PILOT SPIN
Spin Zone => Spin Zone => Topic started by: Lucifer on July 18, 2017, 05:42:27 AM
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https://www.prageru.com/courses/economics/government-cant-fix-healthcare
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https://www.prageru.com/courses/economics/government-cant-fix-healthcare
That's definitely true to an extent, but it's an oversimplified analysis. For another discussion of why health care is so expensive:
http://www.merckmanuals.com/professional/special-subjects/financial-issues-in-health-care/causes-of-high-health-care-costs
(http://www.merckmanuals.com/professional/special-subjects/financial-issues-in-health-care/causes-of-high-health-care-costs)
Giving people more skin in the game will help to reduce unnecessary use of expensive drugs and new technologies, but I don't see how it will make much of a dent in administrative costs which have really run away in this country, more than in e.g. Canada. (I also suspect that article underestimates the impact of defensive medicine to guard against malpractice lawsuits, though I don't have hard evidence for that.)
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That's definitely true to an extent, but it's an oversimplified analysis.
The whole point of the video was to be over simplified. ::)
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The whole point of the video was to be over simplified. ::)
Uh-huh, obviously. But it's a serious issue that ONLY getting government out of the business isn't going to fix, and IMO will only make worse.
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Uh-huh, obviously. But it's a serious issue that ONLY getting government out of the business isn't going to fix, and IMO will only make worse.
Do you understand a good portion of the population doesn't quit understand the problem, and this video is an over simplification for a basic understanding? Geez.....
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Giving people more skin in the game will help to reduce unnecessary use of expensive drugs and new technologies, but I don't see how it will make much of a dent in administrative costs which have really run away in this country, more than in e.g. Canada. (I also suspect that article underestimates the impact of defensive medicine to guard against malpractice lawsuits, though I don't have hard evidence for that.)
And why do you think those costs have run away? I know that my doctor thinks it IS BECAUSE of government regulation. In fact, he has more people working in his billing and accounting department than he does in medical positions. And his legal and insurance bills dwarf almost all the rest of his expenses.
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And why do you think those costs have run away? I know that my doctor thinks it IS BECAUSE of government regulation. In fact, he has more people working in his billing and accounting department than he does in medical positions. And his legal and insurance bills dwarf almost all the rest of his expenses.
Yes, government regulation is PART of it. But deregulation will not solve the problem with malpractice insurance, which as you say, is a huge part of the overhead doctors pay to stay in practice. Also, hospital bureaucracies that have swollen to deal with regulatory requirements won't magically disappear when the regulations are relaxed. They'll just focus more on collecting from indigent/deadbeat patients and dealing with malpractice claims.
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They'll just focus more on collecting from indigent/deadbeat patients and dealing with malpractice claims.
So asking for a debt to be paid is a bad thing?
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So asking for a debt to be paid is a bad thing?
Asking the deadbeats to pay is a good thing.
Asking the indigents to pay is futile. (And RACIST).
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So asking for a debt to be paid is a bad thing?
Wow. I didn't say anything REMOTELY like that. My point was, the bureaucracy overhead will still be there and the result will NOT be lower health care costs.
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Wow. I didn't say anything REMOTELY like that. My point was, the bureaucracy overhead will still be there and the result will NOT be lower health care costs.
Woah. That sounds like you are saying that the billions spent by the fedguv on admin of US health care is done at zero cost to the nation?
Or is your point that the billions spent on health care management can be better done by the fedguv, and that there is a concomitant reduction in overhead costs at the private sector? i.e. there is a one-for-one replacement cost of overhead when ACA(or another fedguv plan) was implemented?
Bold.
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Wow. I didn't say anything REMOTELY like that.
They'll just focus more on collecting from indigent/deadbeat patients
So what is wrong with collecting money from deadbeats?
My point was, the bureaucracy overhead will still be there and the result will NOT be lower health care costs.
So what prevents them from reducing the bureaucracy overhead if the bureaucracy is reduced or eliminated? Seems to me that if you get government out of it and let the free market take over that alone kills the bureaucracy side of it.
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I often like to compare things to the Internet, which is more or less the wild, wild west.
If the govt RAN the internet:
1. Max speed at a home would be about 14.400 Baud (google it if you don't know).
2. You would need to have a 12 character logon with a crazy password just to get on a server.
3. Prices would be by the Kb. Prolly about $3 per 10Kb or so.
4. The rules and regs for use of the Internet would fill 4 large binders.
5. Every citizen would be required to keep their browsing record, and have it avail for viewing by the IP(internet police) within 24 hours notice.
No, I'm not kidding.
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I often like to compare things to the Internet, which is more or less the wild, wild west.
If the govt RAN the internet:
1. Max speed at a home would be about 14.400 Baud (google it if you don't know).
2. You would need to have a 12 character logon with a crazy password just to get on a server. The password would have to be changed every 60 days.
3. Prices would be by the Kb. Prolly about $3 per 10Kb or so.
4. The rules and regs for use of the Internet would fill 4 large binders, and you would be required to attend a 12 hour course and pass a written exam before you could use it.
5. Every citizen would be required to keep their browsing record, and have it avail for viewing by the IP(internet police) within 24 hours notice.
No, I'm not kidding.
FTFY
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Give us the House and we will fix it.
We gave them the House, they did not fix it.
Give us the Senate and we will fix it
We gave them the Senate, and they did not fix it.
Give us the White House and we will fix it.
We gave them the White House, and they still cannot fix it.
7 fucking years later, 7 years of promises, 7 years of show-votes, and they now admit they don't have a workable approach that they can pull themselves together for, let alone get a few vulnerable Dem's to support.
Fucking pansies, this is why I left the Republican party, they cannot win for losing, always snatching defeat from the jaws of victory because deep down they are more interested in their own short term interests than the long term interests of the Nation.
This shows the Dem's the strategery needed to prevent any other major needed reform in the agenda.
The mainstream Republicans seem to have Stockholm syndrome, fucking lightweight self-interested pansies.
'Gimp
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So what is wrong with collecting money from deadbeats?
I never said there was anything wrong with it. And I JUST said that. Why did you repeat that line of questioning?
You know, you consistently put words in my mouth and try to make it look as though I am saying things that you only imagine I am saying. Either you have a reading comprehension problem or you have such hatred of liberals that you try to paint anyone who disagrees with you with the liberal brush. I might just be wasting my energy responding to you.
So what prevents them from reducing the bureaucracy overhead if the bureaucracy is reduced or eliminated? Seems to me that if you get government out of it and let the free market take over that alone kills the bureaucracy side of it.
Nothing prevents them, but bureaucracies generally don't shrink once they are set up, even when their original purpose is gone. They just find other things to do. Until hospitals can't reduce costs any other way, I don't think the administrative structures are going to shrink much if at all.
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Ectually, ALL players in the ACA ponzi deal admitted they were going to add hundreds of admin jobs to fulfill all the req of the ACA collecting, reporting, maintaining, and validating records and reports.
Plus, as a little bonus, we KNOW that the IRS increased payroll significantly to admin the collection, and investigation of ACA monies.
From my advanced graduate econ class, I recall teaching that the way to determine a segment cost, was to remove the segment, and see if the cost disappeared. Ergo - remove ACA, and all the admin costs at the private sector will go. Of course, the IRS costs will not go away, just a little poison pill of ACA, unless Trump really would drain the swamp.
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Woah. That sounds like you are saying that the billions spent by the fedguv on admin of US health care is done at zero cost to the nation?
Or is your point that the billions spent on health care management can be better done by the fedguv, and that there is a concomitant reduction in overhead costs at the private sector? i.e. there is a one-for-one replacement cost of overhead when ACA(or another fedguv plan) was implemented?
Bold.
Neither. I am saying that the HOSPITAL administrative bureaucracies set up to deal, among other things, with excessive government regulation are unlikely to shrink simply because that regulation is repealed. There is also the very large malpractice "industry" driving them, and driving up the cost of medical care. And there is bureaucratic "inertia", i.e. bureaucracies generally don't shrink unless they are forced to, even when their original purpose is lost or reduced. That was the point of my saying that they still will have non-paying patients to go after, though that's only part of what they will be doing.
Then there is the whole problem of the high cost of drugs (pharmaceuticals), which is much higher in this country than many other countries. Although that is partly because the "market" here can bear it because people are not paying for it directly, that is clearly not the whole reason since in places where health care is handled by a single payer system, the cost is much less than here. Note that I am NOT arguing for a single payer system, just stating a fact. But I'm pessimistic that the cost will go down enough to keep a lot of sick people from being bankrupted by it.
It's a complex problem. I am not against repeal and replace. I just think it is not enough of an answer by itself.
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Sorry to disagree(not really) but this goes right back to post 1. If hospital A wants to keep all their ACA staff on after it is repealed, and hospital B fires them all, and a consumer who is paying for care gets to choose in an efficient market, then hospital A will have higher costs.
Economics really isn't that hard at this level. breaking it down, all overhead is bad. There are gradients of overhead. A profit maximizing agent will always endeavor to eliminate super bad overhead(ACA workers, and their benes), while minimizing needed overhead(light bulbs, janitors, prop taxes, etc).
One more time, compare it to the spectacular performance and value of the internet, which is almost fedguv free(but it's changing).
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Give us the House and we will fix it.
We gave them the House, they did not fix it.
Give us the Senate and we will fix it
We gave them the Senate, and they did not fix it.
Give us the White House and we will fix it.
We gave them the White House, and they still cannot fix it.
7 fucking years later, 7 years of promises, 7 years of show-votes, and they now admit they don't have a workable approach that they can pull themselves together for, let alone get a few vulnerable Dem's to support.
Fucking pansies, this is why I left the Republican party, they cannot win for losing, always snatching defeat from the jaws of victory because deep down they are more interested in their own short term interests than the long term interests of the Nation.
This shows the Dem's the strategery needed to prevent any other major needed reform in the agenda.
The mainstream Republicans seem to have Stockholm syndrome, fucking lightweight self-interested pansies.
'Gimp
Literal quotes from Trump are accurate:
“For seven years I’ve been hearing ‘repeal and replace’ from Congress, I’ve been hearing it loud and strong,” the president explained. “And when we finally get a chance to repeal and replace, they don’t take advantage of it. So that’s disappointing.
“I’m sitting in the Oval Office, right next door, pen in hand, waiting to sign something, and I’ll be waiting. And eventually we’re going to get something done and it’s gonna be very good,” he added. “It may not be as quick as we had hoped, but it is going to happen.”
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I never said there was anything wrong with it. And I JUST said that. Why did you repeat that line of questioning?
Is english not your first language? I have to ask this, because anyone (well, except for you) have read this, I have simply asked you a question. I'm not "putting words in your mouth". You made a statement and I asked a simple question, now you are blowing apart.
You know, you consistently put words in my mouth and try to make it look as though I am saying things that you only imagine I am saying.
No, you simply have issues with comprehension
Either you have a reading comprehension problem or you have such hatred of liberals that you try to paint anyone who disagrees with you with the liberal brush.
But you have stated you're not a liberal. ::) And this is a discussion forum, so questions will be asked and positions challenged. This is not your classroom where you control the agenda and can silence any opinions that doesn't follow yours. I've noticed academics have a real problem when they are challenged outside of the safety of their classroom.
I might just be wasting my energy responding to you.
What part of an open forum do you not quite understand?
Nothing prevents them, but bureaucracies generally don't shrink once they are set up, even when their original purpose is gone. They just find other things to do. Until hospitals can't reduce costs any other way, I don't think the administrative structures are going to shrink much if at all.
So you are referring to the bureaucracy of government in healthcare, not the bureaucracy of the healthcare institutions that was created by the ACA?
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Is english not your first language? I have to ask this, because anyone (well, except for you) have read this, I have simply asked you a question. I'm not "putting words in your mouth". You made a statement and I asked a simple question, now you are blowing apart.
I'm not blowing apart, I'm calling you on asking a question twice and a bit frustrated with you on it since it's not the first time you have done it. I probably should have just said "asked and answered".
So you are referring to the bureaucracy of government in healthcare, not the bureaucracy of the healthcare institutions that was created by the ACA?
No, I'm talking about the bureaucracy inside hospitals and other private institutions. Yes, IN THEORY basic economics implies they should shrink, as @lnvflatspin has stated. I'm skeptical it will happen because I've never seen that happen, either in government or in private industry.
One factor that will tend to weigh against it happening is the growing tendency for private hospitals to be bought out by giant corporations. This has happened in the Detroit area over the last 20 years to the point where I don't think there are any private hospitals left there. When there is no or little competition, market forces fail to work as they should.
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No, I'm talking about the bureaucracy inside hospitals and other private institutions. Yes, IN THEORY basic economics implies they should shrink, as @lnvflatspin has stated. I'm skeptical it will happen because I've never seen that happen, either in government or in private industry.
So in a private for profit industry, if they have a department they could shrink and realize cost savings, they wouldn't do it? Why would a private business keep people or the processes if they were no longer needed?
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No, I'm talking about the bureaucracy inside hospitals and other private institutions. Yes, IN THEORY basic economics implies they should shrink, as @lnvflatspin has stated. I'm skeptical it will happen because I've never seen that happen, either in government or in private industry.
Execute me again, but not at all theory. In practice. Efficient markets happen constantly. Also, they happen in every industry, but to a lesser degree in markets which are heavily manipulated.
Frex; When I was in the Army in the mid-70s, and I wanted to go home from BWI to SAN it cost me $366.76 R/T. That was in 1970s dollars. FF to airline dereg and I just got a price on Cactus for $343 in 2017 dollars. Why is there no PanAm today? How can a company like Spirit exist?
BTW the 2017 cost of my flight to Sandy Eggo would be $1667.64.
Skepticism is a good thing. I'm all for it. But dereg the health care industry, get the feds out of it to a very great extent and I will guarantee you that prices will go down. Also for your example of prescription drug prices? What would happen, does one suppose if ALL the fedguv investment in drug reimbursement went away? Really, this is econ 101, second night of class kind of stuff. I would expect a graduate level matriculated person to grasp this - but, well, gee.....?
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Perhaps airfare is not a good comarison. Look at the quality of the commercial airline experience today. It makes the VA look downright pleasant.
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Execute me again, but not at all theory. In practice. Efficient markets happen constantly. Also, they happen in every industry, but to a lesser degree in markets which are heavily manipulated.
And also to a lesser degree in markets where there is little competition. On the provider level there is little competition in the health care system, and ultimately the costs passed down by providers (especially big hospitals, and of course the drug companies) are what determine what the consumer pays, either directly to the provider or in the form of premiums, co-pays, and deductibles.. I don't see that changing solely as a result of deregulation.
I freely admit I could be wrong about that, I am still learning about these things. I found an interesting article from Heritage Foundation http://www.heritage.org/health-care-reform/report/compelling-evidence-makes-the-case-market-driven-health-care-system (http://www.heritage.org/health-care-reform/report/compelling-evidence-makes-the-case-market-driven-health-care-system) that addresses some of my concerns with hard evidence. That's really what I'm looking for, hard evidence, not so much theory.
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Econ 101, 6th class session. As a market matures, it begins to resemble a commodity more and more. Differentiation in vendors and offerings among the long term players can't continue without paradigm shifts in tech, or changes in market supply, like oil with the Barnett Shale pyrolisys, which killed OPEC.
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I found an interesting article from Heritage Foundation http://www.heritage.org/health-care-reform/report/compelling-evidence-makes-the-case-market-driven-health-care-system (http://www.heritage.org/health-care-reform/report/compelling-evidence-makes-the-case-market-driven-health-care-system) that addresses some of my concerns with hard evidence. That's really what I'm looking for, hard evidence, not so much theory.
You posted this while I was writing. I think everyone should read this, and then read it again. These economists get it, and they put it out there plainly enough to see easily. It reinforces what mistakes we've made along the way, and all we need now is a way to chart the dereg of health care. It can be done, but it'll take congress and prez to work together.
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Give us the House and we will fix it.
We gave them the House, they did not fix it.
Give us the Senate and we will fix it
We gave them the Senate, and they did not fix it.
Give us the White House and we will fix it.
We gave them the White House, and they still cannot fix it.
7 fucking years later, 7 years of promises, 7 years of show-votes, and they now admit they don't have a workable approach that they can pull themselves together for, let alone get a few vulnerable Dem's to support.
Fucking pansies, this is why I left the Republican party, they cannot win for losing, always snatching defeat from the jaws of victory because deep down they are more interested in their own short term interests than the long term interests of the Nation.
This shows the Dem's the strategery needed to prevent any other major needed reform in the agenda.
The mainstream Republicans seem to have Stockholm syndrome, fucking lightweight self-interested pansies.
'Gimp
I'm just as pissed off as you are, but one thing you have to remember is that Senate majority we gave them is 52-48 where Obama had a 60-40 majority when he passed Obamacare. And even with that majority, THEY got very little else done.
And do you really want a Republican party that votes in 100% lockstep like the Democrats did to pass O-Care?
We have another chance in around 16 months to try for a workable majority. I hope we don't blow it, but at this point, I don't have much faith.
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Give us the House and we will fix it.
We gave them the House, they did not fix it.
Give us the Senate and we will fix it
We gave them the Senate, and they did not fix it.
Give us the White House and we will fix it.
We gave them the White House, and they still cannot fix it.
7 fucking years later, 7 years of promises, 7 years of show-votes, and they now admit they don't have a workable approach that they can pull themselves together for, let alone get a few vulnerable Dem's to support.
Fucking pansies, this is why I left the Republican party, they cannot win for losing, always snatching defeat from the jaws of victory because deep down they are more interested in their own short term interests than the long term interests of the Nation.
This shows the Dem's the strategery needed to prevent any other major needed reform in the agenda.
The mainstream Republicans seem to have Stockholm syndrome, fucking lightweight self-interested pansies.
'Gimp
The in the pocket republicans are now challenging the American people to vote them out. Time to call their bluff, let's help Trump drain the swamp mid-term.
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The in the pocket republicans are now challenging the American people to vote them out. Time to call their bluff, let's help Trump drain the swamp mid-term.
But we need to vote in different Republicans, or third party candidates that will improve the situation. If we merely vote out the Republicans and vote in the Democrats again, we will be even worse off.
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But we need to vote in different Republicans, or third party candidates that will improve the situation. If we merely vote out the Republicans and vote in the Democrats again, we will be even worse off.
There will be plenty of people ready to challenge the RINO's in the primaries. Hopefully after watching the boondoggle this year in congress we can start getting rid of these people.
I do feel the battle cry for 2018 will be "Drain the Swamp!".
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The reason the Republicans can't fix health care is because they are trying to replace a government program with another government program, when the problem is that there is no government program that can fix the problems we have.
I think the fix should be relatively easy. As Herman Cain said, you have to define the problem before you can fix it.
Step 1. Identify just what were the biggest problems with our health system before Obamacare.
Step 2. Figure out a way to reduce those problems. (eg: indigent care, catastrophic events, pre-existing conditions).
Step 3. Repeal Obamacare and implement those changes necessary that will get the best improvements to the problems identified in step 1.
The Democrats, and now the Republicans think throwing the whole system out and replacing it with a whole new, government mandated, partisan bureaucracy is the answer.
It isn't.
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But we need to vote in different Republicans, or third party candidates that will improve the situation. If we merely vote out the Republicans and vote in the Democrats again, we will be even worse off.
This is why the Primaries are so important. There needs to be a grass roots movements for people to target the Establishment Republicans, and replace them with candidate that hopefully won't turn into Establishment Republicans. Not an easy task, as once politicians get a taste of power, an social climbing (committee appointments, leadership, etc) they become CORRUPT.
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There will be plenty of people ready to challenge the RINO's in the primaries. Hopefully after watching the boondoggle this year in congress we can start getting rid of these people.
I do feel the battle cry for 2018 will be "Drain the Swamp!".
Problem is, if the Rs get rid of the RINOs, then the R's majority will drop from 52-48 to a minority of about 80-20 and they will get NOTHING done.
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Problem is, if the Rs get rid of the RINOs, then the R's majority will drop from 52-48 to a minority of about 80-20 and they will get NOTHING done.
That makes no sense at all.
Voting out the RINO's in the primaries and running good republican candidates in their place will only strengthen congress.
The democrats don't stand a chance as long as the keep letting the progressives run their party. They have become their own worse enemy.
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Interesting read.
http://thehill.com/homenews/administration/342618-conservatives-target-congress-not-trump-after-healthcare-collapse
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This is going to fail as well. The establishment republicans are playing a long game in hopes of getting Trump defeated in 2020 so they can get one of their own back in power (either R or a D).
2018 will prove to be interesting. It's my belief we'll start to see a bunch of establishment politicians from both sides being shown the curb.
http://www.recorder.com/House-budget-blueprint-key-to-success-of-Trump-tax-agenda-11357282
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The problem is that if the Republicans don't show progress on some things we will get another Democrat in 2020. However, I don't think a lot of the establishment Republicans in the House, and Senate care that much. As long as they keep their seats, and committee positions in order to line their own pockets, and retain power, they are happy. Go along to get along, and be a part of the gravy train. That's all they care about. The establishment Republicans are worse hypocrites than the Democrats.
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The problem is that if the Republicans don't show progress on some things we will get another Democrat in 2020.
I don't think so. Since the progressives have hijacked the democrat party, and 8 years of Obama still on people's minds, the vote will go to a replacement during the primaries and to the R in the general.
The democrats have screwed the pooch and until they show they are willing to clean house and rid themselves of the coastal limousine liberals, people are going to stay away from them (except for the Alt Left Progressives, but they are a minority).
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The Democrats may smarten up, and run a moderate, populist that can be embraced by union types, and blue collar, middle America workers. Naaaaa. They are still eating brie cheese, drinking Chardonnay, and ridiculing FLY OVER AMERICA.
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I never thought I'd see the day I agreed on something Gimp said.
And I don't understand how this became political,blue and red, with a lot of trash talking and not caring that a problem is solved as long as the other guys don't get their way.
The best analogy to healthcare costs is higher education costs. When the federal government opened the floodgates by guaranteeing student loans and eliminating all credit requirements the cash has been POURING into colleges and universities. What happens when you suddenly have tons of $ coming in, you raise prices simply because you can. And expand programs and fatten administration bankrolls. Why is college so expensive? Simply because it can be. Healthcare is the same.
Some goofballs on here talk of it being like any other business. It's not even close in any way, especially in the sense that it's a free market. Not even close to being a free market. My wife needed an ultrasound not too long ago and since we were nowhere near our deductible we asked what that was going to cost. No one had a clue and we were told we wouldn't know until the bill arrived. So it's not like you're going to a competitor because you think Hospital A charges more than Hospital B.
At least a few people will disagree, but healthcare is not a luxury, it is a basic human need. In that sense, some regulation is necessary. In the costs to patients especially. It's absurd that the bill arrives with some obscene dollar amount and then down below has an insurance discount of maybe 40%. Costs are costs, and it shouldn't cost me more for the same treatment based on whether I have insurance or not. Don't give me the volume discount crap I've heard before because it's just that - crap. I wouldn't be opposed to costs being regulated by a board of industry professionals.
The government is getting more involved in this and it's only going to get worse. I won't feel sorry for the HC providers or the insurance companies when the government blunders the system beyond repair. They're bringing this on themselves with no regard for the patients and no desire for self-control.
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Not being able to get a price in advance is a problem.but having the government set prices is not the solution.
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Anyone here say the government should set HC prices? I'd like to see an INDUSTRY board take control of many of the problem areas, including pricing.
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Anyone here say the government should set HC prices? I'd like to see an INDUSTRY board take control of many of the problem areas, including pricing.
Noted.
But i still dont like it. I prefer transparent pricing.
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Anyone here say the government should set HC prices? I'd like to see an INDUSTRY board take control of many of the problem areas, including pricing.
Why not just let the free market work, just like any other free market?
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Why not just let the free market work, just like any other free market?
While I do agree that healthcare is a different "commodity" than others I do think market competition can work. Why do you think hospitals, and healthcare systems advertise? Artificial, government, price controls do not work. The market can limit costs, and create an equilibrium between service, and cost through NATIONAL competition.
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Availability to insurance has been the focus only because pricing is out of control. There's not a person here who hasn't looked at a HC bill and wondered in what fairytale land that number came from. I almost never see a doctor. In the last 20 years I've been just a few times. Once for a car accident when a lady hit me head-on. A spider bite. A colonoscopy. And a problem with my arm muscle. It was the last one that baffled me the most. A tech took x-rays, then the doc sees me for maybe at the most 3-4 minutes, has the nurse give me a steroid shot, and the bill after the insurance discount is almost $5,000. You have to wonder how that's possible. How they designed a system that has to be so expensive. This is a crisis and I don't think many of the people in charge are taking it as seriously as they should be. When the government takes control, and they're slowly doing just that, it's not going to be good for anyone.
I've suggested before that some of the things that need fixed are:
1. Stop requiring repeat doctor visits to get prescriptions refilled.
2. Institute more para-professionals. I had to see a doctor to tell me that a brown recluse spider bite wasn't fatal, that I'd be fine? (Man, that was a tense hour-long wait in the waiting room)
3. Pricing should be regulated by an industry board. I didn't say set in stone, but at least within a range.
4. The federal government writes flood insurance...why not medical malpractice? It would certainly help control costs. I'm not a fan of liability caps, because if a doctor or pharmaceutical company blunders their job through carelessness they owe the person they destroyed. You want liability caps, why not for EVERY liability case and not just medical malpractice? It just doesn't make sense to me to want caps for only medical liability cases when those are the ones that affect people most personally. Medical malpractice insurance is one of those areas that could and should be government provided.
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Why not just let the free market work, just like any other free market?
Like any other free market? You think our health care system is a free market? Really?
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The market can limit costs, and create an equilibrium between service, and cost through NATIONAL competition.
In fairytale land maybe. They've never chosen to do so...because they don't have to and there's no incentive for them to do so. Hence, why this thread exists. I'm thinking many people here don't even think a problem exists.
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Like any other free market? You think our health care system is a free market? Really?
It's not, and that is the problem. In the instances around the country where healthcare is operated in a free market situation, it works extremely well. Here's one that is very affordable and works extremely well https://atlas.md/
Also https://www.bizjournals.com/wichita/news/2017/03/08/atlasmd-founder-featured-on-fox-news-program.html
3. Pricing should be regulated by an industry board. I didn't say set in stone, but at least within a range.
Do we have an "industry board" to set prices on automobiles? plumbers? groceries? homes? Why do we need one to set prices on a free market healthcare?
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In fairytale land maybe. They've never chosen to do so...because they don't have to and there's no incentive for them to do so. Hence, why this thread exists. I'm thinking many people here don't even think a problem exists.
The reason they've never chosen to do so is government interference and regulation. Remove that and let the free market take place and an equilibrium will happen.
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In fairytale land maybe. They've never chosen to do so...because they don't have to and there's no incentive for them to do so. Hence, why this thread exists. I'm thinking many people here don't even think a problem exists.
One of my clients is a major, regional healthcare system. They spend huge dollars advertising, and are also going through a capital improvement initiative to modernize various facilities, and equipment to remain competitive with other healthcare systems in order to attract more patients. Fairytale Land? What would happen if some or all the Obamacare restrictions went away?
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In fairytale land maybe. They've never chosen to do so...because they don't have to and there's no incentive for them to do so. Hence, why this thread exists. I'm thinking many people here don't even think a problem exists.
Oh, there is a problem all right. I just don't like it when the cure is worse than the illness.
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If I'm the goofball that said health care is a free market, then I guess that's on me(I didn't say that, or imply it). However, exactly what I SAID was: Efficient markets happen constantly. Also, they happen in every industry, but to a lesser degree in markets which are heavily manipulated.
In case it wasn't clear by context in the 'why govt can't fix health care' thread - I will say clearly the US health care market is heavily manipulated. (kind of surprised that this even needs to be said - duh)
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Along with:
But dereg the health care industry, get the feds out of it to a very great extent and I will guarantee you that prices will go down. Also for your example of prescription drug prices? What would happen, does one suppose if ALL the fedguv investment in drug reimbursement went away?
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Since there is some confusion on what was said and implied let me make it crystal clear;
1. Health care is NOT NOW a free market.
2. Health care COULD move toward an efficient market, through a dereg mechanism.
3. That dereg may want to consider the airline industry model, modified to suit the specific needs of health care in the nation.
4. I will guarantee that if health care is dereg AND decoupled from fedguv spending, that prices will go down, options will improve, care will be better, and patient lives overall will improve.
Yes, that's a bold statement to make(4) but I am confident that it would happen. Consumers are the best consumers of price and value. The govt is almost surely, and very likely the WORST consumers of price and value. Eventually, we might get to a problem like airlines where cost is the driving factor, and customer service suffers. However, lets not forget that there is always first class, or business class with nearly all airlines(Spirit exempted), and that while the customer experience with airlines is forced to a cattle-call level, it is what the airline consumer has chosen.
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The government takeover of Health Insurance was part of the government takeover of student loans.
With so much money changing hands, the democrats jut HAD to cut themselves in on the corruption.
As obamacare was being written and arms twisted to get it passed, the amount of bribes (donations) paid to certain democrats by insurance providers increased and was focused to those who would be in a position to help influence the massive amount of policy to be made by the HHS Secretary.
As with anything government, democrats just HAVE to put their beak in the water and suck. They can't help it. It's what democrat politicians do.
Put health insurance back in the open market, take the artificial government restraints off of it, and allow people to decide how and when they CHOOSE to be covered and pay for their own coverage, without paying for every shit bag democrat's dreams, the prices will stabilize and drop of their won accord.
Democrats HATE freedom of choice. They want to choose for you because that paves teh way for graft, bribery, corruption and power flowing their way.
This discussion has never been about anything but money and power. Least of all, it is about health insurance.
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It's never going to a free market system. You're dreaming. The system is so much of a debacle now and was corrupted by all the greed. You want examples, look at the epi-pen thing that hit the news a while back. And Shkreli.
Yeah, free market at its best.
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The best way to fix a debacle i to blow it up and let the market forces dictate the outcome.
Anything less is just perpetuating democrat corruption..
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It's never going to a free market system. You're dreaming. The system is so much of a debacle now and was corrupted by all the greed. You want examples, look at the epi-pen thing that hit the news a while back. And Shkreli.
Yeah, free market at its best.
So you want to keep it under government control and regulation?
And what's wrong with the AtlasMD model? It's working under the free market system, it's affordable. Is that a problem?
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The best way to fix a debacle i to blow it up and let the market forces dictate the outcome.
Anything less is just perpetuating democrat corruption..
Yeah, because Heather Bresch, the Mylan CEO responsible for the epi-pen thing, and daughter of Senator Grassley (R) is a democrat.
You idiots who keep saying it's a R vs D thing ...
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Yeah, because Heather Bresch, the Mylan CEO responsible for the epi-pen thing, and daughter of Senator Grassley (R) is a democrat.
You idiots who keep saying it's a R vs D thing ...
Heather Bresch is the daughter of Sen Joe Manchin (D)
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Heather Bresch is the daughter of Sen Joe Manchin (D)
You're right. I transposed names. Sorry about that.
It's still not a democrat vs republican thing.
The puzzling thing about Rand's rant, saying Obamacare is terrible, is that his beef isn't with Obamacare, but with the insurance company itself.
And Trump's answer is to just let Obamacare fail...is so vague. HIS JOB is find a solution and implement it. Jesus Christ, to say "it's bad, I'm just gonna let it fail". What a fucking moron.
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Please, everyone stop using 'free market'. In the US we have a modified or regulated capitalist system. a totally free market in the US is completely impossible, even the internet is not completely free.
There are gradients of regulation in the US. Almost all markets are moving from a low to high regulation environment in the US. This is the way that socialism works, and we've been moving more socialist for decades. The link to the two markets where dereg happened is very telling. Customer value went up, prices went down, and consumers got an all around better deal. The health care model is modestly different in some respects, but in my not so humble opinion it's a market that screams for dereg.
If one sees a $5000 bill for a relatively simple medical intervention, it's interesting to know where all that money went, and who got to keep it. Pretty sure the MD who provided treatment doesn't get to keep even a small slice of the money. So - where did it all go? And how can we reduce overhead so that the price/value of care is better aligned?
When the overhead recipients far exceed the provider income, then the overhead recipients begin to run the show. and they will fiercely protect their overhead, without providing much in the way of actual health care. This is what we are seeing right now. All the leaches are killing the industry by all sucking blood from the patient.
At the fed level I prefer bold strokes. It's not going to be painless, and it's not going to come without some people being disenfranchised. This is one of the main problems we have, that people who don't PAY into a system consider that they are DESERVING of the system, and if they have to do with less(or none) they will scream with every invective they can find. Just like a certain senator calling another group of elected officials 'murderers'. That kind of rhetoric(always, always from the left) is what stops anyone from stepping up and doing the right thing for ALL consumers of health care - which is every person within the borders of the nation. But - a small minority of vocal stakeholders who can't/won't PAY decide how the entire country lives with a failed system.
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And Trump's answer is to just let Obamacare fail...is so vague. HIS JOB is find a solution and implement it. Jesus Christ, to say "it's bad, I'm just gonna let it fail". What a fucking moron.
Do you understand how government works? Ever take a civics class?
It's not "his job to find a solution", this must come from Congress, get approved then go to the Senate for approval, then to his desk for either approval or veto.
And for what it's worth, yes Trump has made recommendations to congress on the matter. But it's still up to them to make the changes and send it up for a signature.
So who's being the fuckin' moron here?
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And Trump's answer is to just let Obamacare fail...is so vague. HIS JOB is find a solution and implement it. Jesus Christ, to say "it's bad, I'm just gonna let it fail". What a fucking moron.
Are you saying that is what Trump wants? Like his first choice or something?
It's a last ditch effort to try to salvage at least part of his campaign promise. Something most politicians don't give a shit about as long as they think they can get re-elected.
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Trump has made some mistakes, obviously. Lately, he has said a few things in which I disagree. WRT Obamacare: "Let it Fail". The optics are bad on this. It makes it seem he is OK with putting people at risk for healthcare coverage. I know he doesn't mean that, but it can be spun as such. The second is, "I don't own Obamacare". Well, yes you do. You agreed to that when you took the oath of office. You own it more, if you fail to repeal, and/or replace it.
This is basic communication, and he needs to sharpen it up. NOW.
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As for the Trump angle, I'm pretty sure he's fit to be tied with congress. He can't unilaterally declare ACA defunct. It was legally written by congress, passed by congress, signed by the exec, and even gone through judicial review. So all three hands of govt have validated it. the only mechanism now for removal of ACA is either congress repealing, or SCOTUS invalidating. Frankly, with Gorsuch on the bench I would find one of the more onerous features of ACA and put it before the bench again. I would much prefer a judicial solution which wipes it out completely than a watered down republican 'solution' which retains all the junk parts of the law(mandatory enrollment), and gets rid of the smaller elements that are less glaring.
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Trump has made some mistakes, obviously. Lately, he has said a few things in which I disagree. WRT Obamacare: "Let it Fail". The optics are bad on this. It makes it seem he is OK with putting people at risk for healthcare coverage. I know he doesn't mean that, but it can be spun as such. The second is, "I don't own Obamacare". Well, yes you do. You agreed to that when you took the oath of office. You own it more, if you fail to repeal, and/or replace it.
This is basic communication, and he needs to sharpen it up. NOW.
Disagree.
Obamacare is the law as it stands. And it's failing big time. Again, it's up to congress to address and come up with a solution, then send it to Trump for a signature.
Trump does not have the power or authority to "fix" the ACA. He can certainly make recomendations and try to get congress to come up with a plan, but at the end of the day it's congress, not Trump that has to put a bill forward for signature.
The establishment (both R and D's) are doing this in hopes of damaging Trump, it's the long game I have spoken about. In reality, they are sinking their own ship. Trump knows if it fails it's on their (congress) back, not his.
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The best analogy to healthcare costs is higher education costs. When the federal government opened the floodgates by guaranteeing student loans and eliminating all credit requirements the cash has been POURING into colleges and universities. What happens when you suddenly have tons of $ coming in, you raise prices simply because you can. And expand programs and fatten administration bankrolls. Why is college so expensive? Simply because it can be.
Government hikes the available student loan amount and the colleges hike the tuition to match. Bring down the amount available via student loans and tuition would decrease.
My wife needed an ultrasound not too long ago and since we were nowhere near our deductible we asked what that was going to cost. No one had a clue and we were told we wouldn't know until the bill arrived. So it's not like you're going to a competitor because you think Hospital A charges more than Hospital B.
My wife and I had the exact opposite experience. She was without insurance for a six month period and need a knee operation. We were able to negotiate the cost of the operating suite, doctor fee and a knee brace they wanted her to wear. The only folks that wouldn't budge was the anesthesiologist group. We ended up with a pretty good deal. We met with the guy at the ortho office to pick up the brace. He gave us some outlandish price and we told him we were paying cash and could not afford that. He disappeared for a bit and came back and sold it to us for $75.
At least a few people will disagree, but healthcare is not a luxury, it is a basic human need. In that sense, some regulation is necessary. In the costs to patients especially. It's absurd that the bill arrives with some obscene dollar amount and then down below has an insurance discount of maybe 40%. Costs are costs, and it shouldn't cost me more for the same treatment based on whether I have insurance or not. Don't give me the volume discount crap I've heard before because it's just that - crap. I wouldn't be opposed to costs being regulated by a board of industry professionals.
The government is getting more involved in this and it's only going to get worse. I won't feel sorry for the HC providers or the insurance companies when the government blunders the system beyond repair. They're bringing this on themselves with no regard for the patients and no desire for self-control.
Maybe we should get rid of the antitrust exemption health insurance companies have.
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My major complaint is with his choice of words, and style in which he communicated it. I would never say I didn't own it, if I were the President. What happened to "The Buck Stops Here"?
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1. Stop requiring repeat doctor visits to get prescriptions refilled.
Can't do that for all refills. My thyroid stuff needs blood work to make sure the dosage does not need to be adjusted. Many other drugs are like that.
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You're right. I transposed names. Sorry about that.
It's still not a democrat vs republican thing.
The puzzling thing about Rand's rant, saying Obamacare is terrible, is that his beef isn't with Obamacare, but with the insurance company itself.
And Trump's answer is to just let Obamacare fail...is so vague. HIS JOB is find a solution and implement it. Jesus Christ, to say "it's bad, I'm just gonna let it fail". What a fucking moron.
Why is it his job? He didn't write the bill that created the ACA. Congress wrote that bill. They are trying to do something. Personally I would kill it altogether and go back and figure out how take care of those with per-existing conditions and those that simply cannot buy insurance. You could probably do that for a lot less than we are spending for the ACA. Why not put those people on Medicare?
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One of the big roadblocks is not being able to sell across state lines. How are you going to fix that? It is a state's right issue as each state has an insurance commissioner setting standards he/she feels works for his/her state. Are we going to tell them to go to hell?
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Can't do that for all refills. My thyroid stuff needs blood work to make sure the dosage does not need to be adjusted. Many other drugs are like that.
I mostly agree with you, but I took Gerhart's comment to mean that you don't need a DOCTOR visit for that. A trip to the lab, a reading by a PA (who may want to check with Dr.) and most med refills can be handled without actually taking up the doctor's time.
My brother had high blood pressure and was scripted a medication. He then went on a diet and exercise regimen. After a few months, he began feeling like shit. He went to the doctor and found that exercise and diet mostly negated his need for meds and now he was being over medicated. But a PA, or possibly even a nurse, could have handled that too.
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One of the big roadblocks is not being able to sell across state lines. How are you going to fix that? It is a state's right issue as each state has an insurance commissioner setting standards he/she feels works for his/her state. Are we going to tell them to go to hell?
Insurance companies are very happy not having to deal with competition across state lines.
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Insurance companies are very happy not having to deal with competition across state lines.
And we know why. We need to get them out of their comfort zone, and make them compete.
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Insurance companies are very happy not having to deal with competition across state lines.
I don't believe that is the case. I think the state insurance bureaucracies don't wan't to give up their little power empires.
I do believe in States Rights, but I also believe in inter-state commerce and competition.
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How is it that the federal government knows what's best for any individual state? Health care and health care insurance in FL is going to be markedly different in FL than in NY. I have no problem with each state setting the standards they expect for their citizens.
But health care insurance isn't the only problem we're facing. It's the mindless bureaucratic requirements forced on HC providers. It's the cost structure the HC providers have put in place. And yes, a big part of it is the HC insurers and their requirements. It's not like you can point your finger at any one part of the system and say that's the only part that's broken. Every cog in the machine is defective.
I don't think it's too much to ask to have a system like this:
1. Tiered professionals. Clinics staffed with people who can treat minor ailments like bee stings, small cuts, etc. The more serious problems get bumped up to MDs.
2. A clear cost structure up front for things that are done on a regular basis. Ex. A colonoscopy is $1200. If billing systems can produce invoices after-the-fact, they sure as hell can do it before hand. Obviously, the doctor isn't going to know up front everything he'll have to do, but he'll certainly know the next few things you're about to be charged for. And everyone gets the same price.
3. Standardized insurance policies. No more BS where Company A covers something and Company B doesn't. Every company uses the same standardized codes to eliminate the crapload of confusion. If an insurer doesn't cover something and a consumer disagrees the issue is brought before an industry council to make a binding decision.
4. Here's the part that's hard for me to swallow, but I do think it's necessary. If you're denied coverage through the open market you can opt for a version of a state FAIR plan. Like auto and home insurance, each company is required to take a pro-rata share of the undesirable risks.
The only reason this is tough for me is that I don't like the idea of fat people or smokers or alcoholics or drug abusers, etc. abusing their bodies and then expecting insurance to pay to keep them breathing. Yes, I'm talking about most of you fatties on here. Sorry, but that's the way I see it.
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How is it that the federal government knows what's best for any individual state? Health care and health care insurance in FL is going to be markedly different in FL than in NY. I have no problem with each state setting the standards they expect for their citizens.
Fine. Then get the government (federal) out of the healthcare insurance business and let the companies compete.
But health care insurance isn't the only problem we're facing. It's the mindless bureaucratic requirements forced on HC providers. It's the cost structure the HC providers have put in place. And yes, a big part of it is the HC insurers and their requirements. It's not like you can point your finger at any one part of the system and say that's the only part that's broken. Every cog in the machine is defective.
You do realize much of this was brought on by the ACA don't you?
I don't think it's too much to ask to have a system like this:
1. Tiered professionals. Clinics staffed with people who can treat minor ailments like bee stings, small cuts, etc. The more serious problems get bumped up to MDs.
2. A clear cost structure up front for things that are done on a regular basis. Ex. A colonoscopy is $1200. If billing systems can produce invoices after-the-fact, they sure as hell can do it before hand. Obviously, the doctor isn't going to know up front everything he'll have to do, but he'll certainly know the next few things you're about to be charged for. And everyone gets the same price.
3. Standardized insurance policies. No more BS where Company A covers something and Company B doesn't. Every company uses the same standardized codes to eliminate the crapload of confusion. If an insurer doesn't cover something and a consumer disagrees the issue is brought before an industry council to make a binding decision.
4. Here's the part that's hard for me to swallow, but I do think it's necessary. If you're denied coverage through the open market you can opt for a version of a state FAIR plan. Like auto and home insurance, each company is required to take a pro-rata share of the undesirable risks.
So on one hand you want the government to get out of the healthcare business, but on the other hand you want it regulated?
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" You do realize much of this was brought on by the ACA don't you?"
Bullshit. These problems existed LONG before ACA. They're the reason people were so upset and that ACA even came into existence.
" So on one hand you want the government to get out of the healthcare business, but on the other hand you want it regulated?"
I didn't say that I did or did not want the government in the healthcare business. That thought had never occurred to me. But yes, I'd like to see more, much more, industry-provided self oversight so that the government could be less involved. It's the lack of self control and greed that's wreaking havoc on the system. But it's to the point where yes, the government is going to have to get more involved.
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" You do realize much of this was brought on by the ACA don't you?"
Bullshit. These problems existed LONG before ACA. They're the reason people were so upset and that ACA even came into existence.
There were previous problems yes, but the ACA has blown those problems way over the top.
Have you actually read any of the ACA? From your ranting it doesn't appear as you have.
" So on one hand you want the government to get out of the healthcare business, but on the other hand you want it regulated?"
I didn't say that I did or did not want the government in the healthcare business. That thought had never occurred to me. But yes, I'd like to see more, much more, industry-provided self oversight so that the government could be less involved. It's the lack of self control and greed that's wreaking havoc on the system. But it's to the point where yes, the government is going to have to get more involved.
So with a 2,000 plus page bill called the ACA, a bill that essentially took over healthcare in this country and has created one of the largest quagmires of our time, your solution is............more government control?
Really?
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ACA added layers, and layers of overhead. It's thousands of pages of regulations, rules, conditions, etc. IRS admitted publicly it was going to require at least 110 new revenue agents. I'm confident that the number of fed 'crats employed due to ACA is in the thousands. Plus, the overhead for insurers, billing agencies, legal firms, hospitals. Every 'crat got well fed by ACA. It pumped billions into the govt from taxes, fees, compliance. Then, even more billions were spent doing what crats do. Move paper from in tray to out tray, and refill the in tray.
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Give us the House and we will fix it.
We gave them the House, they did not fix it.
Give us the Senate and we will fix it
We gave them the Senate, and they did not fix it.
Give us the White House and we will fix it.
We gave them the White House, and they still cannot fix it.
7 fucking years later, 7 years of promises, 7 years of show-votes, and they now admit they don't have a workable approach that they can pull themselves together for, let alone get a few vulnerable Dem's to support.
Understand your frustration. "Repeal and Replace" was an effective campaign slogan, unfortunately, up to a few months ago, anyone using the slogan had no idea what it meant or how to implement it. The AHCA and the BHCA were secretly devised by a small group of people with zero input from anyone actually involved in health care, so we ended up with "replacement" programs worse that the original ACA. I'm glad a few Senators had the gumption to realize that they weren't good bills that actually improved things. During the last few months, never seen a person stand up and truly explain why the new bills were better. President Obama did a much better job of understanding the ACA and going out there and publicly providing support. President Trump was incapable of either.
All that being said, the ACA, AHCA and the BHCA are doomed to failure as they all share a fatal flaw, none address the basic problem of how we deliver health care and the cost of doing so. That's a tough one, since reducing heath care costs means some very politically powerful organizations will see a reduction in profit.
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. President Obama did a much better job of understanding the ACA and going out there and publicly providing support.
You mean like going out and telling us "If you like your doctor, you can keep your doctor" and "The average household will see a decrease of $2500 a year in premiums"?
Some support.
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You mean like going out and telling us "If you like your doctor, you can keep your doctor" and "The average household will see a decrease of $2500 a year in premiums"?
Some support.
Exactly like that!! President Obama understood the ACA did make the effort to go out there and sell the program. Perhaps I've missed them, but did President Trump or any other leading Republican give any type of speech or meeting selling the virtues of their programs?? Do remember the President saying the House bill was "mean" - some support!
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Exactly like that!! President Obama understood the ACA did make the effort to go out there and sell the program. Perhaps I've missed them, but did President Trump or any other leading Republican give any type of speech or meeting selling the virtues of their programs?? Do remember the President saying the House bill was "mean" - some support!
So "selling the program" equals outright lies and misleading the public, and you're perfectly ok, even congratulatory about it.?
Guess you think Jonathan Gruber is a stand up guy as well.
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So "selling the program" equals outright lies and misleading the public, and you're perfectly ok, even congratulatory about it.?
Guess you think Jonathan Gruber is a stand up guy as well.
LOL!!! If a President want his policies to pass, he does indeed need to sell it to Congress and the public at large. Obama and the Dems did that, Trump and the Republicans did not.
Seem to remember some quotes from the current President o health care... something along the lines of "best health care ever, for everyone", "beautiful health plan", "lower costs and better coverage".... Of course the President has an impeccable reputation with stating only truth!
I take it you believe the proposed Senate health care bill meets those criteria and is an improvement over the ACA?
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LOL!!! If a President want his policies to pass, he does indeed need to sell it to Congress and the public at large. Obama and the Dems did that, Trump and the Republicans did not.
You seem to forget one huge detail: The President (BHO) did not "sell" congress and the public at large on Obamacare. The ACA was so good it was developed in secret (remember Nancy Pelosi "we need to vote on it to see what's in it" ) and the actual bill went through congress with ZERO republican support and passed the senate on reconciliation because it would not have had the votes to get through the senate.
There was no selling, just a massive bill shoved through that most congressmen (democrats) and senators (democrats) admitting they didn't even read it. The actual contents of the bill was kept from the public right up until it was voted and signed.
Legislation so good it had to be forced on the public.
I take it you believe the proposed Senate health care bill meets those criteria and is an improvement over the ACA?
I haven't seen the senate bill, and neither have most Americans because the finalized bill is yet to be written, and hasn't even been voted on.
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There is a missing element that needs to be addressed too - There are a lot of people that work in healthcare and the biggest cost driver is their salaries. In order to have meaningful cost cutting, a lot or even most of these people will have to lose their jobs. And not just lose their jobs, but make their jobs unnecessary and unsustainable.
Healthcare is a bubble.