shouldn't look to those to solve the greater problems with the industry.

My core value is that everyone should have health care. It doesn't matter what the short term costs are or if it pushes up the deficit or insurance companies or malpractice lawyers are making bank. The sooner everyone has easy access to care and especially preventative medicine, the less we'll need emergency medicine, emergency care, or more serious procedures because things are being taken care of right away before they balloon into something large. We'll work on cost, too, through whatever method we can, but that's secondary.

Is this a valid summary?
I would agree with your second paragraph, though I would switch the priorities. The more we can reduce the costs, the easier it will be to make sure everyone has access to care. There is a reality we are up against that we cannot ignore - that money has to come from somewhere and if we rely too much on "forget the price tag" that will have a domino effect that will make our end goals even harder, with other financial consequences for the working and middle classes.
     
subego
Clinically Insane
Join Date: Jun 2001
Location: Chicago, Bang! Bang!
Status: Offline
Reply With Quote
May 16, 2017, 12:07 PM
 
Originally Posted by Snow-i View Post
I wouldn't even know how to make mayonnaise (not that I would want to).
I wouldn't either, but it's just mixinated egg yolk, vegetable oil, and a bit of lemon juice.
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 12:17 PM
 
Originally Posted by Snow-i View Post
I would agree with your second paragraph, though I would switch the priorities. The more we can reduce the costs, the easier it will be to make sure everyone has access to care. There is a reality we are up against that we cannot ignore - that money has to come from somewhere and if we rely too much on "forget the price tag" that will have a domino effect that will make our end goals even harder, with other financial consequences for the working and middle classes.

I don't think it is a "forget the price tag" sort of argument though. I suspect Laminar was just trying to get to some core fundamentals and leaving this whole variable aside for the purpose of that particular thread, so consider this a fork to your discussion with him...

My point is that single payer just requires a different way of thinking, namely what I was saying about indirect benefits. They are hard to measure, but we can't just pretend that they don't exist. There are many ways these indirect benefits can drive down costs, and at least some of them must be a thing given the obvious lower costs of health care in countries with single payer.

So, let's start here... Would you acknowledge that there are indirect benefits? If so, what would you say these are?
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 05:25 PM
 
Originally Posted by besson3c View Post
I don't think it is a "forget the price tag" sort of argument though. I suspect Laminar was just trying to get to some core fundamentals and leaving this whole variable aside for the purpose of that particular thread, so consider this a fork to your discussion with him...

My point is that single payer just requires a different way of thinking, namely what I was saying about indirect benefits. They are hard to measure, but we can't just pretend that they don't exist. There are many ways these indirect benefits can drive down costs, and at least some of them must be a thing given the obvious lower costs of health care in countries with single payer.

So, let's start here... Would you acknowledge that there are indirect benefits? If so, what would you say these are?
Besson, I'm not going to make your arguments for you. If you have indirect benefits in mind of single payer, you are welcome to offer them up for scrutiny. Single payer, IMO, is a non-starter for the US.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 05:28 PM
 
Originally Posted by besson3c View Post
Not to bud into your conversation with Snow-i, but this does sound like a good reflection of some differences of PoV if not his, and I'd like to add that there is no doubt a ton of indirect financial benefit to universal health care that is hard to debate because it is hard to measure. It certainly seems logical to imagine benefits of old people not having to save up as much for emergency unexpected health care procedures, fewer medical bankruptcies, more job mobility, etc.
Besson, those old people would still be paying for healthcare through a lifetime of higher taxes. You act as if the government's money just comes into existence. it comes from someone. All of it. Every cent. Actually, we lose a good size chunk of those cents to government inefficiency and overhead.

How would single-payer reduce costs in the United States? Are you suggesting we nationalize the pharma industries? That's actually one area that the US is exceedingly good at (which all those single payer countries benefit massively from).
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 05:29 PM
 
Originally Posted by Snow-i View Post
Besson, I'm not going to make your arguments for you. If you have indirect benefits in mind of single payer, you are welcome to offer them up for scrutiny. Single payer, IMO, is a non-starter for the US.

Why is it a non-starter?
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 05:31 PM
 
Originally Posted by Snow-i View Post
Besson, those old people would still be paying for healthcare through a lifetime of higher taxes. You act as if the government's money just comes into existence. it comes from someone. All of it. Every cent. Actually, we lose a good size chunk of those cents to government inefficiency and overhead.

How would single-payer reduce costs in the United States? Are you suggesting we nationalize the pharma industries? That's actually one area that the US is exceedingly good at (which all those single payer countries benefit massively from).
Why don't you address the things in my list first, which I just came up with off the top of my head in less than a minute (i.e. they don't require a ton of imagination or creative thought)? Since you've stated that single-payer is a non-starter, I don't want to waste either of our time with a conversation you may not be interested in having due to your possible ideological mindset.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 05:31 PM
 
Originally Posted by besson3c View Post
Why is it a non-starter?
Just what makes you think it would work in the US? You're the one trying to convince us it's a good idea. Onus is on you to make a case.
     
Snow-i
Professional Poster
Join Date: Dec 2006
Location: Maryland
Status: Offline
Reply With Quote
May 16, 2017, 05:33 PM
 
Originally Posted by besson3c View Post
Why don't you address the things in my list first, which I just came up with off the top of my head in less than a minute (i.e. they don't require a ton of imagination or creative thought)? Since you've stated that single-payer is a non-starter, I don't want to waste either of our time with a conversation you may not be interested in having due to your possible ideological mindset.
Can you point me to this list? Not seeing it.
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 05:41 PM
 
Originally Posted by Snow-i View Post
Just what makes you think it would work in the US? You're the one trying to convince us it's a good idea. Onus is on you to make a case.

What makes the US drastically different than other countries in this respect?

- large population: works in Japan. While obviously the populations aren't identical, I don't see a particularly compelling argument that the system couldn't scale further
- population density/clustering patterns: works in Canada. Obviously there are problems in rural areas, but this is likely the case with any sort of system?
- pharma profit motive, cutting edge sort of arguments: here is another indirect benefit. If you increase the pool of people that might potentially use your product, even if the per usage cost is lower, isn't this worth further analysis? There are still people in the US uncovered or who don't wish a treatment or drug because it is way overpriced. This is perhaps the most complicated factor in my mind, but I don't think it is unfair to say that there are no clear conclusions either way, and this is at least worthy of further not non-starter sort of discussion?
- Americans are really unhealthy: isn't this kind of a circular argument in some sense?
- lots of potential abuse: I think you'll find that in any country
- healthcare is currently really expensive and will remain so: another circular argument?
- malpractice lawsuits: maybe a thing, but as you acknowledged, just one factor among many?
- Americans don't have an appetite for single payer politics: to me this is not a reason. It either works or it doesn't work, your ideological feelings (either way) don't change this. We need to start with finding what works.

I don't think the onus is on me to prove that this works, it works everywhere else. What makes the US special?
     
besson3c  (op)
Clinically Insane
Join Date: Mar 2001
Location: yes
Status: Offline
Reply With Quote
May 16, 2017, 05:42 PM
 
Originally Posted by Snow-i View Post
Can you point me to this list? Not seeing it.
Not to bud into your conversation with Snow-i, but this does sound like a good reflection of some differences of PoV if not his, and I'd like to add that there is no doubt a ton of indirect financial benefit to universal health care that is hard to debate because it is hard to measure. It certainly seems logical to imagine benefits of old people not having to save up as much for emergency unexpected health care procedures, fewer medical bankruptcies, more job mobility, etc.
Paco responded to this, just to jog your memory.
     
 
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 03:18 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.,