View Full Version : Trumpcare Unveiled
So the first draft of Trumpcare has been unveiled. My suspicion is that it is going nowhere, and will hand Trump his first big defeat unless significantly amended. Probably the 2 biggest issues involve it being an amendment rather than repeal of Obamacare, and it is chocked full of entitlements that will blow the budget. As of today, it appears that Sen. Paul, Cruz, and Lee will not support it. However, we will need to see what comes out of conference.
Rather than Trumpcare or Obamacare, I'd like to see the .gov get the F*** out of medicine. We didn't need them in it before, and we don't need them in it now. Doctors and their patients should be making medical decisions, not the government or the insurance companies.
This is not Trumpcare, it is GOPCare. No one willown it's success or failure as much as Paul Ryan.
This is not Trumpcare, it is GOPCare. No one willown it's success or failure as much as Paul Ryan.
http://www.washingtonexaminer.com/mike-pence-warns-gop-lawmakers-against-healthcare-revolt/article/2616703#.WL8jrfwXFw0.twitter
and...
"Our wonderful new Healthcare Bill is now out for review and negotiation," Trump tweeted Tuesday afternoon.
I'm curious to see what comes out of reconciliation. This bill contains no provisions for interstate portability and requires insurers to accept pre-existing conditions. Thus, I have no faith that it will decrease costs.
Backed by Trump is not the same as owned by Trump. Did his team write it? Will he and his administration pump it as hard as Obama did witn the ACA? We'll see.
Congressional Republicans, mostly led by Boehner and now his protege were the primary failures in the ACA debacle and they failed for eight years to even field a tepid counter-narrative. If this fails it will never make it to Trump's desk, so this will fall more on Ryan than anyone, period. :)
Rather than Trumpcare or Obamacare, I'd like to see the .gov get the F*** out of medicine. We didn't need them in it before, and we don't need them in it now. Doctors and their patients should be making medical decisions, not the government or the insurance companies.
Most Americans are expecting Uncle Sam to foot their bill after age 65. Thus, expect him to play a prominent role...
FromMyColdDeadHand
03-07-17, 23:54
What I think is crazy is that it took seven years from BHOs election to when 'Obamacare' was at fully implemented state, but Trump is a failure if it isn't replaced in 7 weeks. The other thing is that what part of health-care is Obama-care. It isn't like Obama-care replaced everything- so what portion of change do we need to say that we have killed 'Obamacare'?
What I think is crazy is that it took seven years from BHOs election to when 'Obamacare' was at fully implemented state, but Trump is a failure if it isn't replaced in 7 weeks. The other thing is that what part of health-care is Obama-care. It isn't like Obama-care replaced everything- so what portion of change do we need to say that we have killed 'Obamacare'?
First, I'm not sure anyone expecting Obamacare to be repealed in the first 7 weeks, or even the first 7 months. However, I think there is an expectation that Obamacare gets repealed this year. I'm not sure that this House "rough draft" moves the ball in that direction at all. Hopefully the Senate version is more thoughtful.
As for what would constitute killing Obamacare - getting rid of the mandate that insurers accept all pre-existing conditions. That provision is what drove premiums through the ceiling. It is also a very popular provision which is why the GOP is in a pickle.
The campaign promise by virtual every member of the GOP, including Trump, was to repeal and replace. They needs to honor that promise.
Rather than Trumpcare or Obamacare, I'd like to see the .gov get the F*** out of medicine. We didn't need them in it before, and we don't need them in it now. Doctors and their patients should be making medical decisions, not the government or the insurance companies.
This. But the industry needs to self regulate for cost control. I've seen bills for $174 for $0.94 worth of gauze and $1096 for $10 worth of iv supplies. The industry shot itself in the foot with these practices leading to these regs that are now screwing their customers as well as them.
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First, I'm not sure anyone expecting Obamacare to be repealed in the first 7 weeks, or even the first 7 months. However, I think there is an expectation that Obamacare gets repealed this year. I'm not sure that this House "rough draft" moves the ball in that direction at all. Hopefully the Senate version is more thoughtful.
As for what would constitute killing Obamacare - getting rid of the mandate that insurers accept all pre-existing conditions. That provision is what drove premiums through the ceiling. It is also a very popular provision which is why the GOP is in a pickle.
The campaign promise by virtual every member of the GOP, including Trump, was to repeal and replace. They needs to honor that promise.
Locally, we've begun to see "membership" clinics. Similar to the old "pre paid legal" arrangements some folks had (and may still have) with law firms. You pay a monthly fee, and all PCP type functions are 100% covered by that Dr office, or offered at a substantially reduced rate. For example, MRIs are $40 I think. No insurance required.
I had heard once that these were not allowed because it was actually considered insurance, or some such shit. Obviously they've figured out how to get around that.
Do you think we'll see more of these type arrangements since it's becoming obvious that the GOP will be unable to fix this mess?
They (GOP) are the dog who finally caught the car they've been chasing...now what?!?
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Locally, we've begun to see "membership" clinics. Similar to the old "pre paid legal" arrangements some folks had (and may still have) with law firms. You pay a monthly fee, and all PCP type functions are 100% covered by that Dr office, or offered at a substantially reduced rate. For example, MRIs are $40 I think. No insurance required.
I had heard once that these were not allowed because it was actually considered insurance, or some such shit. Obviously they've figured out how to get around that.
Do you think we'll see more of these type arrangements since it's becoming obvious that the GOP will be unable to fix this mess?
They (GOP) are the dog who finally caught the car they've been chasing...now what?!?
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What you describe sounds a lot like concierge care which is increasingly popular. The big issue is what happens when people need a hospital, skilled nursing home, etc.
polydeuces
03-08-17, 08:19
Rather than Trumpcare or Obamacare, I'd like to see the .gov get the F*** out of medicine. We didn't need them in it before, and we don't need them in it now. Doctors and their patients should be making medical decisions, not the government or the insurance companies.
You must have a blessed life, clearly never incurred any serious medical bills for you your spouse or your children.
polydeuces
03-08-17, 08:24
And for the record as I've said it before and I'll say it again Obama care is the best thing that ever happened to me and my family for the first time in 20 years i no longer got f*cked over by the health insurance companies.
It seems there are many like me.
FromMyColdDeadHand
03-08-17, 08:26
First, I'm not sure anyone expecting Obamacare to be repealed in the first 7 weeks, or even the first 7 months. However, I think there is an expectation that Obamacare gets repealed this year. I'm not sure that this House "rough draft" moves the ball in that direction at all. Hopefully the Senate version is more thoughtful.
As for what would constitute killing Obamacare - getting rid of the mandate that insurers accept all pre-existing conditions. That provision is what drove premiums through the ceiling. It is also a very popular provision which is why the GOP is in a pickle.
The campaign promise by virtual every member of the GOP, including Trump, was to repeal and replace. They needs to honor that promise.
I saw on the pre-exisitng conditions that one idea was to put all those people in a pool and subsidize that pool. My understanding is that premium went up across the board to help cover these people - and then we subsidize people in general because of the higher premiums. Remove the high expense people from the general pools, premiums come down for general pools and the subsidies are more targeted. That was my understanding.
All I know is that a lot more money started being charges and flowing around, and I can tell you from the my wife's perspective and a doc, she didn't see the money. The hospitals didn't seem to see the money. My feeling is that some insurance companies made out like bandits. That or the money got soaked up in admin, tech and other stuff.
Swing and a miss.
Time to get back to the drawing board and do it right.
This. But the industry needs to self regulate for cost control. I've seen bills for $174 for $0.94 worth of gauze and $1096 for $10 worth of iv supplies. The industry shot itself in the foot with these practices leading to these regs that are now screwing their customers as well as them.
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No industry will self regulate cost control. As Libertarian oriented as I am, I recognize not all industries can work in a purely free market model and either do require at least some regulations and or, a method of forcing cost containment on them via competition. So far, Pharma, insurance, and hospitals have lobbied their way out of any legit cost containment. Personally, I feel pharma at the top of the driver for costs overall, but that's another topic for another day.
Hell, even a national public web site that allowed people cost compare various hospitals etc in their area could help market driven forces, but that's just one aspect of the issue here. Insurance companies check and negotiate all the time costs with hospitals and other vendors. Pharma on the other hand may be the single largest price driver out there and that's an industry out of control in our nation.
Everybody is so busy looking for a "gotcha" on Trump; they are lost on the fact that he is not 100 days in and making good on his efforts to roll this shit back on something they did back in '09 that had been voted on by Congress and pushed through by the Pelosi bunch
Govt hates ceding authority. Govts first and main job is to create more govt.
So.
If anyone here has any big ideas past complaining, I'd love to see them beat the odds, get elected, and try to fight with all the deep state, unelected cronies who don't want to give up their positions.
Otherwise, be patient
You must have a blessed life, clearly never incurred any serious medical bills for you your spouse or your children.
Not at all. I've just taken the responsibility of providing my family with proper medical insurance coverage. A feat which has become more and more difficult and more and more expensive as the decades pass and the government becomes more and more involved. The lawyers and bean counters aren't helping the situation either.
You need a hand out from your uncle Sam to make this work? I don't. Never have. Like most things, I need the government to leave me alone, stay out of my way, and I will handle it myself. Its all their laws and interference that make it difficult for people to do what they need to do.
C'mon. Is this anything new?
Everybody is so busy looking for a "gotcha" on Trump; they are lost on the fact that he is not 100 days in and making good on his efforts to roll this shit back on something they did back in '09 that had been voted on by Congress and pushed through by the Pelosi bunch
Govt hates ceding authority. Govts first and main job is to create more govt.
So.
If anyone here has any big ideas past complaining, I'd love to see them beat the odds, get elected, and try to fight with all the deep state, unelected cronies who don't want to give up their positions.
Otherwise, be patient
I see the intended or unintended pun there! :D ...and the difference between .gov and a virus is nil.
Eurodriver
03-08-17, 09:14
This whole piece of legislation is an absolute POS and proof the GOP still sucks.
This whole piece of legislation is an absolute POS and proof the GOP still sucks.
Winner winner.
The Federal government has been involved in health care too long to remove it from the process. The government needs to be involved as an enforcement tool to ensure cleanliness and competence of staff and facilities. DOJ needs to be involved to monitor and enforce administrative rules, HIPAA, etc. The prevention of hospitals and medical groups gaming the system to enhance profits would fall under the purview of DOJ.
I know someone with an extensive amount of knowledge concerning health care administration at the top level. They were involved in the health care industry when Medicare first started up and they recently retired, so I respect their opinion. Their opinion is that if the Federal government passed one regulation it would drive down health care costs dramatically. In their opinion legislation should be enacted that prohibits private industry and insurance companies from negotiating rates for medical care and prescription drugs.
Competition would drive down the prices. If hospital A charges a lot more for an appendectomy than hospital B and people respond to differences in cost, hospital A will have to reduce the charge to be competitive. If pharmacy C charges more for an identical drug than pharmacy D, people will go to pharmacy D to purchase their prescription.
Insurance companies should be able to compete across state lines to offer health insurance. Why they are not allowed to do it is complex and the rules need to be simplified. A person or family should be allowed to purchase a catastrophic health insurance plan to manage costs and not have a one size fits all plan forced on them by the government.
A high risk pool needs to be instituted for persons with pre-existing medical conditions. The pool can be subsidized with government funds instead of the current practice of subsidizing everyone and forcing draconian insurance premiums on people who are young, healthy and trying to establish a solid financial foundation to plan for retirement.
The biggest dragon to slay will be dramatic reduction of Federal bureaucracy to reduce government costs.
No industry will self regulate cost control. As Libertarian oriented as I am, I recognize not all industries can work in a purely free market model and either do require at least some regulations and or, a method of forcing cost containment on them via competition. So far, Pharma, insurance, and hospitals have lobbied their way out of any legit cost containment. Personally, I feel pharma at the top of the driver for costs overall, but that's another topic for another day.
Hell, even a national public web site that allowed people cost compare various hospitals etc in their area could help market driven forces, but that's just one aspect of the issue here. Insurance companies check and negotiate all the time costs with hospitals and other vendors. Pharma on the other hand may be the single largest price driver out there and that's an industry out of control in our nation.
Economics has shown us that free markets are the best cost control. Government attempts at price controls have NEVER, EVER worked. It didn't work in NY with rent controls. It didn't work with gasoline. And it is not working now with Medicare and Medicaid which are nothing more than elaborate attempts at price controls for the top consumers of healthcare (i.e. elderly and poor). There is only one way to reduce costs - remove the government price controls that create market distortion for those not protected by the price controls (i.e. those with private insurance or no government plan at all), incentivize the consumer to conserve healthcare resources, and foster competition across the industry.
For those who disagree, take a look at the one area of healthcare that is not experiencing out of control price increases - elective and cosmetic surgery. That's right, the price of LASIK and a pair of new tits has increased at a far slower rate than bypass or knee replacement over the past 15 years. Why? Because the consumer is incentivized to shop around, find a good deal, and minimize their payment.
The GOP is on the right track when it comes to interstate portability, and it is really perplexing how that did not make it into this bill. Ultimately, I think the GOP is falling into the trap of wanting to provide access to quality healthcare to everyone in order to be popular. That goal is a unicorn that can never be achieved. Those who think it can be fail to understand the fundamental difference between healthcare coverage and access to quality care. For example, every Medicaid patient has coverage; very few have access to quality care. A very similar analogy can be made to those receiving veterans healthcare coverage - enjoy the wait that price controls have created.
Economics has shown us that free markets are the best cost control. Government attempts at price controls have NEVER, EVER worked. It didn't work in NY with rent controls. It didn't work with gasoline. And it is not working now with Medicare and Medicaid which are nothing more than elaborate attempts at price controls for the top consumers of healthcare (i.e. elderly and poor). There is only one way to reduce costs - remove the government price controls that create market distortion for those not protected by the price controls (i.e. those with private insurance or no government plan at all), incentivize the consumer to conserve healthcare resources, and foster competition across the industry.
For those who disagree, take a look at the one area of healthcare that is not experiencing out of control price increases - elective and cosmetic surgery. That's right, the price of LASIK and a pair of new tits has increased at a far slower rate than bypass or knee replacement over the past 15 years. Why? Because the consumer is incentivized to shop around, find a good deal, and minimize their payment.
The GOP is on the right track when it comes to interstate portability, and it is really perplexing how that did not make it into this bill. Ultimately, I think the GOP is falling into the trap of wanting to provide access to quality healthcare to everyone in order to be popular. That goal is a unicorn that can never be achieved. Those who think it can be fail to understand the fundamental difference between healthcare coverage and access to quality care. For example, every Medicaid patient has coverage; very few have access to quality care. A very similar analogy can be made to those receiving veterans healthcare coverage - enjoy the wait that price controls have created.
I'm 100% for effective free market incentives that create competition that lowers costs. I'm just not convinced at this point it will work, especially where pharma is concerned.
Not at all. I've just taken the responsibility of providing my family with proper medical insurance coverage. A feat which has become more and more difficult and more and more expensive as the decades pass and the government becomes more and more involved. The lawyers and bean counters aren't helping the situation either.
You need a hand out from your uncle Sam to make this work? I don't. Never have. Like most things, I need the government to leave me alone, stay out of my way, and I will handle it myself. Its all their laws and interference that make it difficult for people to do what they need to do.
C'mon. Is this anything new?
Just asking, to maybe give you a different perspective, not argue - have you done this on your own 'taken the responsibility of providing my family with proper medical insurance coverage' or through employers or other pools?
As an example, COBRA for my health insurance would have been 1107.00 a month, I was paying 450ish as my share. If I really wanted to retire I could have done so, but taking 20% of what I wanted to draw off the top would have kept me working until 65.
That 1107.00 would be a much larger percentage of income for someone making 1/2 to 2/3 what I was making.
Averageman
03-08-17, 10:42
What would be wrong about turning the issue over to the States?
Interstate sales of insurance?
Being able to go on line and compare pricing at hospitals?
Income spent on Health Insurance being tax free?
I would guess some form of Medicaid and Medicare will continue to be needed, but also allowing the States to take control of their own programs and allowing interstate sales of medical insurance would both likely drive prices down.
If you didn't like the program in Florida, you could vote with your feet and move across the State line to Georgia.
The Federal Government getting involved just made a giant boondoggle ripe for corruption.
legislation should be enacted that prohibits private industry and insurance companies from negotiating rates for medical care and prescription drugs.
I don't see how would that work. In terms of pharmaceuticals, unless other manufacturers were able to immediate offer generics for ANY drugs you would in essence further entrench the monopoly that companies currently have. The EpiPen is an example of that.
I think we also need to be aware that the biggest thing big pharma wanted to kill in Obamacare was the provisions that Medicare and Medicaid could bargain for pricing.
Competition would drive down the prices. If hospital A charges a lot more for an appendectomy than hospital B and people respond to differences in cost, hospital A will have to reduce the charge to be competitive.
That may work for more 'elective' procedures that you schedule, but no one schedules appendicitis or a heart attack. People aren't going to negotiate price for those events.
Those were the things that I don't understand about your friend's proposals.
Averageman
03-08-17, 10:52
I don't see how would that work. In terms of pharmaceuticals, unless other manufacturers were able to immediate offer generics for ANY drugs you would in essence further entrench the monopoly that companies currently have. The EpiPen is an example of that.
Streamlining the FDA procedures and in turn for doing so requiring some pricing cuts would be a reasonable compromise.
I think we also need to be aware that the biggest thing big pharma wanted to kill in Obamacare was the provisions that Medicare and Medicaid could bargain for pricing.
To get the streamlined system, the trade off might be worth the price cut.
That may work for more 'elective' procedures that you schedule, but no one schedules appendicitis or a heart attack. People aren't going to negotiate price for those events.
You could always elect to make some of these decisions before requiring emergency care couldn't you? I agree though, you would still require emergency care.
Those were the things that I don't understand about your friend's proposals.
There wont be a perfect system, but the more involved the Federal Government is the less competition will take place in the free market.
Singlestack Wonder
03-08-17, 12:19
What would be wrong about turning the issue over to the States?
Interstate sales of insurance?
Being able to go on line and compare pricing at hospitals?
Income spent on Health Insurance being tax free?
I would guess some form of Medicaid and Medicare will continue to be needed, but also allowing the States to take control of their own programs and allowing interstate sales of medical insurance would both likely drive prices down.
If you didn't like the program in Florida, you could vote with your feet and move across the State line to Georgia.
The Federal Government getting involved just made a giant boondoggle ripe for corruption.
+10.....
Just asking, to maybe give you a different perspective, not argue - have you done this on your own 'taken the responsibility of providing my family with proper medical insurance coverage' or through employers or other pools?
As an example, COBRA for my health insurance would have been 1107.00 a month, I was paying 450ish as my share. If I really wanted to retire I could have done so, but taking 20% of what I wanted to draw off the top would have kept me working until 65.
That 1107.00 would be a much larger percentage of income for someone making 1/2 to 2/3 what I was making.
For the first few years after college I had to pay out of pocket myself. After that, I was working enough hours in my chosen career that they paid for it. Over time "full coverage" means less and less. Now there are monthly fees per family member and co-pays on everything. Its complete BS and its out of control.
Full disclosure in this discussion: My mother was a nurse for 44 years before retirement and most of our friends and family were/are medical professionals, so I have a little insight into this issue as well.
I don't see how would that work. In terms of pharmaceuticals, unless other manufacturers were able to immediate offer generics for ANY drugs you would in essence further entrench the monopoly that companies currently have. The EpiPen is an example of that.
I think we also need to be aware that the biggest thing big pharma wanted to kill in Obamacare was the provisions that Medicare and Medicaid could bargain for pricing.
That may work for more 'elective' procedures that you schedule, but no one schedules appendicitis or a heart attack. People aren't going to negotiate price for those events.
Those were the things that I don't understand about your friend's proposals.
I'm glad you brought up the EpiPen because it highlights a lot of misunderstanding and false assumptions regarding drugs in America. Yes, the price of the EpiPen did go up this past year - a lot. This sparked outrage from consumers because, you know, life saving shit should not interfere with discretionary funds set aside for cigarettes and $5,000 trips to Disney. But I digress. Anyway, the media made it sound like little Johnnys were dropping like flies in response to this relatively rarely used life saving treatment (which never cost more than a cheap AR) becoming so expensive. Never did anyone discuss that an equivalent competitor responded within weeks to deliver a low cost alternative. Holy Shit the media said - the free market works! Right? Nope.
In reality, there are very few conditions that can't be treated with drugs that cost $4-10 for a months supply. Drugs for diabetes, hypertension, hyperlipidemia, and many antibiotics are on the "$4 list" at CVS and Walmart. Yes, the latest and greatest chemotherapeutic costs an arm and a leg. We have charity mechanisms to cover that. However, most Americans pay out the ass because they either 1) engage in a lifestyle disease process such as smoking, 2) or they don't have the wherewithal to discuss less expensive options with their doctor usually because someone else is footing the bill (think Medicare and Medicaid).
We need to come to grips as a society that some people might need to actually change their lifestyles to afford their meds. This most often means stopping the $200/month smoking habit. If they did that, then they could afford 4 EpiPens a year...
For the first few years after college I had to pay out of pocket myself. After that, I was working enough hours in my chosen career that they paid for it. Over time "full coverage" means less and less. Now there are monthly fees per family member and co-pays on everything. Its complete BS and its out of control.
Full disclosure in this discussion: My mother was a nurse for 44 years before retirement and most of our friends and family were/are medical professionals, so I have a little insight into this issue as well.
It is true - one way to keep monthly costs down is to raise deductibles and copays.
My mother was an RN, as was my first wife. Mom retired a loong time ago, ex-wife and I are still friends and she is still working. She prefers orthopedics, but floats a lot. She tells me that many nights she's the only actual RN on the pod and has 4 to 6 aides working under her. She became a nurse to do patient care and she doesn't much care for what it has evolved into.
I'm glad you brought up the EpiPen because it highlights a lot of misunderstanding and false assumptions regarding drugs in America. Yes, the price of the EpiPen did go up this past year - a lot. This sparked outrage from consumers because, you know, life saving shit should not interfere with discretionary funds set aside for cigarettes and $5,000 trips to Disney. But I digress. Anyway, the media made it sound like little Johnnys were dropping like flies in response to this relatively rarely used life saving treatment (which never cost more than a cheap AR) becoming so expensive. Never did anyone discuss that an equivalent competitor responded within weeks to deliver a low cost alternative. Holy Shit the media said - the free market works! Right? Nope.
In reality, there are very few conditions that can't be treated with drugs that cost $4-10 for a months supply. Drugs for diabetes, hypertension, hyperlipidemia, and many antibiotics are on the "$4 list" at CVS and Walmart. Yes, the latest and greatest chemotherapeutic costs an arm and a leg. We have charity mechanisms to cover that. However, most Americans pay out the ass because they either 1) engage in a lifestyle disease process such as smoking, 2) or they don't have the wherewithal to discuss less expensive options with their doctor usually because someone else is footing the bill (think Medicare and Medicaid).
We need to come to grips as a society that some people might need to actually change their lifestyles to afford their meds. This most often means stopping the $200/month smoking habit. If they did that, then they could afford 4 EpiPens a year...
Okay, as is fairly predictable you dismiss the price increase on the epipen as 'because, free market' and just as predictably I'm going to counter with 'fvcking profiteering has no place in medicine.' Now that we've got that out of the way....
A couple of observations/questions:
What kind of doctor are you? The kind who wants a lot of patient input and questions or the kind that doesn't? How many patients do you see (in a non-emergent setting) that actively question treatment or want to discuss a lower priced alternative? I think most people are somewhat intimidated by doctors and do not feel comfortable questioning them. Some doctors also give that vibe.
You say very few conditions such as diabetes that can't be treated with drugs that are on the four dollar list. My friend's wife has diabetes. They pay over 600.00 a month for her scrip until they meet their out-of-pocket. You have any idea why that is other than a doctor pushing a new drug?
I agree with lifestyle choices. I believe you made reference to guys on this site complaining about not being able to afford insurance while at the same time having racks of guns. That example just goes to show the relative importance many normal folks place on insurance in their hierarchy of discretionary spending.
I was paying 450ish a month for my share of health insurance. That same amount for a guy working for 12.00 an hour is going to be a deal breaker for him.
Finally, what percentage of the patients you see are smokers? IIRC only 16 or 17 percent of the adult population still smokes.
I've always wondered this and I'm very un-researched on this topic, so I ask this questions with genuine naivete:
Why is healthcare (both the cost of treatment as well as the cost of drugs and such) so much more expensive here than the rest of the world?
I see about 32 patients during a typical ED shift. I cover 20 ICU bed when on call in the unit. Most of the patients in the ED are not having an immediate emergency and I'm able to discuss a full range of treatment options, costs, and risks. Keep in mind that about 20-25% of ED patients have no coverage and many of those are acutely aware of cost (others have no intention of paying the bill). The ICU less so, but we still discuss cost-effectivness all the time. In the ED and ICU, just under half of my patients smoke. That is because smoking is associated with a high incidence of acute exacerbations of chronic diseases - selection bias.
As for your friend, feel free to PM me their med list and testing supplies, and I'll tell you why it's so expensive. It's hard to address your anecdote without knowing what she takes. However, metformin and glipizide are about $10/month. Vials of 70/30 insulin are about $100-200/month, and those who want the convenience of a dial pen can expect to pay about what your friend pays. My point being that I have some uninsured patients who can't afford $600/month but we still find a regimen far less expensive but perhaps involves a little more frequent needle sticks. Many times it's only $10/month in meds and $50/month in testing supplies.
Finally, I get the sense that you don't trust free markets at least in the healthcare arena. But since I answered all of your questions (to the best of my ability), answer me this one: what about the past 40 years makes you think that MORE regulations is going to help prices? I mean, look at what has happened as cost have soared with ever increasing regulations and price controls. Why not apply some free market principles? What in hell do you have to lose?
I've always wondered this and I'm very un-researched on this topic, so I ask this questions with genuine naivete:
Why is healthcare (both the cost of treatment as well as the cost of drugs and such) so much more expensive here than the rest of the world?
In order of significance:
1) Americans consume a massive amount of high tech, high cost healthcare resources. Look at the per capita number of CT scanners, MRIs, etc. We perform more stress tests, cardiac caths, dialysis, knee replacements, etc. than any other country. This is because patients expect it and satisfaction scores are strongly linked to resource utilization at least on the imaging side - the more tests, the happier the patient. Also, the culture in American medical schools is such that errors are not tolerated, and doctors are trained to rule out a list of all possible disease instead of focusing only on likely disease.
2) Americans want good care RIGHT NOW. Our emergency departments, urgent cares, and diagnostic centers are churning out volume 24/7/365. It cost a lot of money to make me work nights and weekends.
3) Americans taken a huge burden of indigent care. Unlike the 3rd world, many of our poor are fat, addicted, and demand care comparable in quality to what you get. Thus we must cost share; you pay more to cover their cost.
4) Regulations and compliance requires that we hire an army of bean counters to document our compliance. It once took 1 office manager for a medium practice; it's now 3-4.
5) Supply/demand mismatch. Physician, nurse, etc. labor is at a relative shortage compared to people wanting care.
6) Cost of wearhousing the elderly. About 10% of Medicare's budget is skilled nursing care. Much of that is done via family/home health in other countries.
7)Malpractice and defensive medicine. However, many studies looking at reform do not reflect reduced costs. Texas is an example where costs continued despite reforms.
For those who say corporate salaries and lobbying, I say show me the numbers. Those expenses are a rounding error on the $3T we spend every year.
I agree with lifestyle choices. I believe you made reference to guys on this site complaining about not being able to afford insurance while at the same time having racks of guns. That example just goes to show the relative importance many normal folks place on insurance in their hierarchy of discretionary spending.
Short of having cancer I have discovered that "private pay" and "prescription plans" are cheaper than insurance. I see the side by side numbers when I "private pay" and insurance basically means I would pay more.
Obviously I can't go to the hospital with every upset tummy or stubbed toe or that would change. And yeah I have racks of guns, but I haven't really bought anything new in the last few years. Much like the cost of health insurance, I simply can't afford to do so.
And I shouldn't have to sell off my guns to buy insurance any more than other people should have to sell of their house, cars or watch to buy health insurance. I bought my guns instead of investing in a 401k. Compared to how I've seen 401ks fair in the last 20 years, I think I made a better investment.
I'm actually preparing to sell my home and move to a place with a more manageable cost of living and more affordable house prices. I'm making that "lifestyle change" because I realize I'm getting near the age where I'm going to need health insurance and there won't be any subsidizes for me.
I'm actually preparing to sell my home and move to a place with a more manageable cost of living and more affordable house prices. I'm making that "lifestyle change" because I realize I'm getting near the age where I'm going to need health insurance and there won't be any subsidizes for me.
Most common sense response to costs I've seen in a long time... I know people living in my old condo building in downtown Seattle complaining that the rising cost of dues is cutting into their lifestyle, but the concept of "sell and move to something you can afford" is akin to suggesting they sell a child.
Averageman
03-08-17, 19:53
I enlisted in 1981.
What was promised when I enlisted in the Military and what is now a reality 35+ years later are remarkably different, the world turns, things change. No one was "Grandfathered" (well except our political hero's) the rest of us sucked it up and now pay up.
When reality hits and people with this program end up getting the same treatment the Military got, it will set in.
People being generally corruptible, greedy and always looking for an edge to take care of number one, this too will fail.
Why do I get the feeling that some in the HC industry think Americans suck. That they're rubes to be fleeced while they're in distress, and are far to stupid to educate on costs while the person making in the top 3-5% of all wage earners in America is looking down on them? :rolleyes:
It's like that in any industry. There is always "some" but the vast majority approach every patient encounter with the same diligence they would give their own family member. The numbers in healthcare are probably similar to LE.
Short of having cancer I have discovered that "private pay" and "prescription plans" are cheaper than insurance. I see the side by side numbers when I "private pay" and insurance basically means I would pay more.
Obviously I can't go to the hospital with every upset tummy or stubbed toe or that would change. And yeah I have racks of guns, but I haven't really bought anything new in the last few years. Much like the cost of health insurance, I simply can't afford to do so.
And I shouldn't have to sell off my guns to buy insurance any more than other people should have to sell of their house, cars or watch to buy health insurance. I bought my guns instead of investing in a 401k. Compared to how I've seen 401ks fair in the last 20 years, I think I made a better investment.
I'm actually preparing to sell my home and move to a place with a more manageable cost of living and more affordable house prices. I'm making that "lifestyle change" because I realize I'm getting near the age where I'm going to need health insurance and there won't be any subsidizes for me.
I don't know man. Some of what you are saying sounds a little scary. I kinda understand where you are coming from with insurance, but other parts give me the heebegeebes. I may disagree with you on some stuff at times, but I seriously hope that it all works out for you. Seriously.
Finally, I get the sense that you don't trust free markets at least in the healthcare arena. But since I answered all of your questions (to the best of my ability), answer me this one: what about the past 40 years makes you think that MORE regulations is going to help prices? I mean, look at what has happened as cost have soared with ever increasing regulations and price controls. Why not apply some free market principles? What in hell do you have to lose?
To your statement. You are correct, I do not believe in completely unregulated free markets, primarily in areas such as energy, healthcare, communications. I have never believed that Reaganomics did anything except feather the pockets of the rich and increase the deficit. That doesn't mean that I think the defense buildup was unwarranted, quite the opposite. I just recognize the cost to us as a Nation. I've cursorily read and studied Keynes and Heyek as well as Galbraith. My conclusion, I believe some regulation is needed.
What about the past 40 years makes you think that MORE regulations is going to help prices?
I don't want to engage in a circular argument but I'd really appreciate it if you could show me a specific new regulation (as opposed to policy) that I champion. I suppose you could say wanting to curb the power that lobbyists hold sway over our government is embracing new regulation, If so, I'll give you that one.
One fundamental change that I've seen in the last 40 years is the change from WE to ME. Even though Chainsaw Al Dunlap rapidly fell from what grace he had, his belief that most important goal of a business is to return dividends and make money for shareholders is the model most businesses run on today. As a result being profitable, providing a decent wage for workers, and building long term corporate stability are suborned to maximizing shareholder profit.
I think Galbraith said it best: The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.
The bitter pill for me to swallow in all of this is the fact that my future well-being is contingent on the corporations in my portfolio doing just that, maximizing profit. I also know that one day the whole house of cards that is our economy will implode and come tumbling down.
My friends wife has the dial pen. What exactly makes it more expensive? On the expense subject: Not to long ago my GP sent me to a Pulmonologist(sp?) to convince me I had asthma. After lung doc proved it to me and then convinced me I wasn't going to die of COPD if I took a steroid inhaler he prescribed a one dose a day inhaler. My copay was a couple hundred, but they had a card I could use to defray the costs, unfortunately you couldn't use it on my insurance. So I finished the sample and went back for another prescription. I ended up on an Advair Diskus twice a day for 20.00 a quarter through Express Scripts. Once again, what made the other so expensive?
To your statement. You are correct, I do not believe in completely unregulated free markets, primarily in areas such as energy, healthcare, communications. I have never believed that Reaganomics did anything except feather the pockets of the rich and increase the deficit. That doesn't mean that I think the defense buildup was unwarranted, quite the opposite. I just recognize the cost to us as a Nation. I've cursorily read and studied Keynes and Heyek as well as Galbraith. My conclusion, I believe some regulation is needed.
What about the past 40 years makes you think that MORE regulations is going to help prices?
I don't want to engage in a circular argument but I'd really appreciate it if you could show me a specific new regulation (as opposed to policy) that I champion. I suppose you could say wanting to curb the power that lobbyists hold sway over our government is embracing new regulation, If so, I'll give you that one.
One fundamental change that I've seen in the last 40 years is the change from WE to ME. Even though Chainsaw Al Dunlap rapidly fell from what grace he had, his belief that most important goal of a business is to return dividends and make money for shareholders is the model most businesses run on today. As a result being profitable, providing a decent wage for workers, and building long term corporate stability are suborned to maximizing shareholder profit.
I think Galbraith said it best: The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.
The bitter pill for me to swallow in all of this is the fact that my future well-being is contingent on the corporations in my portfolio doing just that, maximizing profit. I also know that one day the whole house of cards that is our economy will implode and come tumbling down.
My friends wife has the dial pen. What exactly makes it more expensive? On the expense subject: Not to long ago my GP sent me to a Pulmonologist(sp?) to convince me I had asthma. After lung doc proved it to me and then convinced me I wasn't going to die of COPD if I took a steroid inhaler he prescribed a one dose a day inhaler. My copay was a couple hundred, but they had a card I could use to defray the costs, unfortunately you couldn't use it on my insurance. So I finished the sample and went back for another prescription. I ended up on an Advair Diskus twice a day for 20.00 a quarter through Express Scripts. Once again, what made the other so expensive?
In addition to curtailing lobbying, I was under the distinct impression that you wanted to regulate the profits on insurance companies as well as the salaries of healthcare executives. Is that not so? In addition, when curtailing lobbying and corporate profits do not balance the books, would you be in favor of government rationing?
I'd say there are very few on this board who would advocate a completely unregulated free market in healthcare. I certainly don't. I do think that free market principles and "Reaganomics" led to the greatest rise in across the board standards of living that the world has seen. That is especially true in healthcare. But certainly some regulations are needed such as licensing, safety mechanisms, etc. In other words, I would like to shift the government's role from one of cost containment to quality assurance. That will likely mean a net deregulation and overall smaller government footprint.
As for your friend's wife's pen, some of the increased cost is due to production. On the other hand, most of the cost is kinda like the price on a Wilson Combat CQB Elite - some people are just willing to fork over the cash instead of settling for the much less expensive Springfield Loaded which would be vials of 70/30 insulin in the medical world. ;)
Finally, I get the feeling that you have had some physician-patient interactions that have left you more than a little distrustful of my current profession. Perhaps it's the limitations of written communication, but that is the tone that I'm getting. If so, that is too bad. I hope that you find a doc that you trust since it will likely make you healthier and lengthen your warranty.
Chears.
I would like to shift the government's role from one of cost containment to quality assurance. That will likely mean a net deregulation and overall smaller government footprint.
Oh my God ^THIS^! So much of THIS! Please Santa? I'll be a good boy all year, I promise, just for THIS!
Oh my God ^THIS^! So much of THIS! Please Santa? I'll be a good boy all year, I promise, just for THIS!
I'm here on Wednesdays and Thursdays; try the veal...;)
Once again, what made the other so expensive?
Free market and rights protection. Others were likely brand names of a higher cost; those are the ones that the companies usually offer coupons on. Those discount rates generally can be realized only with commercial insurances. I have multiple patients who can't afford inhalers. $4 Walgreen's or Sam's Club formularies are decent but by no means comprehensive. There are multiple examples of newer, expensive brand name drugs that are superior to cheaper generic alternatives. There are examples of drug companies playing on FDA regulations, like a story of URL Pharma winning rights for the colchicine and jacking up a price 50 times. Despite this, I don't want to make an impression that I am piling on pharma. It takes an insane amount of money to bring a new drug from the development stage to the market. It is also a never guaranteed investment on their part. It is a tough and intertwined situation where a behavior of every party involved in a process contributes to cost increase.
Finally, I get the feeling that you have had some physician-patient interactions that have left you more than a little distrustful of my current profession. Perhaps it's the limitations of written communication, but that is the tone that I'm getting. If so, that is too bad. I hope that you find a doc that you trust since it will likely make you healthier and lengthen your warranty.
Chears.
Oh, good lord no. I've had the same GP for 20 years. I see him for an annual physical and once at the six month break to check scripts. Up until he and the pulmonologist convinced me I had asthma I'd also see him a couple times a year for bronchitis. His office nurse jokes that when she sees me or one other guy on the schedule she knows they are going to have to work the schedule because we spend too much time talking. He's a great doc. During an office visit I told him I was thinking about doing Adkins and asked what he thought, next visit he asked about it because my weight hadn't really dropped. After my explanation of what I'd been doing he said 'generally Adkins is pretty easy to do, but maybe your not smart enough for it.....' I like the guy, plus, as I said, he is a good doc. I actually worry about him working too hard.
All the other docs my family or I have seen at the clinic are top drawer. It is doctor owned and apparently they are picky.
For the record, I don't think doc's are overpaid, or even really a big part of the problem.
ETA: Re salaries for CEO's - I believe in some degree of market regulation but salary regulation is way over that line. It is just greed that irks me and should irk everyone. Nothing I can do about it except vote with my wallet and grouse.
I volunteer one day a week for an NPO that revitalizes housing. For the longest time I did not volunteer with them because I thought they paid their Executive Director too much for an organization that relies on donations and volunteer labor. Not too long ago they restructured and I started with them.
Free market and rights protection. Others were likely brand names of a higher cost; those are the ones that the companies usually offer coupons on. Those discount rates generally can be realized only with commercial insurances. I have multiple patients who can't afford inhalers. $4 Walgreen's or Sam's Club formularies are decent but by no means comprehensive. There are multiple examples of newer, expensive brand name drugs that are superior to cheaper generic alternatives. There are examples of drug companies playing on FDA regulations, like a story of URL Pharma winning rights for the colchicine and jacking up a price 50 times. Despite this, I don't want to make an impression that I am piling on pharma. It takes an insane amount of money to bring a new drug from the development stage to the market. It is also a never guaranteed investment on their part. It is a tough and intertwined situation where a behavior of every party involved in a process contributes to cost increase.
Thanks. Am I the only one on this site who isn't a doctor? :D
I don't know man. Some of what you are saying sounds a little scary. I kinda understand where you are coming from with insurance, but other parts give me the heebegeebes. I may disagree with you on some stuff at times, but I seriously hope that it all works out for you. Seriously.
I'm not saying it's comfortable. But it's what I can afford to do in my current situation. I really don't have an alternative. It's not like I can stop buying guns and get health insurance instead. I stopped being able to buy guns a couple years back.
And if something major happens, regardless of if I can get insurance for a pre existing, I'm probably going to have to have a fire sale anyway. It's a very precarious way to do things, but when you have only shitty options you choose the one that seems best.
Honestly, much as I despised him as a President, I was seriously hoping Obamacare was going to provide a low cost insurance option even if it turned out to be Dr. DMV it would have been better than nothing. I knew they'd pick my pocket to pay for it regardless.
At any rate, once I sell the house and move to a more manageable cost of living environment, I should be able to afford basic health care. Then I only have to make it to 65 and I intend to live like a welfare king, I figure if I have at least 5 kids with 5 unemployed mothers I should have benefits for everything.
In order of significance:
1) Americans consume a massive amount of high tech, high cost healthcare resources. Look at the per capita number of CT scanners, MRIs, etc. We perform more stress tests, cardiac caths, dialysis, knee replacements, etc. than any other country. This is because patients expect it and satisfaction scores are strongly linked to resource utilization at least on the imaging side - the more tests, the happier the patient. Also, the culture in American medical schools is such that errors are not tolerated, and doctors are trained to rule out a list of all possible disease instead of focusing only on likely disease.
2) Americans want good care RIGHT NOW. Our emergency departments, urgent cares, and diagnostic centers are churning out volume 24/7/365. It cost a lot of money to make me work nights and weekends.
3) Americans taken a huge burden of indigent care. Unlike the 3rd world, many of our poor are fat, addicted, and demand care comparable in quality to what you get. Thus we must cost share; you pay more to cover their cost.
4) Regulations and compliance requires that we hire an army of bean counters to document our compliance. It once took 1 office manager for a medium practice; it's now 3-4.
5) Supply/demand mismatch. Physician, nurse, etc. labor is at a relative shortage compared to people wanting care.
6) Cost of wearhousing the elderly. About 10% of Medicare's budget is skilled nursing care. Much of that is done via family/home health in other countries.
7)Malpractice and defensive medicine. However, many studies looking at reform do not reflect reduced costs. Texas is an example where costs continued despite reforms.
For those who say corporate salaries and lobbying, I say show me the numbers. Those expenses are a rounding error on the $3T we spend every year.
That's an excellent overview and absolutely correct, but I would certainly add technology relative to evolving standards of care to that list. 20 years ago, I diagnosed appendicitis based on years of experience and what I learned from Cope's Diagnosis of the Acute Abdomen. I was right about 85% of the time. Now, by the time I get the call from the ER, the patient has already had a $1200 CT scan. Their appendicitis has already been diagnosed with a very high degree of accuracy. I can't remember the last time I took out a normal appendix. The list of truly astonishing technology advances that have happened over the last 10 years is an increasingly long and expensive one, and you have to add the expensive tweaks that constantly happen to the existing technology. ie, 128-slice CT scanners, 3-Tesla magnet MRI's, etc etc etc. AND...it's especially expensive to the health care system when you take into account the fact that practically every hospital in America, including the rural hospitals that might be 10 miles apart, has to have that technology.
I would like to shift the government's role from one of cost containment to quality assurance. That will likely mean a net deregulation and overall smaller government footprint.
As you know, they're doing both at the same time. The government is increasingly tying reimbursement to outcome measurement.
http://www.nrhi.org/work/what-is-macra/what-is-macra/
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I'm not saying it's comfortable. But it's what I can afford to do in my current situation. I really don't have an alternative. It's not like I can stop buying guns and get health insurance instead. I stopped being able to buy guns a couple years back.
And if something major happens, regardless of if I can get insurance for a pre existing, I'm probably going to have to have a fire sale anyway. It's a very precarious way to do things, but when you have only shitty options you choose the one that seems best.
Honestly, much as I despised him as a President, I was seriously hoping Obamacare was going to provide a low cost insurance option even if it turned out to be Dr. DMV it would have been better than nothing. I knew they'd pick my pocket to pay for it regardless.
At any rate, once I sell the house and move to a more manageable cost of living environment, I should be able to afford basic health care. Then I only have to make it to 65 and I intend to live like a welfare king, I figure if I have at least 5 kids with 5 unemployed mothers I should have benefits for everything.
Well, Viagra will be off-patent by the time you are 65. So, no need for a prescription drug plan to help you sire those 5 chitlens.
However, assuming that you will some day need to off load a few of those transferable Class 3 items in your safe, I certainly hope that you remember me before posting anything on EE. ;)
http://www.redstate.com/sweetie15/2017/03/08/ted-cruz-warns-new-obamacare-repeal-bill-cannot-pass-senate-written/
Cruz confirmed what I suspected, the House's original turd sandwich can't pass the Senate. In fact, I doubt it would pass the House. However, I'm anxious to see the final version that comes to a floor vote.
Spicer has invited all sides to read the bill and offer suggestions. Whether the offer is genuine is tbd.
Averageman
03-09-17, 10:54
http://www.redstate.com/sweetie15/2017/03/08/ted-cruz-warns-new-obamacare-repeal-bill-cannot-pass-senate-written/
Cruz confirmed what I suspected, the House's original turd sandwich can't pass the Senate. In fact, I doubt it would pass the House. However, I'm anxious to see the final version that comes to a floor vote.
I'm surprised that instead of leaving this up to a bunch of career politicians, our POTUS hasn't brought in some retired Surgeon Generals, some Economists and some folks who actually run Hospitals to sit around in a locked room until they can come up with a better answer than this.
Clearly there is enough built in negativism on one side of the isle that is going to oppose this no matter how good it can be. That they haven't anything better at this point seems to lead me to believe they are incapable of doing so.
All this crowing about how bad Obama-Care was and is and no one in the GOP decided to come up with something better than this?
Singlestack Wonder
03-09-17, 11:02
One of the key issue with healthcare costs is the fact that in the early 70's as more health insurance became available, healthcare providers started using the logic that if insurance companies were now footing the tab, they could charge exponentially more. When band aids cost upwards of $30 each during a hospital stay, its obvious where the issues are. The same can be said for doctor's and other healthcare workers income. Of course when malpractice insurance companies realized the inflated incomes that health care providers were achieving due to milking insurance companies, they too inflated their rates. The health care industry is just as out of control as the federal budget.
One of the key issue with healthcare costs is the fact that in the early 70's as more health insurance became available, healthcare providers started using the logic that if insurance companies were now footing the tab, they could charge exponentially more. When band aids cost upwards of $30 each during a hospital stay, its obvious where the issues are. The same can be said for doctor's and other healthcare workers income. Of course when malpractice insurance companies realized the inflated incomes that health care providers were achieving due to milking insurance companies, they too inflated their rates. The health care industry is just as out of control as the federal budget.
I notice a predictable phenomenon when I had to take my cars to the body shop for minor damage over the past 3 years. The guy providing me an estimate would want to know if I was paying cash, or would this be an insurance claim. In each case, the quotes were much higher if I told them that my insurance would handle payment. People don't care how much they are charged provided that someone else is footing the bill. In fact, people are sometimes incentivized to be charged MORE if a 3rd party is paying. That is why auto insurers have "preferred shops," and the analogy can easily be drawn to healthcare networks - cost containment.
The answer to this issue is very simple. Make health insurance similar to car, disability, or homeowners insurance - a policy that you very rarely use. This can be done through a massive expansion of pre tax health savings accounts that allow employers contributions much like a 401K.
The effects would be an almost immediate reduction in healthcare costs that dramatically expands actual access to quality care. This would be much better than simply providing subsidies for "coverage" plans that do not contain costs or provide actual access to care.
In addition to curtailing lobbying, I was under the distinct impression that you wanted to regulate the profits on insurance companies as well as the salaries of healthcare executives. Is that not so? In addition, when curtailing lobbying and corporate profits do not balance the books, would you be in favor of government rationing?
I'd say there are very few on this board who would advocate a completely unregulated free market in healthcare. I certainly don't. I do think that free market principles and "Reaganomics" led to the greatest rise in across the board standards of living that the world has seen. That is especially true in healthcare. But certainly some regulations are needed such as licensing, safety mechanisms, etc. In other words, I would like to shift the government's role from one of cost containment to quality assurance. That will likely mean a net deregulation and overall smaller government footprint.
As for your friend's wife's pen, some of the increased cost is due to production. On the other hand, most of the cost is kinda like the price on a Wilson Combat CQB Elite - some people are just willing to fork over the cash instead of settling for the much less expensive Springfield Loaded which would be vials of 70/30 insulin in the medical world. ;)
Finally, I get the feeling that you have had some physician-patient interactions that have left you more than a little distrustful of my current profession. Perhaps it's the limitations of written communication, but that is the tone that I'm getting. If so, that is too bad. I hope that you find a doc that you trust since it will likely make you healthier and lengthen your warranty.
Chears.
When you say quality assurance, do you mean outcome-based compensation for Docs?
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In a direct sense, no.
First, outcomes are dependent on many factors outside of physician performance such as patient complexity and compliance. Such measures work only when the patients are financially held to account for their behavior (obesity, tobacco use, etc.), and nobody wants that level of intrusion by regulators.
Second, outcome based compensation only works when 3rd party payers are footing most of the bills. It is very hard to have outcome centered reimbursement after shifting the payment burden from the govt and insurance companies to the patients which is the core of what I propose.
Third, my plan puts the dollar directly in the hands of patients who will naturally gravitate toward physicians and institutions providing the best VALUE. Naturally, outcomes are part of that value equation (cost being another), so my plan indirectly addresses outcomes.
In the more concrete terms of our current system, I am very much in favor of payment models that reward evidence/guideline based practices provided that those guidelines are reasonable and established by speciality consensus. I'm even in favor of financial penalties in our current system for harmful practice patterns such as lengthy ED boarding times, over utilization of harmful imaging studies in children, etc. Basically, I accept that the best way to lead a man to do the right thing is by his wallet, and our current system lays the power of the purse in the hands of 3rd party payers. However, these penalties would need to be vetted much better than some of the recent CMS Core Measures which leave a lot to be desired when it comes to measuring real quality; the blood culture - pneumonia core measure being a prime example. I'm also a big proponent of initiatives such as the Choosing Wisely Campaign which seeks to eliminate maladaptive testing and practice habits.
However, my hope is that the penalties and rewards under our current system could be replaced by putting the dollar in the patient's had who can make their own value judgements. The government would then just insure a baseline level of safety, quality, and accurate outcome reporting.
Singlestack Wonder
03-09-17, 13:42
When you say quality assurance, do you mean outcome-based compensation for Docs?
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Great point! Same logic should be applied to teachers and other government employees. The pay curve would definitely go down. Inflated healthcare employee salaries as well as other ridiculously inflated costs are far out of control.
Great point! Same logic should be applied to teachers and other government employees. The pay curve would definitely go down. Inflated healthcare employee salaries as well as other ridiculously inflated costs are far out of control.
So, tell me more about these ridiculous salaries.
Great point! Same logic should be applied to teachers and other government employees. The pay curve would definitely go down. Inflated healthcare employee salaries as well as other ridiculously inflated costs are far out of control.
Mine was a genuine question, rather than a statement. The weakness of any outcome-based comp would be patient compliance.
I don't think that's a workable solution.
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In a direct sense, no.
First, outcomes are dependent on many factors outside of physician performance such as patient complexity and compliance. Such measures work only when the patients are financially held to account for their behavior (obesity, tobacco use, etc.), and nobody wants that level of intrusion by regulators.
Second, outcome based compensation only works when 3rd party payers are footing most of the bills. It is very hard to have outcome centered reimbursement after shifting the payment burden from the govt and insurance companies to the patients which is the core of what I propose.
Third, my plan puts the dollar directly in the hands of patients who will naturally gravitate toward physicians and institutions providing the best VALUE. Naturally, outcomes are part of that value equation (cost being another), so my plan indirectly addresses outcomes.
In the more concrete terms of our current system, I am very much in favor of payment models that reward evidence/guideline based practices provided that those guidelines are reasonable and established by speciality consensus. I'm even in favor of financial penalties in our current system for harmful practice patterns such as lengthy ED boarding times, over utilization of harmful imaging studies in children, etc. Basically, I accept that the best way to lead a man to do the right thing is by his wallet, and our current system lays the power of the purse in the hands of 3rd party payers. However, these penalties would need to be vetted much better than some of the recent CMS Core Measures which leave a lot to be desired when it comes to measuring real quality; the blood culture - pneumonia core measure being a prime example. I'm also a big proponent of initiatives such as the Choosing Wisely Campaign which seeks to eliminate maladaptive testing and practice habits.
However, my hope is that the penalties and rewards under our current system could be replaced by putting the dollar in the patient's had who can make their own value judgements. The government would then just insure a baseline level of safety, quality, and accurate outcome reporting.
I gotcha. I've yet to meet a Doc that would be for outcome-based comp. for exactly the reasons you state.
My mother is retired from the medical field...if you want to get her stirred up, advocate outcome compensation. She was the Workman's Comp Manager for a large Ortho firm, and apparently non-compliance and attempts at outright fraud (by the "patients" not the docs) are common on that side of things.
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The proposed outcome-based compensation will not on an individual case compensation basis.
I gotcha. I've yet to meet a Doc that would be for outcome-based comp. for exactly the reasons you state.
My mother is retired from the medical field...if you want to get her stirred up, advocate outcome compensation. She was the Workman's Comp Manager for a large Ortho firm, and apparently non-compliance and attempts at outright fraud (by the "patients" not the docs) are common on that side of things.
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The principles that I propose are essentially indentical to what was embraced by the GOP before it controlled Washington. Things like the expansion of HSAs have been floated by most GOP candidates for President for a long time. Granted, I take it a big step beyond the average Republican since I call for at least a partial replacement of Medicare.
Mine was a genuine question, rather than a statement. The weakness of any outcome-based comp would be patient compliance.
I don't think that's a workable solution.
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Another issue with outcome-based comp for institutions is that it can create a powerful incentive for these institutions to patient select unless careful measures are taken. For example, let's say that the national average mortality for bypass surgery is 2%, and the 3rd party payers are going to reduce their payments to any institution with mortalities higher than 3.5%. Well, that creates a powerful incentive for hospitals to reject higher risk patients. It can become a self-fulfilling prophecy as these higher risk patients are dumped on regional access hospitals that operate on much tighter margins than private hospitals. With less money comes worse outcomes and so on...
Having said that, some outcome based performance measures are well designed and helpful. You just need to be very careful with the incentives and unintended consequences.
The CBO has scored Trumpcare. According to their estimates, it will increase the number of uninsured by some 20 million over the next decade mostly by limiting the expansion of Medicaid. Since Medicaid is largely paid by the federal government, this will reduce the budget deficit by $330B.
Now, a couple of points.
1) Very few people will actually lose insurance. That is because Medicaid is not insurance; it is a payment plan where the government picks up the tap and below market rates for most treatment.
2) There is not a lot of evidence that further expansions of Medicaid are cost effective or change clinical outcomes. A NEJM article looking at the Oregon experience showed that a couple years after that state expanded Medicaid, healthcare utilization went up, but outcomes were actually flat. This is not all that surprising to me since our country consumes healthcare resources at a remarkable rate compared to the rest of the world but our outcomes are not dramatically better than other developed countries. That is because the driving factor behind healthcare outcomes is personal behavior, and simply adding more use of doctors and medications are not going to overwhelm a personal choice to engage in unhealthy behaviors. Thus, curtailing Medicaid is not a bad thing; it is in fact necessary for our survival.
3) Trumpcare does very little to change the trajectory of healthcare cost. The will be some modest dip, but it's cost savings are delayed. That is largely because of a) the prohibition against insurers discriminating against those with pre-existing conditions is maintained, and b) the need for cost sharing to cover the losses from those with Medicaid or no coverage.
4) The CBO analysis may be wrong. The CBO is very weak at dynamic analysis and can only score what it sees on paper. Thus, it overestimated the number of people who would be covered by Obamacare and may underestimate the number of people who will be have decent access to healthcare provided by Trumpcare.
It sounds like this bill it toast. Ryan will take most of the blame, Trump will get his nose bloodied a little, and some of you will likely get screwed as Obamacare continues its downward spiral.
Trump should hold a press conference (or Tweet) tomorrow morning that he is calling on the House to retract the healthcare bill since the Dems plan to filibuster Gorsuch. Once the Senate unleashes the nuclear option for Gorsuch, it will be much easier to do the same for a more aggressive healthcare bill.
Straight Shooter
03-23-17, 21:31
So, tell me more about these ridiculous salaries.
SHHEEEEEEEEEEEEEEEEET- ERRBODY KNOWS DOCTORS & TRUCK DRIVERS MAKE AAAALLL DA MONEY...just see the trucking thread.
The CBO has scored Trumpcare. According to their estimates, it will increase the number of uninsured by some 20 million over the next decade mostly by limiting the expansion of Medicaid. Since Medicaid is largely paid by the federal government, this will reduce the budget deficit by $330B.
Now, a couple of points.
1) Very few people will actually lose insurance. That is because Medicaid is not insurance; it is a payment plan where the government picks up the tap and below market rates for most treatment.
2) There is not a lot of evidence that further expansions of Medicaid are cost effective or change clinical outcomes. A NEJM article looking at the Oregon experience showed that a couple years after that state expanded Medicaid, healthcare utilization went up, but outcomes were actually flat. This is not all that surprising to me since our country consumes healthcare resources at a remarkable rate compared to the rest of the world but our outcomes are not dramatically better than other developed countries. That is because the driving factor behind healthcare outcomes is personal behavior, and simply adding more use of doctors and medications are not going to overwhelm a personal choice to engage in unhealthy behaviors. Thus, curtailing Medicaid is not a bad thing; it is in fact necessary for our survival.
3) Trumpcare does very little to change the trajectory of healthcare cost. The will be some modest dip, but it's cost savings are delayed. That is largely because of a) the prohibition against insurers discriminating against those with pre-existing conditions is maintained, and b) the need for cost sharing to cover the losses from those with Medicaid or no coverage.
4) The CBO analysis may be wrong. The CBO is very weak at dynamic analysis and can only score what it sees on paper. Thus, it overestimated the number of people who would be covered by Obamacare and may underestimate the number of people who will be have decent access to healthcare provided by Trumpcare.
Without cost containment of some type, be it by market forces or regulation (I know, a dirty word), or combination of both, it will be short term improvements at best, or none at all. Each industry passes the buck and blame as to who is driving costs. As you and others have said, also includes expectations of people who want latest greatest tech to diagnose all aches and pains, etc.
It sounds like this bill it toast. Ryan will take most of the blame, Trump will get his nose bloodied a little, and some of you will likely get screwed as Obamacare continues its downward spiral.
Trump should hold a press conference (or Tweet) tomorrow morning that he is calling on the House to retract the healthcare bill since the Dems plan to filibuster Gorsuch. Once the Senate unleashes the nuclear option for Gorsuch, it will be much easier to do the same for a more aggressive healthcare bill.
Call me a pessimist, but this is exactly what was planned. He tried to fix healthcare, but congress didn't go along with him. Political posturing. Obamacare, TrumpCare, Ryancare, whoever care are all destined to fail. It's just how steep an angle they take when augering the healthcare system into the ground.
Unless the government can figure out how to turn shit into diamonds there is no way to economically sustain paying for advanced healthcare for a higher and higher % of the population. We are all living longer and as we age we draw on the system so we can live longer. People retire and move onto Medicare/Medicaid and suck the government tit dry living into their nineties having cataracts surgery, artificial joint implants, open heart surgery and god knows what else. I'm no economist, but even I can figure out that when you have a HUGE imbalance of withdrawals vs deposits bad stuff happens.
We will have single payer soon enough and then EVERYONE except the political elite will have VA style crap care and go back to dying from previously curable conditions. Either that or we are going to have a retirement type system where if you don't save in your youth you're going to suffer after retirement.
Either that or we are going to have a retirement type system where if you don't save in your youth you're going to suffer after retirement.
^^My choice as I did scrimp and save in my youth. Tired of paying for those that didn't.
skywalkrNCSU
03-24-17, 10:04
Maybe we should look to implement policies that address the supply side vs always looking at the demand side
Averageman
03-24-17, 10:13
The Federal Government needs to understand that they aren't good at this and back out with a bill that returns the system to a somewhat pre Obama-Care condition. The problem seems to be that Obama-care passed in the first place, the Federal government made a promise and the promise is circling the drain for many reason.
It's not as difficult to knock some of the cost out for healthcare for most people who want insurance in the United States.
Deregulate Health Insurance so that it can be sold across State Lines.
Allow small Business's to band together and buy at the rates of larger business's.
Turn the Business of providing care for the poor and elderly who cannot afford insurance over to the States.
Allow all monies spent on Health Care and Insurance to be Tax Free. This would include charitable monies given to folks to help cover pre existing condition expenses.
Streamline the FDA drug approval process and allow terminal patients to "volunteer" to be a part of these programs.
Allow Emergency Rooms to turn away those with non life threatening cases.
Tort Reform.
That seems pretty common sense and a good place to start.
The problem is many people want Health Care, but don't want to either pay for Health Care or do the necessary things to stay healthy.
http://www.redstate.com/sweetie15/2017/03/08/ted-cruz-warns-new-obamacare-repeal-bill-cannot-pass-senate-written/
Cruz confirmed what I suspected, the House's original turd sandwich can't pass the Senate. In fact, I doubt it would pass the House. However, I'm anxious to see the final version that comes to a floor vote.
Sensei, have you heard, read anything lately from Dave Brat regarding all this. He seems very level headed but he is also not talking in specifics of health care. He's speaking from an economics point and also from the point of don;t hang the loss of health care around the Rs neck. IOW he is saying that if not careful all will collapse and be hung around Trumps neck... which I am sure would please every Dem and 50% of Rs... but aside from that I was wondering if you had any thoughts on where he's coming from. He doesn't seem to have an agenda other than to say hold up, we can do this, but it has to be done in certain order to work, otherwise it will likely go wrong in a bad way. I can't really follow it. I'll try to find a few links from him. Just curious if you have heard him and think he's on the right track, or is even defining his track for that matter. Again, this over my head real fast.
https://www.youtube.com/watch?v=acrsrc4AEEI
https://www.youtube.com/watch?v=JRlBiVIo-5A
https://www.youtube.com/watch?v=fQKIeO11Yg4
https://www.youtube.com/watch?v=a12blRpydPo
Looks like the bill was pulled from the house floor.
This looks like a major failure for Ryan. He needs to stop being a RINO and get a real repeal and replace bill in there.
Sensei, have you heard, read anything lately from Dave Brat regarding all this. He seems very level headed but he is also not talking in specifics of health care. He's speaking from an economics point and also from the point of don;t hang the loss of health care around the Rs neck. IOW he is saying that if not careful all will collapse and be hung around Trumps neck... which I am sure would please every Dem and 50% of Rs... but aside from that I was wondering if you had any thoughts on where he's coming from. He doesn't seem to have an agenda other than to say hold up, we can do this, but it has to be done in certain order to work, otherwise it will likely go wrong in a bad way. I can't really follow it. I'll try to find a few links from him. Just curious if you have heard him and think he's on the right track, or is even defining his track for that matter. Again, this over my head real fast.
https://www.youtube.com/watch?v=acrsrc4AEEI
https://www.youtube.com/watch?v=JRlBiVIo-5A
https://www.youtube.com/watch?v=fQKIeO11Yg4
https://www.youtube.com/watch?v=a12blRpydPo
I think that Brat is essentially correct but sometimes intentionally vague. Let's be honest. When he says things like "remove regulations" and "a free market solution" he is referring to the regulation that requires insurers to offer coverage despite pre-existing conditions. This specific regulation is why healthcare premiums went way up after the ACA's passage. Imagine what would happen to your auto insurance premium if companies like Allstate had to offer equivalent cost coverage to everyone regardless of driving record, DUI history, age, etc.
Trumpcare keeps this provision and it goes back to Trump promising everyone great coverage back in the campaign. Well, this the a sticking point for the Freedom Caucus because that one provision in Trumpcare essentially kicks the rising cost time bomb down the road a decade longer than Obamacare (Trumpcare buys some time by removing other regulations in keeping a quasi employee mandate). However, Brat and other Freedom Caucus members are afraid to mention this particular regulation by name because it has become a defacto entitlement that is popular with the Free Shit Army which is comprised of soldiers with a bunch of pre-existing conditions.
Averageman
03-24-17, 15:11
Looks like the bill was pulled from the house floor.
This looks like a major failure for Ryan. He needs to stop being a RINO and get a real repeal and replace bill in there.
For this to work Ryan is going to have to get over himself.
There is no reason why after seven years of saying they were going to repeal this the GOP hasn't gotten on the same sheet of music.
Don't try and fix the ACA, repeal it.
Come up with something that would fix the issues that 85% of the American Citizens have with affordable medical care. Work together, include all other members of the GOP and push forward.
Instead Paul wants to spike that ball.
This whole thing and the way Ryan is handling it, leads me to believe Tax Reform and a real budget are going to end up the same way.
I have no faith or confidence that Paul Ryan will accomplish anything, ever. :mad:
Looks like the bill was pulled from the house floor.
This looks like a major failure for Ryan. He needs to stop being a RINO and get a real repeal and replace bill in there.
Seriously, what a bunch of idiots...
I've seen monkey shit fights at the zoo that were more organized.
skywalkrNCSU
03-24-17, 16:02
They sure didn't have a problem proposing a full repeal of Obamacare when they were the minority party and knew it wouldn't get passed. There are zero excuses now. They have had PLENTY of time over the years to draft legislation that would address the issues but they haven't because they are either incompetent or beholden to other interests that give them money. Probably some of both.
Digital_Damage
03-24-17, 16:17
Everyone loses with this outcome except the Democrats.
Trump has already stated they will not revisit the issue.
He is laying this at the feet of the "freedom caucus", if he can't have his way he is going to make them pay for it.
Doc Safari
03-24-17, 16:24
Everyone loses with this outcome except the Democrats.
Trump has already stated they will not revisit the issue.
He is laying this at the feet of the "freedom caucus", if he can't have his way he is going to make them pay for it.
Here is the best answer I've come across:
http://www.breitbart.com/big-government/2017/03/24/health-care-bill-failure-art-of-the-deal/
Exactly two weeks ago, this author predicted the defeat of the American Health Care Act — and explained that it was a step towards the final, actual deal that will repeal and replace Obamacare.
President Donald Trump faces three irreconcilable factions: the GOP establishment, conservatives, and Democrats. He must bring them together — to “deliver the goods,” a key rule in The Art of the Deal. But first he must show them “the downside” — and convince them they will fail on their own.
The most difficult faction to deal with is the Republican establishment — not because they are politically strong, but because on policy issues like health care, they are convinced that they have all the answers and that Trump just does not understand.
So he let them make the first move — and he exposed two things about them: first, that they had not come up with a plan that was ready for prime time; second, that they had not done any of the political legwork necessary to sell their plan to voters.
Trump gave Speaker Paul Ryan and the House Republican leadership enough rope to hang themselves. Instead of dictating terms to him, they will now depend on him to save them, politically. They must accept whatever plan he will put forward.
But Trump will not make the next move. He will let the conservatives move first. They are the big winners in the first round — much more so than the Democrats, who are enjoying the spectacle of Republican dysfunction but have no role to play yet.
The conservatives will proceed with their demand for a full repeal of Obamacare. And then they will face the ire of voters who are deeply unhappy with Obamacare but upset about losing the paltry, expensive health insurance they currently have.
That, too, will strengthen Trump, and convince conservatives they need his leadership.
Whereupon Trump will turn to the moderate Democrats and offer them a deal — perhaps catastrophic health coverage in exchange for repealing Obamacare.
Democrats would take that deal because they would see a government-backed catastrophic insurance system as a possible path to the universal health care system of their dreams. Republicans would take that deal — after exhausting all of the other options — because it would leave enough room for the free market to provide insurance for most health issues, and for states to experiment with their own policies. And the more health care stakeholders who can be brought into the process, the better.
My take: I HOPE Trump is doing a rope-a-dope. He knew this bill was so bad that he let if fail and embarass everyone who wanted it, and like Joel Pollak says, they will come running to him to bail them out. He's crazy like a fox.
And here's some interesting comments by Trump indicating we're right:
https://news.grabien.com/story-trump-what-will-happen-i-think-obamacare-unfortunately-will
After Paul Ryan's ObamaCare replacement bill failed to garner enough Republican support to pass a House vote Friday, President Trump announced his planned path forward: "Let ObamaCare explode."
Trump said that if things get bad enough, Democrats will come aboard the reform effort. At that point, Trump said, it will become possible to pass a bill even better than Ryan's.
"The losers are Nancy Pelosi and Chuck Schumer because now they own ObamaCare," Trump said. "They own it, 100 percent own it. And this is not a Republican health care, this is not anything but a Democrat health care, and they have ObamaCare for a little while longer until it ceases to exist, which it will at some point in the near future."
Digital_Damage
03-24-17, 16:28
Here is the best answer I've come across:
http://www.breitbart.com/big-government/2017/03/24/health-care-bill-failure-art-of-the-deal/
My take: I HOPE Trump is doing a rope-a-dope. He knew this bill was so bad that he let if fail and embarass everyone who wanted it, and like Joel Pollak says, they will come running to him to bail them out. He's crazy like a fox.
90% of breitbart is tabloid nonsense.
that viewpoint makes no sense.... the Dems are VERY against catastrophic insurance.
The program will not lose enough money over the next two years for Democrats and the freedom caucus to come running.
The Dem plan is to drag everything out for the next two year in order to gain seats in hope of a majority in one of the houses.
Doc Safari
03-24-17, 16:30
90% of breitbart is tabloid nonsense.
that viewpoint makes no sense.... the Dems are VERY against catastrophic insurance.
The program will not lose enough money over the next two years for Democrats and the freedom caucus to come running.
The Dem plan is to drag everything out for the next two year in order to gain seats in hope of a majority in one of the houses.
Forget it's on Breitbart. Joel Pollak is usually a pretty astute writer IMHO.
Although I do agree with your last sentence. Trump is walking a tightrope but he also his privy to insider information we are not.
RetroRevolver77
03-24-17, 17:01
Ron Swanson sums it up best:
https://www.youtube.com/watch?v=sy9FRli7ODg
7n6
I think that Brat is essentially correct but sometimes intentionally vague. Let's be honest. When he says things like "remove regulations" and "a free market solution" he is referring to the regulation that requires insurers to offer coverage despite pre-existing conditions. This specific regulation is why healthcare premiums went way up after the ACA's passage. Imagine what would happen to your auto insurance premium if companies like Allstate had to offer equivalent cost coverage to everyone regardless of driving record, DUI history, age, etc.
Trumpcare keeps this provision and it goes back to Trump promising everyone great coverage back in the campaign. Well, this the a sticking point for the Freedom Caucus because that one provision in Trumpcare essentially kicks the rising cost time bomb down the road a decade longer than Obamacare (Trumpcare buys some time by removing other regulations in keeping a quasi employee mandate). However, Brat and other Freedom Caucus members are afraid to mention this particular regulation by name because it has become a defacto entitlement that is popular with the Free Shit Army which is comprised of soldiers with a bunch of pre-existing conditions.
Just found another interview with Brat from this morning on WRVA. Jimmy Barret is a pretty good interviewer. I haven't heard it all yet but Brat did use the term 'mini-entitlement' regarding something... I need to listen again to see just what he is talking about.
Also I did hear Brat react to the "Freedom caucus killed it" mantra. There were 80 Rs according to him ready to vote NO but the FC is only 30 strong.
This sounds like Brat is getting a lot of info out, better so than those others. Check it out and see if it sheds any new/additional light. the reason I'm asking/concerned whatever is.... again my gut feeling. This whole situation seemed to go mighty smoothly. So much so that I would not be surprised if Trump set this up this way to give it to Schumer and Pelosi .. AND.. to keep Ryan on the hot seat with said seat being a parachuteless ejection seat.
Brat says over and over... Trump is being paid a dis-service and being mis-informed by the Rs. some of the Rs.
http://1140wrva.iheart.com/media/play/27709364/
Now if you want to see and hear the words of a true RINO look no further than Paul Ryan... and I suspect that is who Dave Brat is speaking of when he says Trump is being misinformed.
But listen to this.... You can watch the whole thing and hear him throw the Freedom Caucasus under the bus. but go to 05:20 - 05:30
at 05:20 he claims he and other Rs were "doing the Democrats a favor", "doing the architects of Obamacare a favor" ... Now that is pure BS but it shows you how his mind works and how he would insert a nice little white lie to make himself look good. Again I think that was also directed at the Freedom Caucasus. But let's just say it's true. Why on Earth he would even be thinking along the lines of doing a Democrat politician a favor is beyond me and I can tell you... Trump would do just the opposite. Which again I think today represented a power battle with regard to Trump vs the Rs as whole. He can now align with any of them and most easily get rid of Ryan. So it looks like Trump put Ryan, Pelosi, and Schumer in the penalty box and got a clear field for the rest of the game. I have a hard time believing that's not exactly what he wanted.
https://www.youtube.com/watch?v=2k7exARTqUE
RetroRevolver77
03-24-17, 18:50
Just found another interview with Brat from this morning on WRVA. Jimmy Barret is a pretty good interviewer. I haven't heard it all yet but Brat did use the term 'mini-entitlement' regarding something... I need to listen again to see just what he is talking about.
Also I did hear Brat react to the "Freedom caucus killed it" mantra. There were 80 Rs according to him ready to vote NO but the FC is only 30 strong.
This sounds like Brat is getting a lot of info out, better so than those others. Check it out and see if it sheds any new/additional light. the reason I'm asking/concerned whatever is.... again my gut feeling. This whole situation seemed to go mighty smoothly. So much so that I would not be surprised if Trump set this up this way to give it to Schumer and Pelosi .. AND.. to keep Ryan on the hot seat with said seat being a parachuteless ejection seat.
Brat says over and over... Trump is being paid a dis-service and being mis-informed by the Rs. some of the Rs.
http://1140wrva.iheart.com/media/play/27709364/
Now if you want to see and hear the words of a true RINO look no further than Paul Ryan... and I suspect that is who Dave Brat is speaking of when he says Trump is being misinformed.
But listen to this.... You can watch the whole thing and hear him throw the Freedom Caucasus under the bus. but go to 05:20 - 05:30
at 05:20 he claims he and other Rs were "doing the Democrats a favor", "doing the architects of Obamacare a favor" ... Now that is pure BS but it shows you how his mind works and how he would insert a nice little white lie to make himself look good. Again I think that was also directed at the Freedom Caucasus. But let's just say it's true. Why on Earth he would even be thinking along the lines of doing a Democrat politician a favor is beyond me and I can tell you... Trump would do just the opposite. Which again I think today represented a power battle with regard to Trump vs the Rs as whole. He can now align with any of them and most easily get rid of Ryan. So it looks like Trump put Ryan, Pelosi, and Schumer in the penalty box and got a clear field for the rest of the game. I have a hard time believing that's not exactly what he wanted.
https://www.youtube.com/watch?v=2k7exARTqUE
Obamacare is about to implode and as Ryan stated 1/3rd of the country is already down to a single provider due to costs. So by passing a reformed bill, they could keep the American people from feeling the pain of the ever expanding care costs that what was forced on them by the Democrats.
Just found another interview with Brat from this morning on WRVA. Jimmy Barret is a pretty good interviewer. I haven't heard it all yet but Brat did use the term 'mini-entitlement' regarding something... I need to listen again to see just what he is talking about.
Also I did hear Brat react to the "Freedom caucus killed it" mantra. There were 80 Rs according to him ready to vote NO but the FC is only 30 strong.
This sounds like Brat is getting a lot of info out, better so than those others. Check it out and see if it sheds any new/additional light. the reason I'm asking/concerned whatever is.... again my gut feeling. This whole situation seemed to go mighty smoothly. So much so that I would not be surprised if Trump set this up this way to give it to Schumer and Pelosi .. AND.. to keep Ryan on the hot seat with said seat being a parachuteless ejection seat.
Brat says over and over... Trump is being paid a dis-service and being mis-informed by the Rs. some of the Rs.
http://1140wrva.iheart.com/media/play/27709364/
Now if you want to see and hear the words of a true RINO look no further than Paul Ryan... and I suspect that is who Dave Brat is speaking of when he says Trump is being misinformed.
But listen to this.... You can watch the whole thing and hear him throw the Freedom Caucasus under the bus. but go to 05:20 - 05:30
at 05:20 he claims he and other Rs were "doing the Democrats a favor", "doing the architects of Obamacare a favor" ... Now that is pure BS but it shows you how his mind works and how he would insert a nice little white lie to make himself look good. Again I think that was also directed at the Freedom Caucasus. But let's just say it's true. Why on Earth he would even be thinking along the lines of doing a Democrat politician a favor is beyond me and I can tell you... Trump would do just the opposite. Which again I think today represented a power battle with regard to Trump vs the Rs as whole. He can now align with any of them and most easily get rid of Ryan. So it looks like Trump put Ryan, Pelosi, and Schumer in the penalty box and got a clear field for the rest of the game. I have a hard time believing that's not exactly what he wanted.
https://www.youtube.com/watch?v=2k7exARTqUE
The reason why you need to listen to it again is because Brat spent 10 min saying essentially nothing. To illustrate my point, in under 5 sentences tell me what specific measure(s) are sticking points for the House Freedom Caucus. You can't do it, can you? Sure, you hear euphemisms like free market solution, deregulation, etc. but what specific regulations does his group oppose?
It is the regulation on insurers mandating they accept pre-existing conditions. That provision has become immensely popular despite being exceptionally retarded from a cost and basic understanding of insurance standpoint. However, neither Trump nor the establishment Republicans want to write a bill that removes it, and the Freedom Caucus only wants to talk around it.
This should be a wake up call to everyone who is tied to this country. You are all ****ed. Your leaders are so afraid of you that they will not even publicly debate this clear abortion of a provision - much less put forth a meaningful alternative. Keep in mind that only about 30 million Americans are affected by this pre-existing condition problem. Good luck getting them to address the real problems affecting everyone like Medicare.
The reason why you need to listen to it again is because Brat spent 10 min saying essentially nothing. To illustrate my point, in under 5 sentences tell me what specific measure(s) are sticking points for the House Freedom Caucus. You can't do it, can you?
I think that's why I keep asking. Most of the time I hear Brat, he's rushed or it's just a sound bite and I'm thinking ok, maybe there is something specific he knows to do or wants to do. But you are right, I can't tell you or anyone else what he wants to do. I can't see what this thing is he speaks of that Trump is being mis-lead on. So I get to thinking ok, he must be talking about something obvious but at the same time simply not obvious to me or over my head. but your take on it is simply that he's saying no but doesn't really have a 'yes' alternative?
That's not good. I thought it was just me never hearing his plan or not understanding his references. Man... that's distressing. Can't trust the old guard and the new guard doesn't have a plan. Hell, the old guard never had a plan either.
Keep in mind that only about 30 million Americans are affected by this pre-existing condition problem.
'only about' Those folks would be about 9.2% of the population or 15% of the 200,000,000 registered voters.
Serious question, I've never had to deal with this issue. What are the major preexisting conditions that they don't want to cover? Are most self-inflicted by lifestyle choice, inherited or caused by other means?
Do they just refuse to insure, or just for treatment related to the pre-existing condition?
Would a pool of folks with those conditions, paying higher rates work? Or 'general health insurance' which helps cover routine medical issues and accidents with a specific rider to cover the existing condition?
Can't trust the old guard and the new guard doesn't have a plan. Hell, the old guard never had a plan either.
Does anyone doubt that absent the pressure from medical and insurance related special interest groups any President from GHWB through Obama could have convened a commission of SME's and citizens to solve the problem? I don't.
The problem is the process is politicized. It is made worse by our current campaign funding laws and people who want to eliminate all government regulation.
The Dem plan is to drag everything out for the next two year in order to gain seats in hope of a majority in one of the houses.
I'm not sure that's realistically possible. Also the Rs could pass a bill in early 2018 making it a moot point. By that time watching insurance companies drop like flies and deductibles rise it could result in the Rs having 60 Senate seats. Although,,, granted, that would require that the Rs do something right for a change
For this to work Ryan is going to have to get over himself.
I think Webster uses the term 'Paul Ryan is over himself' as the example for Oxymoron.
The problem is the process is politicized. It is made worse by our current campaign funding laws and people who want to eliminate all government regulation.
That. For example they seemed as concerned with passing the replacement on the seven year anniversary as much as they were concerned with the content or benefits. Who actually cares about symbolic dates other than extremist assholes?
The Dems seem mostly concerned with keeping the Obama legacy, even IF a far superior version was available, if it wasn't an upgrade of Obamacare they will mostly resist it.
The GOP seems as concerned with symbolically killing Obamacare as they are with any other consideration, even IF a major overhaul was available that was far superior to any other plan a lot of Republicans would resist it because it would still be labeled Obamacare.
Proof once again the most of Congress is populated by insecure, spoiled little children that stomp their feet and cry if they don't get their way. I think if we pink slipped the entire house and senate and replaced them with ordinary Americans from the jury pool we could do at least as good or better.
ordinary Americans from the jury pool we could do at least as good or better.
I kind of thought that was what they envisioned at the beginning - political office was a service to the nation, not a way to become rich.
I think that's why I keep asking. Most of the time I hear Brat, he's rushed or it's just a sound bite and I'm thinking ok, maybe there is something specific he knows to do or wants to do. But you are right, I can't tell you or anyone else what he wants to do. I can't see what this thing is he speaks of that Trump is being mis-lead on. So I get to thinking ok, he must be talking about something obvious but at the same time simply not obvious to me or over my head. but your take on it is simply that he's saying no but doesn't really have a 'yes' alternative?
That's not good. I thought it was just me never hearing his plan or not understanding his references. Man... that's distressing. Can't trust the old guard and the new guard doesn't have a plan. Hell, the old guard never had a plan either.
The House Freedom Caucus had a plan. It was a quick, no debate, pass-it-to-find out-what's-in-it repeal of Obamacare. Just like the law was passed 7 years ago - in the dead of night and deal with the fallout later. They knew that there would be some backlash, but their seats were relatively safe. They NEVER wanted a lengthy debate or townhall meetings where a face could be put on the relatively few people who would be booted off the exchanges with nowhere else to go.
The moderates like Ryan, Trump, and most Senators (who have more diverse constituents) stood the most to lose from removing the insurance regulations. None of them wanted to take one for the team or face constituents who liked the regulations.
'only about' Those folks would be about 9.2% of the population or 15% of the 200,000,000 registered voters.
Serious question, I've never had to deal with this issue. What are the major preexisting conditions that they don't want to cover? Are most self-inflicted by lifestyle choice, inherited or caused by other means?
Do they just refuse to insure, or just for treatment related to the pre-existing condition?
Would a pool of folks with those conditions, paying higher rates work? Or 'general health insurance' which helps cover routine medical issues and accidents with a specific rider to cover the existing condition?
1) Cancer because it tends to come back
2) Heart and vascular disease
3) Renal disease; especially dialysis which generally qualifies most people for Medicaid and disability.
4) Serious lung diseases like COPD
5) Diabetes
6) Obesity and smoking
I said ONLY 30 million not to trivialize their plot. Instead, I was illustrating the very low likelihood of our elected officials being able to solve problems facing 300 million (like Medicare) if they can't solve this one.
A pool could work for the people currently between 50-65. However, their coverage will not be as good as someone with emplorer-based coverage and their out of pocket expenses will be higher. However, it is tough to deal with constituents weighing 300 lbs who start every sentence with, "I shouldn't have to give up my..."
I kind of thought that was what they envisioned at the beginning - political office was a service to the nation, not a way to become rich.
Yes, the idea was representative government. You close down the shoe store, or leave it to a relative to run, and then go do a couple terms as state representative or whatever, then return to the shoe store.
Unfortunately people only get into politics to gain money and power. Anyone who tries to enter political office for any other reason will be marginalized, neutralized or destroyed by those who have money and power. Those in office are only concerned with issues that result in money and power and projecting an image that results in money and power.
In 2017 with a reported salary of $193,400, Nancy Pelosi's actual net worth was $82,523,017.
Here is all of her assets and holdings.
http://www.davemanuel.com/pols/nancy-pelosi/
Here's the Top 15 richest members of Congress.
http://www.businessinsider.com/richest-members-of-congress-the-hill-2012-8?op=1
The House Freedom Caucus had a plan. It was a quick, no debate, pass-it-to-find out-what's-in-it repeal of Obamacare. Just like the law was passed 7 years ago - in the dead of night and deal with the fallout later. They knew that there would be some backlash, but their seats were relatively safe. They NEVER wanted a lengthy debate or townhall meetings where a face could be put on the relatively few people who would be booted off the exchanges with nowhere else to go.
The moderates like Ryan, Trump, and most Senators (who have more diverse constituents) stood the most to lose from removing the insurance regulations. None of them wanted to take one for the team or face constituents who liked the regulations.
1) Cancer because it tends to come back
2) Heart and vascular disease
3) Renal disease; especially dialysis which generally qualifies most people for Medicaid and disability.
4) Serious lung diseases like COPD
5) Diabetes
6) Obesity and smoking
I said ONLY 30 million not to trivialize their plot. Instead, I was illustrating the very low likelihood of our elected officials being able to solve problems facing 300 million (like Medicare) if they can't solve this one.
A pool could work for the people currently between 50-65. However, their coverage will not be as good as someone with emplorer-based coverage and their out of pocket expenses will be higher. However, it is tough to deal with constituents weighing 300 lbs who start every sentence with, "I shouldn't have to give up my..."
I knew what you meant. :D On my part, I was trying to point out it is a pretty significant amount of voters to upset, especially when you've got bleeding hearts like me who feel terrible about their prospects. Except the smokers. I hate smoking.
On the medicare thing, right now the figures I have are 18% age 60 and over; in 2050 that is supposed to increase to 25%. Somehow that doesn't seem to be an overwhelming amount that couldn't be managed with changes a little less drastic then what folks are talking. I do agree though, dysfunctional political hacks could screw it up.
Let me know how it turns out. According to my financial planner, I'm only good until 2049. I found that out when I asked about the slight downward jog in the chart. Good news is the wife will have enough to keep her in pool boys for the seven years they figure she'll outlast me.
I came across this while catching up on the latest last night. The first couple of entries offer an interesting discussion of the whole mess. I don't know enough about the subject to know if he is on the right track or not but it seems pretty down to earth:
"That's the funny thing about cost-shifting -- it can never solve a cost problem. It just moves the problem somewhere else. Where it moved it was on the back of productivity and tax receipts, both of which have been horrifyingly bad since the 2008 crash. Last fiscal year tax receipts rose by less than 1% despite all the new taxes in the PPACA and higher rates generally while productivity improvements have all but disappeared.
The AHCA cannot resolve this problem because it intentionally refuses to address the driver of the problem in the first instance. Returning to "High Risk Pools" is idiotic because those very pools were on the verge of collapse prior to the PPACA and were a big part of why Obamacare was written and passed! The insurance and medical lobbies wrote the PPACA to get rid of those problems and pools, or so they thought.
They tried denying math but failed because the laws of mathematics are not suggestions. You can't get rid of a cost by making someone else pay it; you simply move it and eventually it comes back and bites you."
Head Shot: "The cost of insuring against a bad event is directly and mathematically determinable by the cost and probability of said event. Second, due to the above mathematical fact if you wish to decrease the amount "insurance" costs there is only one way to do it: You must decrease the cost of the event, the probability of the event or both."
Several entries discussing it here: https://market-ticker.org/
"The cost of insuring against a bad event is directly and mathematically determinable by the cost and probability of said event. Second, due to the above mathematical fact if you wish to decrease the amount "insurance" costs there is only one way to do it: You must decrease the cost of the event, the probability of the event or both."
I thought it was pretty clear from the git go that ACA sought to decrease the probability of events by increasing the pool of people being insured. Predictably, many people rebelled at being told they 'had' to buy insurance.
FromMyColdDeadHand
03-25-17, 13:18
I thought it was pretty clear from the git go that ACA sought to decrease the probability of events by increasing the pool of people being insured. Predictably, many people rebelled at being told they 'had' to buy insurance.
More, reducing the percentage of people that have bad events when insured. The number of events would go up, but the number of people was supposed to go up faster. I like the idea of high risk pools- instead they raised the cost of everyone and then subsided a lot of people. That seems like a paper work nightmare and lots of room for up costing to make sure to cover higher costs.
Thank the good Lord this bill died. It would have further destroyed healthcare and the republicans would have no one to blame. Premiums would continue to climb and less people would be insured. The notion that the ability to buy a policy across state lines would magically cause lower prices due to competition is absurd. Insurance companies in all states would universally do what insurance companies do - raise rates. Obamacare needs to go. But the Rs need to get their collective sh$t together, hire some smart health policy peeps and put together a better plan.
-Repeal/Reform EMTALA.
-Treat people who can pay. Don't treat those who can't. (Beyond the ER, and MEDICALLY NECESSARY treatment to avoid death or loss of limb in the immediate sense).
-Stop treating non-compliance for free.
-Allow healthcare insurance plan shopping anywhere in the US.
I currently pay $277/mo. I am 31, M, Never smoker, No disorders or diseases (not even glasses). I have a nearly $4K deductible.
I COULD pay $49.99/mo, and have a $500 deductible. But that plan "doesn't qualify" with Obamacare.
The goal with all of this healthcare BS is to give as much shit away as possible to people who won't pay for it. ****. That. Aside from life/limb-saving intervention, it's a consumable. Like food. Etc.
So currently, we are all billed for the 20 aspirin that are NOT billed because charity...and we are also billed for the massive insurance costs incurred by insuring noone gets rich of suing, and we must include the profit loss from those who DO successfully sue, and we must pay for...all that shit, that makes your $0.20 ASA 325mg pill cost you $20.
Want to get rid of that? Manage liability. Remove charity cases, stop forcing insurance companies to take shitty clients with preventable diseases at "fit and healthy" rates. Etc. etc. etc.
America is gutless and won't do it though, so nothing is going to fix it. It's all just different ways of drawing the same conclusion, these different "reforms".
Thank the good Lord this bill died. It would have further destroyed healthcare and the republicans would have no one to blame. Premiums would continue to climb and less people would be insured. The notion that the ability to buy a policy across state lines would magically cause lower prices due to competition is absurd. Insurance companies in all states would universally do what insurance companies do - raise rates. Obamacare needs to go. But the Rs need to get their collective sh$t together, hire some smart health policy peeps and put together a better plan.
It needs to go, but it needs to go piece-meal. It will never happen though, successfully, because here is what it boils down to: healthcare that is as heavily regulated as that in America is ****ing EXPENSIVE. Only a certain segment of the population will be motivated enough to provide well enough for themselves to afford it. Either DE-regulate it to the level you would find in other countries, so that it costs less and lowers barrier to entry, at the expense of quality/safety, or charge those who DO work hard to afford it enough money to pay for ALSO those who don't/won't.
I know which way we are going, and it's the latter. There is no way to get this shit for free. Medical personnel will not work for free (personally, if I see someone working in a hospital in a patient-care setting for less than $20/hr (this is in an area where min-wage is $8.15, I think?), I think they have an extra hole in their head unless they are just using it for experience). Hospitals will not lose money (without closing). So we give away as much of it as we can, and the tab is picked up by everyman and everywoman. Socialism at its finest.
Thank the good Lord this bill died. It would have further destroyed healthcare and the republicans would have no one to blame. Premiums would continue to climb and less people would be insured. The notion that the ability to buy a policy across state lines would magically cause lower prices due to competition is absurd. Insurance companies in all states would universally do what insurance companies do - raise rates. Obamacare needs to go. But the Rs need to get their collective sh$t together, hire some smart health policy peeps and put together a better plan.
What? Aren't you tired of all this winning yet?
Just this morning Trump took to Twitter to call out the House Freedom Caucus and Heritage Foundation for his current woes.
Eurodriver
03-26-17, 11:46
Why have I yet to hear absolutely anything on repealing the pre-existing condition regulation?
How can insurance companies function if someone with cancer can simply sign up at $500/mo (hell, even $1000/mo) and then immediately receive treatment?
Why have I yet to hear absolutely anything on repealing the pre-existing condition regulation?
How can insurance companies function if someone with cancer can simply sign up at $500/mo (hell, even $1000/mo) and then immediately receive treatment?
Yes, mandated coverage of pre-existing conditions is a no-go if any bill ever hopes to provide affordable care.
Why have I yet to hear absolutely anything on repealing the pre-existing condition regulation?
How can insurance companies function if someone with cancer can simply sign up at $500/mo (hell, even $1000/mo) and then immediately receive treatment?
Man, I'm hurt. See posts 68, 78, and 90 in this thread. Also see Chris Wallace's interview of Jim Jordan on today's episode of Fox News Sunday.
Eurodriver
03-26-17, 13:36
Man, I'm hurt. See posts 68, 78, and 90 in this thread. Also see Chris Wallace's interview of Jim Jordan on today's episode of Fox News Sunday.
I'm sorry man! Busy af over here.
ETA: Watched Jordan's interview. Sure wish he was speaker. 05:10 is where pre-existing conditions begins.
http://www.foxnews.com/politics/2017/03/26/freedom-caucus-jordan-end-obamacare-blaming-let-s-get-to-work.html
RetroRevolver77
03-26-17, 13:43
-Repeal/Reform EMTALA.
-Treat people who can pay. Don't treat those who can't. (Beyond the ER, and MEDICALLY NECESSARY treatment to avoid death or loss of limb in the immediate sense).
-Stop treating non-compliance for free.
-Allow healthcare insurance plan shopping anywhere in the US.
I currently pay $277/mo. I am 31, M, Never smoker, No disorders or diseases (not even glasses). I have a nearly $4K deductible.
I COULD pay $49.99/mo, and have a $500 deductible. But that plan "doesn't qualify" with Obamacare.
The goal with all of this healthcare BS is to give as much shit away as possible to people who won't pay for it. ****. That. Aside from life/limb-saving intervention, it's a consumable. Like food. Etc.
So currently, we are all billed for the 20 aspirin that are NOT billed because charity...and we are also billed for the massive insurance costs incurred by insuring noone gets rich of suing, and we must include the profit loss from those who DO successfully sue, and we must pay for...all that shit, that makes your $0.20 ASA 325mg pill cost you $20.
Want to get rid of that? Manage liability. Remove charity cases, stop forcing insurance companies to take shitty clients with preventable diseases at "fit and healthy" rates. Etc. etc. etc.
America is gutless and won't do it though, so nothing is going to fix it. It's all just different ways of drawing the same conclusion, these different "reforms".
Obamacare was designed to destroy the Middle-Class's ability to save for retirement and pay for education for their children.
Yes, mandated coverage of pre-existing conditions is a no-go if any bill ever hopes to provide affordable care.
Agree. We also need Tort Reform. Wife is an OB/GYN in Mormon country. She does approx. 35-40 deliveries/month. Also many surgical procedures. NEVER been sued. Her malpractice is close to 80K/yr. Several deliveries/month are from indigent patients or ones that refuse to pay. All that time, energy, lost sleep, and time away from family without compensation. !0's of thousands $$/yr. lost. Can't be written off. Straight loss.
We also need insurance across state lines.
I'm out. This topic can make my blood boil. No easy answers. Can I get some individual responsibility spread across the USA?
Why have I yet to hear absolutely anything on repealing the pre-existing condition regulation?
How can insurance companies function if someone with cancer can simply sign up at $500/mo (hell, even $1000/mo) and then immediately receive treatment?
This. You can't force enough people into the system to make up for it. You can prolong the agony but eventually it will crash the system. A true market solution looks like it would result in a lot of financial pain in both the health care and insurance industries which makes it unlikely either side of will take a real shot at fixing it.
Obamacare was designed to destroy the Middle-Class's ability to save for retirement and pay for education for their children.
Seriously, weren't most middle class folks already working for employers that provided health coverage? My premiums had been going up each year well before Obamacare was passed.
I agree, the ACA (Obamacare) is far from ideal, but to lay the increase in medical costs at the feet of some nefarious plot to destroy the middle class flies in the face of what has actually happened.
Between 1970 and 2008, the share of the economy going to health care rose from 7.2% to an estimated 16.6%, or from about $356 per person in 1970 to an estimated $7,868 per person in 2008.
Employer-sponsored health coverage premiums for family coverage have increased by 97% since 2000, from $6,438 to $12,680 in 2008.
http://kff.org/health-costs/issue-brief/health-care-costs-and-election-2008/
The rate of rise in family insurance premiums actually slowed a little between 2011 - 2016, premiums rose 20% during that period; they rose 31% between 2006 - 2011; and they rose 63% between 2001 - 2006.
The rise in Rx drug spending: 2015 - $457 billion (rose 19.7% in the three years from 2012 and 22.5% in the six years from 2009); 2012 - $367 billion (rose 3.6% in the three years from 2009); 2009 - $354 billion.
Overall, prescription spending amounted to 16.7% of all health care service expenditures in 2015.
http://time.com/money/4503325/obama-health-care-costs-obamacare/
Here is an interesting article about rising healthcare costs which explains the rise from the 60's to today:
https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878
I don't know what the answer is, but it has been going on long enough that it is ridiculous to declare it a plot by Obama to destroy the middle class.
I hate it when basic fairness makes it seem as if I'm defending a guy I never voted for, but damn.
Seems to be a pretty level headed article regarding basic cause and affect. What do you think?
https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878
Thanks,
Dan
Agree. We also need Tort Reform. Wife is an OB/GYN in Mormon country. She does approx. 35-40 deliveries/month. Also many surgical procedures. NEVER been sued. Her malpractice is close to 80K/yr. Several deliveries/month are from indigent patients or ones that refuse to pay. All that time, energy, lost sleep, and time away from family without compensation. !0's of thousands $$/yr. lost. Can't be written off. Straight loss.
We also need insurance across state lines.
I'm out. This topic can make my blood boil. No easy answers. Can I get some individual responsibility spread across the USA?
She doesn't charge other people higher costs to cover her losses for those that don't pay?
Edit: or send/sell those nonpayers to a collection agency? I had a hospital screen up and send me to a collection agency for a bill I did pay.
She doesn't charge other people higher costs to cover her losses for those that don't pay?
Edit: or send/sell those nonpayers to a collection agency? I had a hospital screen up and send me to a collection agency for a bill I did pay.
No, can't do that on a per-patient basis, but when setting prices for services, the rate of non-payment is taken into account...those that can pay do pay more to make up for the $35 billion annually incurred for those that can't (or won't). Of course, "setting prices" is a pretty meaningless concept because private insurers pay a negotiated contract price, and reimbursement for Medicare/Medicaid patient is set by law and is remarkable mostly for its underpayment relative to actual cost of care.
Sure. They can send patients to a collection agency. That's a loser, recovering literally pennies on the dollar.
Of course, "setting prices" is a pretty meaningless concept because private insurers pay a negotiated contract price, and reimbursement for Medicare/Medicaid patient is set by law and is remarkable mostly for its underpayment relative to actual cost of care.
Sure. They can send patients to a collection agency. That's a loser, recovering literally pennies on the dollar.
She also takes a larger percentage of Tricare than any other provider in the practice. We both come from long .mil families so she has a sense of obligation. Tricare reimburses LESS than Medicaid. It's not all about the money, but at some point it has to become a factor. Thanks to the lousy reimbursement rates from Tricare and Medicaid, she will be reducing her number of patients she accepts from either. When the difference between a private insure and Tricare and Medicaid is(averaging) $500-$1200; what do you expect? That adds up to 10's of thousands of $$/yr. Being a Good Samaritan doesn't pay the bills.
Seems to be a pretty level headed article regarding basic cause and affect. What do you think?
https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878
Thanks,
Dan
Overall, it is an excellent historical account of how we got to the period when the ACA was passed. It focuses on a couple of themes that Hmac and I have been harping on: 1) the interplay of increased consumption of high tech resources and 2) government induced market distortions from unintended consequences.
Where I think the article falls short is in chronicling what has happened since the ACA was passed. The author seems to believe that the ACA has changed the trajectory of rising costs for the better, but I'm not convinced. Yes, there was a brief dip in the rate of cost increase 6 years ago, but that had a lot to do with our prolonged economic downturn. Healthcare costs are now back up to increasing at around 5% which is triple inflation and about what we saw prior to the ACA.
I suspect that the ACA's failure to control costs has a lot to do with the fact that it did little to address consumption and regulation/market distortion; it in fact probably exacerbated the later. What the ACA did was mainly to SHIFT costs. It reduced Medicare reimbursements to afford expanded Medicaid, thus taking resources from the sicker elderly population and giving it to a younger poor population. It also massively increased the burden on the middle class to cover those with pre-existing conditions. Small businesses, large corporations, and their employees saw a massive increases in premiums, deductibles, and out of pocket expenses as insurers were required to accept those with pre-existing conditions and cover services previously left to their clients. Its hard to find anyone making between 75-250K who didn't see at least a 30% increase in out of pocket expenses between 2011-2016.
The purpose of Obamacare was to usher in Single Payer while appearing to be a plan to help those without insurance.
Trump decided to stroke his inner retard by attacking the House Freedom Caucus - again. Then, he promises to make a deal with Democrats to get a healthcare bill passed. You known, because so much good healthcare policy has come out of the Democratic Party.
The real reason Trumpcare failed is because only about 20% of Americans wanted it.
Trump decided to stroke his inner retard by attacking the House Freedom Caucus - again. Then, he promises to make a deal with Democrats to get a healthcare bill passed. You known, because so much good healthcare policy has come out of the Democratic Party.
The real reason Trumpcare failed is because only about 20% of Americans wanted it.
Wasn't really Trumpcare so much as GOPcare, Trump endorsed it but it wasn't an EO or anything. The Republicans put up a shitty bill that even all conservatives couldn't get behind. So now we have to wait for Obamacare to implode due to increased premiums and thanks to Trump, no IRS mandate.
Averageman
03-28-17, 10:19
Wasn't really Trumpcare so much as GOPcare, Trump endorsed it but it wasn't an EO or anything. The Republicans put up a shitty bill that even all conservatives couldn't get behind. So now we have to wait for Obamacare to implode due to increased premiums and thanks to Trump, no IRS mandate.
Or do this...
http://www.breitbart.com/big-government/2017/03/27/alabama-republican-rep-mo-brooks-introduces-one-line-bill-to-repeal-obamacare/
The Huntsville Republican titled the bill ‘Obamacare Repeal Act.” It is short and to the point, “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted,” the bill reads.
Brooks, a member of the House Freedom Caucus, told constituents last week that he was a “no” vote on the Obamacare repeal/replace bill offered by Republican Speaker of the House Paul Ryan.
Works for me...
Or do this...
http://www.breitbart.com/big-government/2017/03/27/alabama-republican-rep-mo-brooks-introduces-one-line-bill-to-repeal-obamacare/
The Huntsville Republican titled the bill ‘Obamacare Repeal Act.” It is short and to the point, “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted,” the bill reads.
Brooks, a member of the House Freedom Caucus, told constituents last week that he was a “no” vote on the Obamacare repeal/replace bill offered by Republican Speaker of the House Paul Ryan.
Works for me...
I can make that work.
RetroRevolver77
03-28-17, 12:29
Or do this...
http://www.breitbart.com/big-government/2017/03/27/alabama-republican-rep-mo-brooks-introduces-one-line-bill-to-repeal-obamacare/
The Huntsville Republican titled the bill ‘Obamacare Repeal Act.” It is short and to the point, “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted,” the bill reads.
Brooks, a member of the House Freedom Caucus, told constituents last week that he was a “no” vote on the Obamacare repeal/replace bill offered by Republican Speaker of the House Paul Ryan.
Works for me...
They should repeal the law irregardless. It must be done, no other way around it.
skywalkrNCSU
03-28-17, 13:51
They should repeal the law irregardless. It must be done, no other way around it.
Regardless
Anyways, they won't do it because the GOP is spineless
Regardless
Anyways, they won't do it because the GOP is spineless
And arrogant, and stupid and... :rolleyes:
Averageman
03-28-17, 15:01
And arrogant, and stupid and... :rolleyes:
These Mopes never learn a lesson, but neither do we who vote for them again and again. We expect a different result just because they have an (R) behind their name.
It amazes me that the Republican Rino's could immediately find a to subjugate and infiltrate the original TEA Party and geld it in its infancy, but hapless feckless Democrats open their mouths and the majority Party the GOP turns to warm jelly.
Straight Shooter
03-28-17, 19:51
MY MAN MO...REPRESENTIN!!! Good job ,sir!
All the GOP voted against this in 2008, yet when it comes time to repeal it, the votes are not there.
Why is this?
Its because most of the GOP wants Obamacare, because they are really socialists who have an R behind their name to get elected.
It is as simple as that.
And it isn't Trump's fault he can't get RINOS to repeal it.
All the GOP voted against this in 2008, yet when it comes time to repeal it, the votes are not there.
Why is this?
Its because most of the GOP wants Obamacare, because they are really socialists who have an R behind their name to get elected.
It is as simple as that.
And it isn't Trump's fault he can't get RINOS to repeal it.
All Trump had to do was tell the House and Senate to send him a bill that repeals Obamacare...like he promised to do during the campaign. Instead, we got some 3 tiered crap that Ryan and HHS Secretary Price (Trump's employee BTW) concocted behind closed doors. Rather than tout this crap as the best thing since sliced bread, Trump should have been joining the chorus of Paul, Cotton, Cruz, and the entire Freedom Caucus telling House Republican to go back to the drawing board. But, he didn't do that, did he? No, he didn't. He sent his little toad Bannon to strong arm the Freedom Caucus and even made veiled threats of primaries if they didn't go along with this abomination. Fortunately, they told him to piss-off. So, please stop trying to rewrite history.
All Trump had to do was tell the House and Senate to send him a bill that repeals Obamacare...like he promised to do during the campaign. Instead, we got some 3 tiered crap that Ryan and HHS Secretary Price (Trump's employee BTW) concocted behind closed doors. Rather than tout this crap as the best thing since sliced bread, Trump should have been joining the chorus of Paul, Cotton, Cruz, and the entire Freedom Caucus telling House Republican to go back to the drawing board. But, he didn't do that, did he? No, he didn't. He sent his little toad Bannon to strong arm the Freedom Caucus and even made veiled threats of primaries if they didn't go along with this abomination. Fortunately, they told him to piss-off. So, please stop trying to rewrite history.
Exactly. Ryan Care would have been a total F'ing disaster. No matter the motive, the Freedom Caucus averted a major disaster for the republicans. One that we would never overcome and which would have precipitated government-run single payor healthcare the next time the Dems are in control.
All Trump had to do was tell the House and Senate to send him a bill that repeals Obamacare...like he promised to do during the campaign. Instead, we got some 3 tiered crap that Ryan and HHS Secretary Price (Trump's employee BTW) concocted behind closed doors. Rather than tout this crap as the best thing since sliced bread, Trump should have been joining the chorus of Paul, Cotton, Cruz, and the entire Freedom Caucus telling House Republican to go back to the drawing board. But, he didn't do that, did he? No, he didn't. He sent his little toad Bannon to strong arm the Freedom Caucus and even made veiled threats of primaries if they didn't go along with this abomination. Fortunately, they told him to piss-off. So, please stop trying to rewrite history.
So you think a full repeal is possible?
It isn't.
There are, at best, 25 votes in the senate for a full repeal.
Pro Wrestling Kabuki Theatre.
Do you really think Republicans are Godfearing, Red-blooded Patriots who believe in Beer and Liberty?
Absolutely not
Obamacare kept them relevant. Now the citizenry called their bluff and they are hemming and hawing because they really, really don't want to cede any power.
Obamacare keeps people in cronyism and backroom deals. It gives govt ability to tax and jail for non-compliance.
All government exists to take what was already yours and pare it back to you at a cost and twice what you paid. The ultimate middle-man.
Why do you think the Deep State is pushing SO hard against Trump whereas Obama was openly anti-American and got a Nobel Prize.
They are never repealing this shit.
Remember the AWB sunset? Hope you all took a picture and rubbed out a Freedom Jack. That was the last time in this goddamn country you will see any noticeable, unadulterated de-regulation and restoration of freedom.
So you think a full repeal is possible?
It isn't.
There are, at best, 25 votes in the senate for a full repeal.
Full repeal of Obamacare is part of the Republican Party platform. A repeal bill was supported just 1 year ago by every Republican senator. Give me the names of specific Republican Senators who you think are willing to sign their own death warrants by voting against a full repeal bill now.
It's a mute point because Trump is too much of a pussy to ask for a full repeal and Ryan is too much of a chicken shit to propose one on his own without being asked by Trump.
You can't have it both ways. If you truly dispise the socialists in the Republican Congress, then you should be beating down the WH door demanding that Trump ask for a full repeal bill. That would be the fastest way to begin draining the swamp and get a count of the alligators and snakes in the Republican caucus.
Easily the BEST article that I've seen on where we need to go from here:
http://www.redstate.com/patterico/2017/03/27/next-step-repealing-obamacare-ted-cruz-answer/
It’s called guaranteed renewability — the same concept as the “continuous coverage” described by Cruz in his op-ed. Guaranteed renewability is described in this excellent paper from the Mercatus Center:
[G]uaranteed-renewable insurance permits consumers to renew their coverage at the same premium, regardless of whether they have developed any new chronic health conditions since obtaining the insurance.
If you really want to go deep into the policy analysis, I recommend reading that paper. But the essence of the idea is that, like term life insurance, annual premiums are lower if you buy in when you’re young and healthy. This way, the money that insurance companies need to cover people who have developed serious health conditions is provided voluntarily by younger people who want to buy into guaranteed renewal coverage early, rather than by a government-ordered mandate enforced by penalties (or if you prefer, Justice Roberts, by “taxes”) imposed on people who don’t comply.
FromMyColdDeadHand
03-29-17, 00:33
provided voluntarily by younger people who want to buy into guaranteed renewal coverage early,
Bhhaaaa, ha, ha, ha, ha.
From kids who won't put money into the bank to retire, people think that they will plan tat far ahead on healthcare- something they think that they should get for free and they know someone will provide somehow no matter what.
Our healthcare system sucks. At least I give it to the Dems for secretly planning on a whole new system under their philosophy. A straight repeal of Obamacare might make sure that you don't get primaried, but it is the fastest way to losing the House and Senate in 2018.
Bhhaaaa, ha, ha, ha, ha.
From kids who won't put money into the bank to retire, people think that they will plan tat far ahead on healthcare- something they think that they should get for free and they know someone will provide somehow no matter what.
Our healthcare system sucks. At least I give it to the Dems for secretly planning on a whole new system under their philosophy. A straight repeal of Obamacare might make sure that you don't get primaried, but it is the fastest way to losing the House and Senate in 2018.
The Dems sacrificed the House and Senate to get Obamacare. I suppose you need to ask yourself if you OK with the Republicans giving them back to prevent single payer. Make no mistake, the Dems will be more than happy to secede Congess next time they are in control to finish their plan. This is a game where the most committed win; you've already lost if your not willing to bleed.
Full repeal of Obamacare is part of the Republican Party platform. A repeal bill was supported just 1 year ago by every Republican senator. Give me the names of specific Republican Senators who you think are willing to sign their own death warrants by voting against a full repeal bill now.
It's a mute point because Trump is too much of a pussy to ask for a full repeal and Ryan is too much of a chicken shit to propose one on his own without being asked by Trump.
You can't have it both ways. If you truly dispise the socialists in the Republican Congress, then you should be beating down the WH door demanding that Trump ask for a full repeal bill. That would be the fastest way to begin draining the swamp and get a count of the alligators and snakes in the Republican caucus.
They signed onto the repeal when it had no chance of ever being repealed because obama was in power.
The RINOs want it both ways. They will vote to repeal it when they know it has no chance of being repealed.
When Trump is in power now, they had a chance to repeal it but failed to get the job done.
Why do you think that is ?
Because they don't want it repealed.
skywalkrNCSU
03-29-17, 10:14
They signed onto the repeal when it had no chance of ever being repealed because obama was in power.
The RINOs want it both ways. They will vote to repeal it when they know it has no chance of being repealed.
When Trump is in power now, they had a chance to repeal it but failed to get the job done.
Why do you think that is ?
Because they don't want it repealed.
At the end of the day most of the people with an R beside their name believe the same thing as those with a D beside theirs and they use inconsequential issues like a trans bathroom bill to divide us while allowing them to do whatever they want. People thought Trump was going to drain that swamp but it's not going anywhere.
I said it at the time it was passed, but once a gimme-program like Obamacare gets passed good luck ever getting rid of it. "But but you can't just take it away from all these pooooor people!" :fie: I suspect the Dems knew damn well what they were doing. Create another entitlement and then watch the mean old Republicans try and take it away.
Should have never been passed in the first place.
Averageman
03-29-17, 10:54
And this is why SCOTUS Appointments are so important.
John Roberts owns this one.
skywalkrNCSU
05-09-17, 08:59
Trumpcare 2.0 passed in the house, seems like another poor attempt by the republicans at doing SOMETHING to say they repealed and replaced Obamacare when it will likely do nothing but continue to screw up the healthcare system. At this rate we will have single payer because the whole thing is going to be in ruin.
Averageman
05-09-17, 09:39
I'm beginning to believe we've been snookered.
Everyone with a preexisting condition is now bitching about losing "their" Obama-care.
Letting Pelosi skate by with "We have to pass this to see what is in it" was the biggest fraud since Teapot Dome.
You aint taking away anything, this is legislation being used to promote re election not "fix" health care.
Everyone with a preexisting condition is now bitching about losing "their" Obama-care.
If what Priebus says about the pre-existing conditions treatment is true and sticks through the Senate, I'm on board.
Essentially subsidized high risk pools. No one is denied coverage. You just do not amortize the coat across the healthy crowd.
But no one really knows yet. I'm tired of the wailing from both sides until the bill is well vetted.
Does stink it was passed without being made publicly available
skywalkrNCSU
05-09-17, 11:18
If what Priebus says about the pre-existing conditions treatment is true and sticks through the Senate, I'm on board.
Essentially subsidized high risk pools. No one is denied coverage. You just do not amortize the coat across the healthy crowd.
But no one really knows yet. I'm tired of the wailing from both sides until the bill is well vetted.
Does stink it was passed without being made publicly available
Who do you think is going to subsidize those high risk pools? Taxpayers. The same people who were subsidizing it before but now there are less people paying into the insurance pools.
Averageman
05-09-17, 11:34
Who do you think is going to subsidize those high risk pools? Taxpayers. The same people who were subsidizing it before but now there are less people paying into the insurance pools.
And thus I default back to this just being a game to get reelected.
The corruption and vice of the senate of ancient Rome is looking so much better at this point.
Why don't we just get on with it and elect a horse also?
How does this bill address cost containment? Maybe pharma et al lobbied their way out yet again and all costs dropped on the (ever shrinking) middle class yet again?
Who do you think is going to subsidize those high risk pools? Taxpayers. The same people who were subsidizing it before but now there are less people paying into the insurance pools.
Of course, there is not a magic answer. But, we do know that isolated and clearly identified cost pools are easier to manage/track/subsidize than when they are spread in a zillion pools by county. Especially when the US gov has a hand in it.
Most of the "experts" agree that isolated high risk pools that are subsidized, and then with lower risk pools at a much lower cost, are more efficient cost wise than trying to spread it across everyone. Not a panacea, just more efficient.
Personally, I suspect the Repub plan is half baked, won't "fix" healthcare because it's a very hard problem to fix. They have kicked the hornet's nest, and will now have to deal with it. Was imprudent, especially since they were not ready.
But I also know better than to believe the wailing from the left on how it's going to kill people, etc. "You are going to lose pre-existing condition coverage", "It encourages parents to abort babies", etc.
I'm all in favor of questioning aspects, but let's do it on facts from the actual bill. The loudest wailing people are the ones who are referencing zero data.
And I do think it will be possible to improve some of the severely broken things in ObamaCare.
Who do you think is going to subsidize those high risk pools? Taxpayers. The same people who were subsidizing it before but now there are less people paying into the insurance pools.
This is a minuscule improvement over the current plan. It spreads out the cost of the high risk pool over all tax payers ( corporations, people...) not just those partaking in the Obamacare plans. Not saying it's a good deal, but in theory it does spread the pain over a larger group so it may be less of a hit. The reason these pools were hit with HUGE increases was because not as many folks jumped on the wagon as the obummer said would, so the subsidy pool was small.
Anyway, they should have simply repealed it as a whole and then gone about addressing the issues with cost escalation in a realistic manner vs BS government programs.
This bill IMO stinks just like the original crap Odumbo crammed down our throats. The fact that they have to hide it from review says volumes.
Less Government is the answer.
We need less of this middleman crap.
I dont care about "the Children", the little pygmies in New Guinea, Sad puppies, nor Sarah Mclachlan.
And I do think it will be possible to improve some of the severely broken things in ObamaCare.
Just curious what do you think the most severely broken thing in Obama Care was?
I think it was fatally flawed the moment they allowed big pharma, the hospital lobby, and the insurance lobby's noses under the tent.
I just had some tooth work done. Root canal and cap. Got to talking with the billing clerk about the insurance company write off. I asked her why they charged two different rates? She said because that is all the insurance companies would pay.
I asked if the majority of their patients had insurance. Affirmative. So you stay in business charging what the insurance companies pay but if I don't have insurance you charge me more? (this was said as I was looking beyond her at the granite rock waterfall with the doctors' names engraved on granite slabs which is the center piece of their entry way) No, we charge everyone the same.
I tried one more time, but she was adamant 'we charge everyone the same.' My head hurt.
Until we fix stuff like that, there will be no improvement.
Of course that would call for some degree of regulation, which many folks decry.
Just curious what do you think the most severely broken thing in Obama Care was?
I think it was fatally flawed the moment they allowed big pharma, the hospital lobby, and the insurance lobby's noses under the tent.
Agreed 100%, and I'm not sure the Repubs will do better, for the same reason. This is an area where Donald's "We're going to have a wonderful, the best insurance plan, it's going to be great" rang false. Just going to be very hard to move the needle much.
I just hope they don't break things trying to move the needle to fill the campaign pledge.
My preference would have been for them to regroup, work hard, come up with a real plan even if it took a year or more. This just feels rushed.
That said, I'm not going to criticize it until I see specifics. (Other than criticize the lack of specifics)
This is a minuscule improvement over the current plan. It spreads out the cost of the high risk pool over all tax payers ( corporations, people...) not just those partaking in the Obamacare plans. Not saying it's a good deal, but in theory it does spread the pain over a larger group so it may be less of a hit. The reason these pools were hit with HUGE increases was because not as many folks jumped on the wagon as the obummer said would, so the subsidy pool was small.
The gov is extremely inefficient at redistributing money due to inherent overhead sloppiness. You've seen all the figures about how much every man/woman/child would get if all the subsidies were directly distributed without having to go through dozens of agencies.
There is room for that type of efficiency improvement with the smaller, dedicated high risk pools.
The logic I see is:
- Preexisting conditions should not be excluded or cause people to go bankrupt. So we need to find a way to get them coverage.
- If we just put them in the broader pools, healthy people's costs go up. To a certain extent, that's how insurance works, but the younger/healthy pools are so expensive few are signing up. So we can't stick the young/healthy with this cost.
- Pull the high risk stuff out into separate pools. Maybe even a National pool. Manage them closely to minimize fraud, etc. Use an administrator to process it, but otherwise the gov acts self insured. IE: Get the insurance companies out of it.
- The risk is it turning into a VA type situation, etc. But there should be economy of scale like large corporations get. (My company for decades was self insured, had their own pools, etc)
My previous employer's now cancelled retiree insurance plan gave retirees lower costs by allowing them to participate in the corporate pools, which had lower costs due to a healthier (on average) pool. And lower costs as they were self insured, did not mark up the costs. Just paid an administrator.
Ultimately, we have to decide: Are those with pre-existing conditions going to have to pay more than someone of the same age/sex without high risk conditions?
And if they do, how much is reasonable? 50% higher? Double?
Realistically, they should pay more. Just like you do for car insurance with a bunch of violations or claims. Especially if it's behavioral.
But there is a tipping point that will be reached if they try to charge too much. I expect anything over double the healthy cost will never fly.
None of this will be easy, there is no panacea. Likewise, gov is very prone to screw it up.
I think obamacare was never broken. It was designed to fail in order to usher in single payer.
Everybody wants us to be like Canada or Europe.
But people forget those places have it worse
Why can't we just get tort reform and let me buy insurance from some place 6 states away???
It's all BS...
Sent from my XT1585 using Tapatalk
Actually the decision is far bigger than you describe.
Because what people want is NOT insurance. Insurance should keep you from going bankrupt if you get some very serious illness, not pay for everyday Dr visits and owies.
People also forget what the tax rate is in Canada...
Eurodriver
05-09-17, 15:16
People also forget what the tax rate is in Canada...
Less than ours.
http://www.taxtips.ca/taxrates/canada.htm
Less than ours.
http://www.taxtips.ca/taxrates/canada.htm
Hmm, had a long discussion with a Canadian coworker on this. Similar earning/family situations. They pay a good 15% more in taxes, which is offset somewhat by their retirement pensions, lower medical costs, etc. His prescriptions are essentially free. My read was that I could buy platinum healthcare coverage and still be ahead due to higher US salaries, though the pensions are harder to compare against Social Security. Their 401k equiv is via the govt, ours are commercial.
But then again, he has waited 7 years to get a treadmill test. He's 60, and has risk factors. At 56 I was showing no risk factors, but a treadmill proactively caught a blockage. And immediate stent corrected the problem with no adverse impact to heart function.
I'm not ready to trade.
What Canada did do right is both parties realized their spending was headed toward end game. They put on their big boy pants, buckled down, and sorted out a balanced (mostly) budget. It was a common sense approach, which we will never be able to achieve. Partly because of Washington, and partly because we do not have their common sense as a nation.
Less than ours.
Oops, you left off provencial tax! Here's a popular CA tax calculator:
https://simpletax.ca/calculator
For Quebec, a theoretical C$100k income yields:
You'll owe about $29,873 in tax: $13,324 in federal tax and $16,549 in provincial tax.
Your after-tax income is $70,127. Your average and marginal tax rates are 29.87% and 45.71%.
At $150k earnings, the rates go way up.
To that add a federal Goods and Services Tax of 5% and a provincial sales tax of 9.975%. Property taxes are fairly high as well.
Canada: nice people, beautiful spaces, high taxes!
Everybody wants us to be like Canada or Europe.
But people forget those places have it worse
To be fair, they don't have it worse in all cases. Routine and preventive care is pretty decent in many places where they have socialized medicine. They tend to fall apart when it comes to reacting to bad diagnoses uncovered during a routine exam. Blow out your knee skiing, we'll wait 6 months till you can get an MRI and then some more to get on a table. Find out you have cancer, wait till you can get a PET scan or begin chemo/radiation...
Somehow we need to find a combination where we have great preventative stuff and good treatment options/access for other things.
Maybe a combo of single payer + private insurance. Tax funded preventative/routine care but buy yourself a supplemental plan to cover other stuff or pay cash if you have it.
I dunno. Free market is best market.
If I go to the doctor aside from a check up something has gone horribly, horribly wrong
Otherwise people abuse the ER
https://www.youtube.com/watch?v=nyUFB-Ce4Z0
skywalkrNCSU
05-09-17, 16:28
To be fair, they don't have it worse in all cases. Routine and preventive care is pretty decent in many places where they have socialized medicine. They tend to fall apart when it comes to reacting to bad diagnoses uncovered during a routine exam. Blow out your knee skiing, we'll wait 6 months till you can get an MRI and then some more to get on a table. Find out you have cancer, wait till you can get a PET scan or begin chemo/radiation...
Somehow we need to find a combination where we have great preventative stuff and good treatment options/access for other things.
Maybe a combo of single payer + private insurance. Tax funded preventative/routine care but buy yourself a supplemental plan to cover other stuff or pay cash if you have it.
This is exactly where my mind goes. A broad single payer plan would probably be the most efficient and allowing for private insurance as a supplement would still allow some of the benefits that we currently have. I know the logistics are still incredibly complicated but that has to be a better idea than the mess we have now. Being able to reduce the administrative costs associated with current government funded healthcare would have to help out a lot too, put it all under one umbrella and it would be more efficient by default.
If you want it efficient have it run by people who already work for the Government in a single payer system.
Hmm, had a long discussion with a Canadian coworker on this.
My Canadian friends not thrilled with their health care system, and said as much. Waited 6 months to get an MRI for his shoulder, and by that time it had healed badly, and that ended
Seven in Ten Canadians (68%) Have Skipped Seeing a Doctor Due to Long Wait Times, Timeliness or Other Barriers
Half of Ontarians (49%) Interested in Online Appointments with Ontario-Based Doctors
Monday, January 30, 2017
Toronto, ON – Seven in ten Canadians (68%) have missed a doctor’s appointment for reasons ranging from long wait times to an inability to find a doctor outside of working hours, a new Ipsos survey for Maple has revealed. Long wait times at walk-in clinics are the most common reason for Canadians skipping out on seeing a doctor, with one in four (42%) saying they’ve avoided the clinic for this reason.
Nearly as many Canadians (37%) say they’ve not gone to the doctor’s office when sick because they were unable to get a timely appointment, while a further two in ten (17%) say they’ve passed on a doctor’s appointment because there wasn’t a physician available outside of working hours. The spread of disease at the doctor’s office is a real concern for some, with one in ten (10%) having avoided it when sick due to fear of germs in the waiting room, while another 10% have barriers like transportation issues or physical disabilities that make getting to doctor’s appointments challenging. This leaves one in three (32%) who say they’ve not missed out on seeing a doctor for any of these reasons, meaning that a majority (68%) have missed an appointment for at least one of the aforementioned reasons.
http://www.ipsos-na.com/news-polls/pressrelease.aspx?id=7559
My local paper carries columns by Michael Gerson twice a week. To give you some idea of their slant, they also carry Cal Thomas, Kathleen Parker, and Leonard Pitts.
I often find the Gerson gives me something to think about. In this instance, as I read what he said, I reflected that based on his experience in GWB's administration he probably knows how things traditionally have run.
Even with an understanding that the old ways are not necessarily the best ways, I found this column thought provoking. Despite it's anti-Trump slant, I think others might also.
Michael Gerson: Why Trump can't do what he said he'd do
Michael Gerson • michaelgerson@washpost.com May 10, 2017 (0)
President Donald Trump has already rendered a verdict on his own skills as a legislative negotiator — in a pathetically premature Rose Garden celebration of a House vote to repeal and replace Obamacare. The full picture is not quite so rosy.
As a policy leader, Trump is unique among recent presidents. He doesn’t lead on policy. Normally a president who wants action on health care would try to unite the caucus by putting forth his own substantive ideas and getting legislators to support them. Trump never had a substantive proposal and never showed any command of the details involved, so he could not play that role. He forcefully pushed House Republicans to vote on something, anything, but he didn’t help resolve differences among them.
(this is the crux of Gerson's observations, IMO he is accdurate in this portrayal)
The system is adapting to the vacuum at its heart. Before the first, aborted health care vote, Trump complicated Speaker Paul Ryan’s life. He bullied and offended key congressmen, and showed discrediting ignorance of important policy details. Before the second vote, Trump made some calls to Republican legislators, but it was Vice President Mike Pence who took the legislative lead. And it was Ryan who won the day, addressing the concerns and objections of wavering Republicans one by one, concession by concession.
The result is not pretty — a bill that seriously underfunds Medicaid and leaves a large gap of coverage between Medicaid eligibility and a useful tax credit to purchase insurance. The bill also employs the threat of higher premiums to ensure that people keep continuous coverage, replacing a mandate with a disincentive. But those premiums are not capped — essentially allowing insurers to deny coverage to people with pre-existing conditions who haven’t kept continuous coverage. That is political poison.
Republicans are generally hoping that the Senate will inject some rationality and compassion into the process — adequately funding Medicaid, making the tax credit means-tested and more generous to those at the bottom, and encouraging continuous coverage in some other way. But this is all occurring with very little guidance from the top. The Senate process led by Sen. Lamar Alexander seems, so far, to be designed to function without presidential input.
Trump is giving an entirely new meaning to a “Rose Garden strategy.” His goal is successful votes and Rose Garden ceremonies, with the content of those victories subcontracted. Trump, no doubt, views this as a strong executive focusing on the big picture. But this is not the result of management theory. It is the only possible choice for a chief executive who is being introduced to substantive issues and debates for the first time and seems to find them tedious. “Nobody knew health care could be so complicated,” Trump said at one point, in a statement more fitting to a congressional intern.
It is useful, even necessary, for outsiders to arrive in periodic political waves. It is part of the way that democracies renew themselves without coups and violence. But this kind of outsider perspective is precisely what Trump is not providing.
Some of the reason is just the swift, merciless education provided by reality. Yes, Middle East peace is just as “difficult as people thought.” No, building a wall across a continent isn’t really possible. Yes, health care policy is complicated.
But Trump, more than most, is severed from the people and priorities he ran on. What he said during the campaign about the struggles of the working class is important. But it has almost no relationship to his governing agenda. Trump’s budget director produced a budget to please the House Freedom Caucus, not to deal with the downsides of globalization. Republicans in the House cobbled together a health care bill that has something for almost everyone — except the struggling working class that doesn’t qualify for Medicaid.
This is the price of Trump’s emptiness. On major economic issues, he has not produced policy that tilts toward the needs of the working class. He has not rallied his party to address these problems in practical ways. Instead, he has outsourced his policy priorities, and thus outsourced his political uniqueness.
During the presidential election, we heard, time and time again, that Trump is not a politician and would do what he said he’d do. The two points are actually in tension. Because Trump knows little about governing and less about policy, he can’t do what he said he’d do. And this only adds to the sum of American cynicism
Averageman
05-11-17, 12:23
Trump's Presidency hasn't really made a significant difference in my life. I will say that I am pretty sure if we were nearing the sixth month mark under Hillary my life might have been changed for the worse.
The only saving grace we have at this point is that Hillary did not get elected with a democratic majority in the House and Senate. I'm pretty sure we would have had some rather nasty changes by now and many people may have been standing in line turning in their guns and all while they were watching their country slide further in to Progressive Socialism.
I can give Trump a bit of a waiver on his actions so far, not only are the Democrats lining up in lock step against him, there seem to be few on the right who are willing to help him as POTUS.
The thought of "Draining the Swamp" put fear in the hearts of the Washington Establishment.
my wife is Canadian :) (Vancouver area)
the Canadian Gov does not provide health care but does lay down the guidelines ! its the Province that does and private medical exists there also !
so where you live can greatly impact what is up the east coast is the worse (according to some) with the middle oil rich areas being the best then the west coast
that said its still not the US system ! the one where it seems all world leaders come to when they truly need something done !!
that report being Toronto !! that is in the sucky part :)
my friends in the middle never have issues and get in etc.. same as west coast for the most part
the whole tax rate thing ? well their system I do think is better as far as simple but you might pay more in the long run as said things like GST is where it hits you
if you do not make a lot and rent then Canada might be better off
you really cant compare the two but in general it ends up being quite close with the medical etc.. but on that the medical is not as good for huge things but for basics they are about the same depending on where you are again ! HUGE thing is where you are !!!!
best man at my wedding and I was at his now lives in Edmonton ? yuck :) BUT his life is quite good compared to Hawaii on income and home and medical and other things but you cant compare the two any other way :) our west coast friends that moved east have said the east sucks in the medical side compared to the west
sadly our system has slipped huge for basic things the wait times the getting in the cost etc.. sadly the US system for basic is becoming quite sucky !!!! and needs a major overhaul especially for business owners etc..
my issue is not cost of living or medical etc.. its the lack of freedoms that are happening more and more up that way !
Trump's Presidency hasn't really made a significant difference in my life. I will say that I am pretty sure if we were nearing the sixth month mark under Hillary my life might have been changed for the worse.
Tend to agree on that. I've always been able to have 'reasonably priced' health insurance through work and retirement. I'm not sure what Hilary would have been able to accomplish with the current makeup of the Congress, although I'm sure she would have tried. As you point out, a victory for her with majorities in both chambers would have boded ill for us.
The only saving grace we have at this point is that Hillary did not get elected with a democratic majority in the House and Senate. I'm pretty sure we would have had some rather nasty changes by now and many people may have been standing in line turning in their guns and all while they were watching their country slide further in to Progressive Socialism.
I can give Trump a bit of a waiver on his actions so far, not only are the Democrats lining up in lock step against him, there seem to be few on the right who are willing to help him as POTUS.
The thought of "Draining the Swamp" put fear in the hearts of the Washington Establishment.
I think one of the reasons he isn't getting more cooperation is his willingness to contradict earlier statements.
For example, the White House press release on Comey's firing made it clear that President Trump was acting on the recommendation of the AG and Asst AG. So I'm at coffee and glance up at the news feed on the TV and see where now President Trump is saying 'he' fired Comey. While technically that is true, it kind of goes against what was said earlier.
So right now the feeling might legitimately be 'if he says one thing now, will it be the same tomorrow?' I think many probably feel he is a bit too Machiavellian at this point.
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