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Thread: The health care debate thread.

  1. #391
    Sam the Sheepdog LA Ute's Avatar
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    The health care debate thread.

    This is worth a read (the title is TIC):

    Make America Singapore

    https://mobile.nytimes.com/2017/03/1...&_r=1&referer=
    Last edited by LA Ute; 03-20-2017 at 08:55 AM.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  2. #392
    Quote Originally Posted by Mormon Red Death View Post
    Cuba? Come on you don't really believe that do you? Cuba has what India has... some medical tourism that is essentially breast implants and botox. The rest of the population gets shit for healthcare. Tech speaking they are 40 years behind the usa. At least with India you get us trained docs. Be honest... if you had a serious condition would you even consider going to Cuba for treatment?
    I never said Cuba was top tier at providing treatment. Cuba's a third world country, but they have one of the best healthcare systems among third world countries. They're impoverished, but score better than the US on a fair number of health measures - which, honestly, isn't that hard to do - like infant mortality.

    My point was that Cuba's healthcare research capability is far better than one would expect. They have clinical trials for cancer treatments going on within the US, going through our FDA approval process, etc.

    I've been critical of the US system, even though I work within it. Here's where the US is unquestionably better than another nation - Jamaica. One of my teammates is from Jamaica, where they've never implemented the law Reagan signed that compels emergency care, regardless of a person's ability to pay.

    "The ambulance won't come unless you have the money".

    For a fully market-based healthcare system, we would need to abolish Reagan's law. The ability of people to just show up at the ER with no means to pay is a bowling ball to any kind of individual responsibility, market-based approach. The cost shifting that occurs when people go without healthcare for years, and then show up at the 11th hour, foisting the costs on everyone else, is a major problem - which is a big part of why Obamacare focused on coverage.

    If we had stories of people dying at the entrances of ERs because they couldn't pay, a whole lot of people would be getting insurance instead of owning a car, and for those who got caught gambling with their lives and losing, it would serve society by weeding them out of the gene pool - Darwin award winners.

    (I think this would be a hellish abomination of the values Americans claim to espouse, but at least it would be intellectually honest.)

  3. #393
    I'll say it again, but the real debate that needs to be settled is whether healthcare is a right or a privilege and until some consensus comes on that from the American people there are always going to be two approaches to this issue that are in general opposition of each other.

    I probably would have said in the past it is a privilege but that is what you think when you compare it to the 1850s or something. But today we have the skills, network and resources as a society to provide healthcare to everyone, so why don't we?

    LA I agree with you. After reading quite a bit about the Wyden-Bennett Act I think that IS the best solution for our country.


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  4. #394
    Administrator U-Ute's Avatar
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    Quote Originally Posted by Rocker Ute View Post
    LA I agree with you. After reading quite a bit about the Wyden-Bennett Act I think that IS the best solution for our country.
    It seems quite reasonable. The GOP would hate it.

  5. #395
    Quote Originally Posted by Rocker Ute View Post
    I'll say it again, but the real debate that needs to be settled is whether healthcare is a right or a privilege and until some consensus comes on that from the American people there are always going to be two approaches to this issue that are in general opposition of each other.

    I probably would have said in the past it is a privilege but that is what you think when you compare it to the 1850s or something. But today we have the skills, network and resources as a society to provide healthcare to everyone, so why don't we?
    Technically, clean water is a privilege.

    Healthcare began becoming a right when Reagan signed the law forcing ERs to provide service regardless of a person's ability to pay. That action, compassionate as it was, began wrecking the market incentives for healthcare, for individual responsibility, etc.

    Another prism is whether healthcare is simply a product, like buying office supplies, or whether it is more fundamental to life (liberty and the pursuit of happiness).

    In the US there's a strong, unquestioned consensus that education for schoolchildren is a social obligation we must fulfill. Healthcare, though far more nuanced and complex, is moving toward that kind of status.
    Last edited by Ma'ake; 03-22-2017 at 07:26 AM.

  6. #396
    Quote Originally Posted by Rocker Ute View Post
    I'll say it again, but the real debate that needs to be settled is whether healthcare is a right or a privilege and until some consensus comes on that from the American people there are always going to be two approaches to this issue that are in general opposition of each other.

    I probably would have said in the past it is a privilege but that is what you think when you compare it to the 1850s or something. But today we have the skills, network and resources as a society to provide healthcare to everyone, so why don't we?

    LA I agree with you. After reading quite a bit about the Wyden-Bennett Act I think that IS the best solution for our country.


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    fwiw


    http://www.thedailybeast.com/article...a=twitter_page

  7. #397
    Sam the Sheepdog LA Ute's Avatar
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    She's a smart economics writer, leans libertarian but isn't afraid to say so when the emporer has no clothes.

    Better Health Care for Less Money? It's Not Easy


    https://www.bloomberg.com/view/artic...are-not-really

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  8. #398
    What would happen if the only change we made was that insurance companies could not be for profit? What if they had to sink their profits back into their coverage?

    How big of a change would happen then?

    That should be the first step.

  9. #399
    Quote Originally Posted by LA Ute View Post
    She's a smart economics writer, leans libertarian but isn't afraid to say so when the emporer has no clothes.

    Better Health Care for Less Money? It's Not Easy


    https://www.bloomberg.com/view/artic...are-not-really
    Her take is the typical right's take:

    Health care is really, really, complicated, and because of that it's really, really expensive...and that's all I have. No ideas, no solutions, just excuses.

    Her argument on our lower mortality:

    "Well, we have guns and cars, so I'd expect more people to die because of that." So, is she for gun control and expanding public transportation?

    Then she basically says, "well, we tried Obamacare, and more people died, so that was a failure".

    Then, she says that Obamacare worked, by controlling costs. And, I quote:

    Looking at our health-care-cost growth for the most recent six years, you see that spending as a percentage of GDP was basically flat from 2009 to 2013, then rose 0.5 percent in the two years after Obamacare kicked in.
    So,alksjdf
    So, if Obamacare has worked in some instances, shouldn't we be working to make it better?

    I don't get any of her arguments. They are all just excuses. None of the address the fact that we spend more and have worse healthcare than all the other countries at our level.

    Nevermind, she does address that when she says that we have money, and when that happens, we spend more on healthcare. She just forgets the part that when you spend more, you expect it to be better.

    Like I said, typical right wing/libertarian article.

    We all know it sucks. We all know it is expensive. We all know it's hard.

    Come up with a plan. Hell, we have a plan with Obamacare. Let's work together to make it better.

    But, no, we'd rather blow the whole thing up every 4 or 8 years to prove we were right. And that is a problem that both sides have.

  10. #400
    Administrator U-Ute's Avatar
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    Quote Originally Posted by Utah View Post
    What would happen if the only change we made was that insurance companies could not be for profit? What if they had to sink their profits back into their coverage?

    How big of a change would happen then?

    That should be the first step.
    Just a reminder:

    healthcare-costs.JPG

  11. #401
    Sam the Sheepdog LA Ute's Avatar
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    Just because I post a link to an article doesn't mean I endorse what's said. The subject is complex, and so are the politics. I'm just trying to show those two realities.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  12. #402
    Makes you wonder what administrators are eating to grow so much?!

  13. #403
    Quote Originally Posted by LA Ute View Post
    Just because I post a link to an article doesn't mean I endorse what's said. The subject is complex, and so are the politics. I'm just trying to show those two realities.
    I wasn't going after you and if it came off that way, it wasn't my intent. I was just responding to the article you posted.

  14. #404
    Quote Originally Posted by Utah View Post
    What would happen if the only change we made was that insurance companies could not be for profit? What if they had to sink their profits back into their coverage?

    How big of a change would happen then?

    That should be the first step.
    I worked for 7 years for a large non-profit insurance company, a company with more "heart" than a lot of for profit companies.

    We had a group of actuaries who basically tried to figure out how to find healthy customers, and how to shed unhealthy customers. In a competitive health insurance market, this is how you survive, and thrive - get the Other guys to take unhealthy patients, you have more healthy patients, which insulates you from very expensive cases and gives you cash to expand with.

    Our overhead costs were in line with others in the industry, about 18% of total premiums. The overhead in Medicare is about 1.5%. There are no Medicare salesman who need to drive Mercedes to impress potential customers. When you add up the total difference of administrative overhead between private insurance and a single payer model, Americans pay over $1000 per capita simply for the privilege of having choices.

  15. #405
    This is an interesting article that I think many of us overlook when we think about ourselves. I think the author goes a little overboard in calling it white socialism, but I get where he is coming from. I certainly have benefitted from the socialist policies identified by the author.

    https://www.forbes.com/sites/chrisla.../#481b7878186a

  16. #406
    Quote Originally Posted by UTEopia View Post
    This is an interesting article that I think many of us overlook when we think about ourselves. I think the author goes a little overboard in calling it white socialism, but I get where he is coming from. I certainly have benefitted from the socialist policies identified by the author.

    https://www.forbes.com/sites/chrisla.../#481b7878186a
    Thisisa
    This is a great article.

    It's why I don't like our tax system. The Waltons use the government more than anyone else. They use more roads, they use more police, they use more welfare, etc. Yet, they pay less taxes (when it comes to a % of their pay) than many middle class Americans. This is wrong.

    Why is it we are only against "welfare" when it comes to those who need it the most, but applaud corporate welfare (those who need it the least)?

    I don't get it at all.

    I used the government every step of the way in my life. I grew up poor and on welfare. We used food stamps growing up. I went to public schools. Then, I went to college, where many use grants, loans, etc to pay for their school. I did not get any of that until graduate school (but I did to go the University of Utah, a state school, which recieves funding from taxpayers, so I did benefit from "socialism"), but in the end, I ended up using those welfare programs as well, as I did get fed loans (at 6-8% interest...that's a whole 'nother story).

    This is what republicans, or the tea party, people need to realize. Utah is floated by the federal government. Who do you think pays for I-15 work? Who do you think funds Hill Air Force? What would happen to Ogden/Layton area if Hill shut down? Who sends all the "grants, etc" to Utah, BYU, USU, Weber State, etc?

    As conservatives, we LOVE to laugh at California and mock them for "not doing things right". California would LOVE to get rid of the federal government. They pay much, much more into federal taxes than they get back. If California could keep that money, they would FLOURISH and the rest of the US would die overnight. California would instantly become the sixth largest country, GDP wise, if they broke off from the US. It would cripple the US if California left. California would be just fine if they left. They'd probably be better off.

  17. #407
    Administrator U-Ute's Avatar
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    Quote Originally Posted by Utah View Post
    As conservatives, we LOVE to laugh at California and mock them for "not doing things right". California would LOVE to get rid of the federal government. They pay much, much more into federal taxes than they get back. If California could keep that money, they would FLOURISH and the rest of the US would die overnight. California would instantly become the sixth largest country, GDP wise, if they broke off from the US. It would cripple the US if California left. California would be just fine if they left. They'd probably be better off.
    Indeed. The most conservative states take in more federal money than they give.

    I don't think the people of those states realize how much crunch they'd feel if Trump succeeds in destroying the federal government. Although the health care issue may start to open their eyes.

  18. #408
    Quote Originally Posted by U-Ute View Post
    Indeed. The most conservative states take in more federal money than they give.

    I don't think the people of those states realize how much crunch they'd feel if Trump succeeds in destroying the federal government. Although the health care issue may start to open their eyes.
    It's
    It's also why I don't get why Utahns hate Hatch so much. He bankrolls this state. What happens when he retires and Utah doesn't have SR congressman to keep Hill open? How many times has the fed tried to shut down Hill and Hatch has saved it?

  19. #409
    Quote Originally Posted by U-Ute View Post
    Indeed. The most conservative states take in more federal money than they give.

    I don't think the people of those states realize how much crunch they'd feel if Trump succeeds in destroying the federal government. Although the health care issue may start to open their eyes.
    Couldyou
    Could you imagine what the country of California would be like? It would be fantastic. Good retirement programs, healthcare for all, food would be abundant, great economy...I'd move there in a heartbeat.

  20. #410
    Administrator U-Ute's Avatar
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    The GOP pulled the bill.

    Insert jokes about GOP healthcare bill "pulling out in time" here.

  21. #411
    With GOP healthcare dead - at least for awhile - he's what moderate Republicans need to do to avoid getting pummeled in the 2018:

    - work with Democrats to address the problems in Obamacare, principally the deteriorated insurance markets where just one insurer remains. Revive the Government Option idea that was thrown out of ACA as it was being debated in 2009.

    There are many rural communities where insurance competition is crappy, and many people depend on Medicare & Medicaid, and young families could use affordable coverage. A government option in those areas would be a big improvement in quality of life for the people hanging on, in the face of longer term economics shifts toward urban areas.

    - Aggressively address the other two aspects of healthcare reform: Cost and Care. A reader in the D-News said recently they had an overnight stay at a hospital here in Utah. Bill: $19,000... just for the room.

    If there were any Democrats in Utah's delegation, they could prod the Utah delegation to DC to nudge Herbert and the Legislature to accept expanded Medicaid funding.

    At some point, you need to accept your side lost, and move on, in the interests of your constituents. My confidence in Utah Republicans to do the right thing is... "modest"... but that's what needs to happen.

  22. #412
    How can this be? A friend recently showed me his medical statements and I could not believe it. For years, this friend has received IV injections of a drug called Remicaid. It is primarily used to treat the symptoms of rheumatoid arthritis. He receives these injections about every 8 weeks. For years he had private insurance coverage through Select Health through his wife's employment at Intermountain Healthcare. Select Health is a medical insurance company owned by Intermountain Health. He changed his insurance to United Healthcare Medicare when he became eligible. His last injection while covered by Select Health was done on 12/22/16 at an Intermountain Healthcare facility and the total billed charges were $9,426.97. Select Health paid 6,481.81 and because he had already met his deductible, he paid 0. He just received the billing for his first treatment at University Hospital. The total amount billed to United Healthcare was 19,618.10 and the total paid by United Health was 18,724.18. He paid his deductible of $893.92. The charges for administering the infusion were a little more at Intermountain than at University. The main difference was the price of the drug: 9,426.97 at Intermountain and 18,634.00 at the U.

    There is no reasonable explanation for the discrepancy. The only possible explanations are that Intermountain Healthcare gives Select Health a break because they have common ownership or because it is a negotiated price or the University Hospital is charging United Healthcare Medicare a huge mark-up because it is Medicare. Am I correct that Medicare is not allowed to negotiate the price of pharmaceuticals? Is this the difference? My friend has no incentive to do anything because even if his bill were reduced this time, he will still easily meet his deductible in future infusions.

  23. #413
    So it is Ryan's fault that the GOP healthcare legislation went nowhere? But, Trump said he had a great plan, one that would cover everyone with better coverage and cost less. Where is that plan?

  24. #414
    Sam the Sheepdog LA Ute's Avatar
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    It is 100% the Freedom Caucus's fault. Ideological purists. As far as Trump goes, he knows even less about healthcare than he does about most other subjects. I wouldn't pay attention to a single thing he says about it.


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    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  25. #415
    Quote Originally Posted by LA Ute View Post
    It is 100% the Freedom Caucus's fault. Ideological purists. As far as Trump goes, he knows even less about healthcare than he does about most other subjects. I wouldn't pay attention to a single thing he says about it.


    Sent from my iPhone using Tapatalk
    If you had to rank the subjects he knows nothing about, it would be hard, sort of like making out your tourney bracket. I might go with NATO at no. 1, however.


    Most of the time, that story about Trump handing Merkel an invoice for $300 million or billion or whatever, would be one of the most bizarre stories ever, it it wern't for Nunes jumping out of an uber car in the middle of the night and disappearing. So Merkel wasnt even the most bizarre story of the week.
    Last edited by concerned; 03-27-2017 at 08:49 AM.

  26. #416
    Sam the Sheepdog LA Ute's Avatar
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    How a secret Freedom Caucus pact brought down Obamacare repeal

    http://www.politico.com/story/2017/0...et-pact-236507

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  27. #417
    Administrator U-Ute's Avatar
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    Quote Originally Posted by LA Ute View Post
    It is 100% the Freedom Caucus's fault. Ideological purists. As far as Trump goes, he knows even less about healthcare than he does about most other subjects. I wouldn't pay attention to a single thing he says about it.
    I wouldn't blame them 100%.

    There's also the moderate Republicans whose districts would be significantly affected negatively by the AHCA (rural, white areas) who had mid-term elections to worry about that also balked from supporting it.

    EDIT: I guess, technically, it is the divide between these guys and the Freedom Caucus. You can't blame either of them for standing up for their ideals. Although I will agree that the Freedom Caucus's ideals aren't necessarily grounded in reality.
    Last edited by U-Ute; 03-27-2017 at 10:35 AM.

  28. #418
    So now what LA? Given your background in healthcare, Does Pres. Trump move to the middle to get the moderate Republicans on board and a handful of Democrats? My personal political preference would be toward a move to the middle - best for the country in my opinion - and away from purists on either side of the aisle. Troubling to see Sen. Lee playing the role as one of the senators buoying up the Freedom Caucus members.

  29. #419
    Quote Originally Posted by Utebiquitous View Post
    So now what LA? Given your background in healthcare, Does Pres. Trump move to the middle to get the moderate Republicans on board and a handful of Democrats? My personal political preference would be toward a move to the middle - best for the country in my opinion - and away from purists on either side of the aisle. Troubling to see Sen. Lee playing the role as one of the senators buoying up the Freedom Caucus members.
    I bet Trump will try to sabatoge the existing structure to get it to fail thru regulation etc., so that the Democrats come to him. I'll bet nothing happens legislatively for a while, maybe not until after the 2018 elections. I personally think the Freedom Caucus did the Repubs a favor--the bill was so bad it would have made it much more difficult for the Repubs to run on it in 2018.

    http://www.nbcnews.com/health/health...m_npd_ms_tw_ma
    Last edited by concerned; 03-27-2017 at 01:06 PM.

  30. #420
    Quote Originally Posted by UTEopia View Post
    How can this be? A friend recently showed me his medical statements and I could not believe it. For years, this friend has received IV injections of a drug called Remicaid. It is primarily used to treat the symptoms of rheumatoid arthritis. He receives these injections about every 8 weeks. For years he had private insurance coverage through Select Health through his wife's employment at Intermountain Healthcare...
    Clearly, this is a major error in an individual case.

    The drug is still in its patent period, the Pharmaceutical is recouping the costs of R&D, marketing, and getting a handsome profit for their shareholders. Was this a case of the U being completely "off" in their markup, or was the U getting worked by the Pharma compared to the pricing Intermountain got? Something's not adding up.

    I would have your friend reach out to Senior VP of Health Sciences Vivian Lee, who is a directing the U's effort to better quantify the costs that makeup the "price" of a procedure, healthcare stay, medication, etc.

    I've met Dr. Lee, she's the real deal, the U is lucky to have her level of leadership and impact. I'm certain Dr. Lee would want to hear from your friend, this is the kind of situation she's been talking about, internally.

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