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Thread: The health care debate thread.

  1. #241
    After the hell of billing that I've been going through with my son's accident (we had the one year anniversary of the accident over a month ago and they are still trying to sort out the billing) I see very low hanging fruit to meaningfully bad appreciably fix health care.

    I started tracking it midway of the hours I have spent getting the billing sorted out... I've spent 32.5 hours thus far (without resolution). Presuming at least that much spent by both the providers and my insurance at $20/hour that is $1300 wasted.

    It isn't hard. If I have a $10k out of pocket max and I hit that in day 1 of the accident, the insurance pays everything after. Each and every person I speak to acts as if this is the first claim that has ever been made.

    I wish there was an end in sight.

    After we fix that, then let's tackle better utilization. Those two things alone will do more to make care 'affordable' more than anything that's been done this far.





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  2. #242
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Diehard Ute View Post
    You want to know who the best paying customers are in the healthcare system?

    Prisoners.

    Just let that sink in for a minute.


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    I have a tiny hospital client that would not survive if there were not a state prison next door. You're right, it's great business.

    "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

  3. #243
    Five-O Diehard Ute's Avatar
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    Quote Originally Posted by LA Ute View Post
    I have a tiny hospital client that would not survive if there were not a state prison next door. You're right, it's great business.
    When I worked at the U the prison and jail paid at higher rates that even Medicare.

    We obviously have some work to do when our prisoners get excellent medical care but we argue and fight over how to give it to law abiding folks.

    (And if you ever want to change healthcare, start with Medicare. They get first crack at the negotiating table, and there's not a hospital in the US who will cross them, they'll be out of business if they do)


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  4. #244
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    Quote Originally Posted by Rocker Ute View Post
    After the hell of billing that I've been going through with my son's accident (we had the one year anniversary of the accident over a month ago and they are still trying to sort out the billing) I see very low hanging fruit to meaningfully bad appreciably fix health care.

    I started tracking it midway of the hours I have spent getting the billing sorted out... I've spent 32.5 hours thus far (without resolution). Presuming at least that much spent by both the providers and my insurance at $20/hour that is $1300 wasted.

    It isn't hard. If I have a $10k out of pocket max and I hit that in day 1 of the accident, the insurance pays everything after. Each and every person I speak to acts as if this is the first claim that has ever been made.

    I wish there was an end in sight.

    After we fix that, then let's tackle better utilization. Those two things alone will do more to make care 'affordable' more than anything that's been done this far.

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    Spending 40 hours searching for a way to not pay for health care is probably still cheaper than just paying for it in the long run.

  5. #245
    Quote Originally Posted by U-Ute View Post
    Spending 40 hours searching for a way to not pay for health care is probably still cheaper than just paying for it in the long run.
    Nevermind. Onward and upward.
    Last edited by Rocker Ute; 04-15-2016 at 11:19 PM.

  6. #246
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  7. #247
    Sam the Sheepdog LA Ute's Avatar
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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

  8. #248
    Obama's defense of his shitty legislation. The affordable care act is ridiculous. This is politics at its worst.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  9. #249
    Administrator U-Ute's Avatar
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    Quote Originally Posted by Mormon Red Death View Post
    Obama's defense of his shitty legislation. The affordable care act is ridiculous. This is politics at its worst.
    It is ridiculous in the fact that it does nothing to fix the actual problem: hospital fees are not guided by market principles at all.

  10. #250
    Sam the Sheepdog LA Ute's Avatar
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    Paul Run finally unveils the Republican plan that would replace Obamacare (but only if Trump wins and the GOP keeps both houses of Congress - unless both sides decide to do something shocking and compromise, which is the only way decent health care legislation ever gets passed).

    http://www.reuters.com/article/us-us...-idUSKCN0Z80AQ

    "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

  11. #251
    Administrator U-Ute's Avatar
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    Quote Originally Posted by LA Ute View Post
    Paul Run finally unveils the Republican plan that would replace Obamacare (but only if Trump wins and the GOP keeps both houses of Congress - unless both sides decide to do something shocking and compromise, which is the only way decent health care legislation ever gets passed).

    http://www.reuters.com/article/us-us...-idUSKCN0Z80AQ
    So in my reading of it, there aren't many big differences from Obamacare. It didn't say a anything about the mandatory coverage but it allows competition across state lines.

    I would be interested in knowing more about the coats.

  12. #252
    Sam the Sheepdog LA Ute's Avatar
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    From a Wall Street Journal editorial today:

    The biggest risk is that the two-stage maneuver will hand leverage to the most extreme wings of both parties. On the right, the incentive will be to denounce any replacement as ObamaCare Lite, and the leadership will have given up the leverage of “repeal” as an incentive to vote for a replacement. Conservatives from safe seats could kill reform if they attack as imperfect anything not designed by Ayn Rand.

    Meanwhile, the incentive for Democrats will be to oppose any negotiations and let the GOP twist in the wind. Minority Leader Chuck Schumer has already signaled this strategy, telling reporters that “if they repeal without a replacement, they will own it. Democrats will not then step up to the plate and come up with a half-baked solution that we will partially own. It’s all theirs.”
    Grab some popcorn, folks!

    "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

  13. #253
    Quote Originally Posted by LA Ute View Post
    From a Wall Street Journal editorial today:

    Grab some popcorn, folks!
    The Democrats can then claim it's not a bi-partisan piece of legislation! Brilliant! But perhaps not so original.

    Where have we seen this strategy before? Oh yeah, the GOP response to Obamacare (nee Romneycare, nee the Heritage Foundation market-based approach to Hillarycare)

  14. #254
    Sam the Sheepdog LA Ute's Avatar
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    A true story about how legislation is made:

    In 2009 there was a bipartisan bill for healthcare reform, called the Healthy Americans Act. It had 11 Republican co-sponsors and 9 Democrats, plus Joe Lieberman as an Independent. Principal sponsors were Ron Wyden, liberal Oregon Democrat, and Bob Bennett, not-conservative-enough Utah Republican.


    1. Administration of the program is by new state-sponsored "Health Help Agencies" (HHA). States must establish these organizations, which will approve health plans from private insurers, provide for enrollment in plans, and act as a conduit for premium payments from the federal government to individual insurance carriers.
    2. The "individual mandate:" All citizens and permanent residents would be required to pay for coverage as part of their federal tax liability. Payment would be made via tax withholding by employers. Individuals would effectively pay the federal government, which would channel the funds to the appropriate HHA and from there to the insurers. Employers would no longer provide basic coverage in most cases.
    3. Taxpayers would have a large healthcare standard deduction, which would increase with inflation. This would help taxpayers pay the tax liability that has now replaced insurance premiums. This essentially replaces the tax exclusion for health care benefits presently paid by employers. Certain low-income taxpayers would be eligible for premium assistance.
    4. The size of the standard deduction for 2009 would range from $6,000 for individuals to $15,210 for couples with children, with incremental amounts for additional children. As a standard deduction, this reduces the income reported as subject to tax. However, this deduction would phase out for higher-income taxpayers, reducing to zero for couples earning over $250,000.
    5. Mandates that employers provide salary and wages increases over a two-year period essentially equal to the amount paid previously for basic healthcare insurance premiums, as employers no longer have to provide basic healthcare coverage.
    6. Employers pay a new tax equal to between 3 percent and 26 percent of the national average premium for the minimum benefits package for each employee, depending on their firm size and amount of gross revenues per employee.
    7. What the Heritage plan from the 1990s wanted: The basic plan would be equal to the Federal Employee Health Benefits (FEHB) Program, with some exceptions. For example, Medicare and military healthcare recipients would be outside the scope of this bill.
    8. Premiums can vary only to reflect geography and smoking status.
    9. Individuals can have more expensive (i.e., non-basic) coverage plans paid directly to insurers.
    10. Certain individuals would be phased out of the Medicaid program, via participation in their state's HHA.


    The Bill was introduced in 2007 and 2009 but never went anywhere. Why? Bob Bennett told me that in 2009 the Obama White House health care lobbyists came to him and said the White House liked the Wyden-Bennett bill and wanted to get behind it, but that as a condition to White House support Bennett and Wyden needed to add the "public option" to the bill. The public option was the addition of a government-backed insurance company to compete with the private companies and keep them honest. Bennett told the White House people that he could not do that because he would lose all his GOP co-sponsors and would have to withdraw his own support for his own bill. The White House went elsewhere and Obamacare became the legislative vehicle of choice. The public option was removed from the final Obamacare bill anyway in order to get the 60 votes needed to pass it filibuster-proof.

    So we see how history can turn on details, and that lovers of law or sausage should never know how either is made. We also see that there was at least one bipartisan option, one that would have made people angry on both ideological sides of the issue -- in other words, a true compromise, which IMO is the only way we will ever get decent health care reform that mostly works. To say that the mean old Republicans refused to play ball with Obama on health care is simply false.

    "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

  15. #255
    That would have been great. Having a Public Option underpinning the entire thing is terribly missed by the ACA. If anybody could sign up for Medicare, and if Medicare was allowed to negotiate drug prices the way the VA can, then we would be a big step toward actually giving universal healthcare to everybody. Medicare as the biggest health org should have the strongest negotiating power, but their power to control costs is limited by statute.

    As it is now, individual States can refuse to join the exchanges, individual insurance companies can then pull out of the exchanges (or ACA all together), and everybody is left with increasing prices for diminishing services.

    The Bennett bill sounds like a reasonable compromise, and it would have been perfect with a public option for those who chose it.

    Looking back, Obama should have taken his veto-proof majority and forced through something with the public option. Instead we are going to undergo several more years of uncertainty and chaos in the system while a new set of winners and losers are chosen.

    As an aside, my dad spent many decades complaining about and cursing Medicare from the provider side. He signed up for Medicare a while back, and ironically as a patient he loves it.

  16. #256
    Sam the Sheepdog LA Ute's Avatar
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    The health care debate thread.

    Quote Originally Posted by NorthwestUteFan View Post
    That would have been great. Having a Public Option underpinning the entire thing is terribly missed by the ACA. If anybody could sign up for Medicare, and if Medicare was allowed to negotiate drug prices the way the VA can, then we would be a big step toward actually giving universal healthcare to everybody. Medicare as the biggest health org should have the strongest negotiating power, but their power to control costs is limited by statute.

    As it is now, individual States can refuse to join the exchanges, individual insurance companies can then pull out of the exchanges (or ACA all together), and everybody is left with increasing prices for diminishing services.

    The Bennett bill sounds like a reasonable compromise, and it would have been perfect with a public option for those who chose it.

    Looking back, Obama should have taken his veto-proof majority and forced through something with the public option. Instead we are going to undergo several more years of uncertainty and chaos in the system while a new set of winners and losers are chosen.

    As an aside, my dad spent many decades complaining about and cursing Medicare from the provider side. He signed up for Medicare a while back, and ironically as a patient he loves it.
    The public option is very controversial. The Democrats could not get their 60 senators to vote for it. It seems that even the Obama administration knew it would never pass, but they had to try because Obama had promised the public option to the unions and others during the 2008 campaign. Apart from left-wing commies like you - - most people see the problems a public option would create for the insurance markets.

    It would be an act of real statesmanship for both the Republicans and the Democrats if they can agree on some kind of compromise. Question is whether the extreme bases on both sides will allow that.


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    Last edited by LA Ute; 12-28-2016 at 02:46 PM.

    "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

  17. #257
    Sam the Sheepdog LA Ute's Avatar
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    From Megan McArdle, a smart, moderately conservative writer on economics.

    Obamacare Didn’t Fail Because It’s Timid

    https://www.bloomberg.com/view/artic...use-it-s-timid


    Sent from my iPhone using Tapatalk

    "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

  18. #258
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    Prediction time: will the GOP repeal Obamacare without having something to replace it with?

    My prediction is: no.

    They don't want to be on the hook for providing a solution and don't want to take away the healthcare of 20m Americans.

    By leaving it intact, they get to continue to blame Obama for all our healthcare cost problems.


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  19. #259
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by U-Ute View Post
    Prediction time: will the GOP repeal Obamacare without having something to replace it with?

    My prediction is: no.

    They don't want to be on the hook for providing a solution and don't want to take away the healthcare of 20m Americans.

    By leaving it intact, they get to continue to blame Obama for all our healthcare cost problems.


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    The problem is, they can't just flip a switch and end the current law with an immediate replacement in place. It's too complex. To succeed they need to do something bipartisan. That'll require a few members to be willing to be "primaried" by their own party.


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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

  20. #260
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    Trump is revealing a few details about his healthcare reform effort.

    https://www.washingtonpost.com/polit...=.b4afd1acbed6

    His plan doesn't necessarily dovetail with what Republicans are saying, but the details are still sketchy. But it gives me a little hope that they'll actually come up with a real plan.

  21. #261
    Quote Originally Posted by U-Ute View Post
    Trump is revealing a few details about his healthcare reform effort.

    https://www.washingtonpost.com/polit...=.b4afd1acbed6

    His plan doesn't necessarily dovetail with what Republicans are saying, but the details are still sketchy. But it gives me a little hope that they'll actually come up with a real plan.
    How crazy would it be if he tells the Republicans in Congress the only bill he will sign is one providing a single-payer option (for those who choose it), with government price negotiation for drugs/devices/services? He has in the past spoken approvingly about the systems in Scotland and Sweden.

    Something that far out of left field out of DC would simply be 'Tuesday' for DJT.

  22. #262
    Administrator U-Ute's Avatar
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    "Yeah, he didn't mean that." - the GOP says about Trump's statement that the replacement will cover everyone.

    https://politicalwire.com/2017/01/17...e-health-care/

    President-elect Donald Trump “promised insurance for everyone this weekend, but Senate Republicans say they are operating under the assumption that Trump meant to say access to insurance for everyone,” BuzzFeed reports.

    “The vow clashes with all of the major Obamacare replacement plans put forward by Republicans, which prioritize choice over universality. But some Republicans in the Senate say they are working on repealing and replacing Obamacare under the belief that Trump misspoke.”

  23. #263
    I bet he can be talked into going to universal coverage if his inner thigh gets properly massaged.

  24. #264
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    Quote Originally Posted by NorthwestUteFan View Post
    I bet he can be talked into going to universal coverage if his inner thigh gets properly massaged.
    That was an image I didn't need right after lunch.

    My inner-eye is burning now.

  25. #265
    Healthcare can't be fixed. There is no solution. Nothing that is a quarter of the economy is fixable. Certain aspects and components can be manipulated and improved/worsened but it's too big, too intrinsically complicated, and too far reaching to fix. The worst part is all the money that is wasted trying to change models every time the political winds change. ACA is not good, but it's replacement will not be better, and repeal/change is just going to increase costs as the payment/reimbursement models change yet again.

    It's all talk because it's completely inaccessible. The only real change that is happening is that smaller independent insurers and independent providers are getting squeezed out in favor of consolidation. Brand name medical centers are starting to franchise, and your Hospital of the future is likely to be a Mayo or MD Anderson franchise in the same way your hotel is a Hilton or Marriot.

    Once the the number of players is substantially reduced and the complexity of interactions and transactions is reduced, then there will be some meaningful changes. Until then, mostly talk.

    that's my take anyway.
    Last edited by jrj84105; 01-18-2017 at 05:47 PM.

  26. #266
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by jrj84105 View Post
    Healthcare can't be fixed. There is no solution. Nothing that is a quarter of the economy is fixable. Certain aspects and components can be manipulated and improved/worsened but it's too big, too intrinsically complicated, and too far reaching to fix. The worst part is all the money that is wasted trying to change models every time the political winds change. ACA is not good, but it's replacement will not be better, and repeal/change is just going to increase costs as the payment/reimbursement models change yet again.

    It's all talk because it's completely inaccessible. The only real change that is happening is that smaller independent insurers and independent providers are getting squeezed out in favor of consolidation. Brand name medical centers are starting to franchise, and your Hospital of the future is likely to be a Mayo or MD Anderson franchise in the same way your hotel is a Hilton or Marriot.

    Once the the number of players is substantially reduced and the complexity of interactions and transactions is reduced, then there will be some meaningful changes. Until then, mostly talk.

    that's my take anyway.
    You make an excellent point. To me the issue is the definition of "fixed." If that word means universal coverage with low premiums, low deductibles, and high quality, then yes, health care is impossible to fix. It's all about expectations, which are stratospheric in the USA. Politicians don't tell people the truth and people don't want to hear the truth.

    "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. #267
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    Quote Originally Posted by LA Ute View Post
    You make an excellent point. To me the issue is the definition of "fixed." If that word means universal coverage with low premiums, low deductibles, and high quality, then yes, health care is impossible to fix. It's all about expectations, which are stratospheric in the USA. Politicians don't tell people the truth and people don't want to hear the truth.
    True. While "healthcare" may not be able to be fixed because of the subjectivity of it all, one thing that can be fixed is the "healthcare market". That's what really needs to be fixed.

    Anyone who knows and remembers ColoUte should follow him on Twitter (@ColoUte). He has some amazing insights since he works in the industry. Plus he still drops bombs about the Utes every once in a while.

  28. #268
    Quote Originally Posted by LA Ute View Post
    You make an excellent point. To me the issue is the definition of "fixed." If that word means universal coverage with low premiums, low deductibles, and high quality, then yes, health care is impossible to fix. It's all about expectations, which are stratospheric in the USA. Politicians don't tell people the truth and people don't want to hear the truth.
    It would be nice if we could decide whether health care, like education, is a benefit to society that should be provided to all, including the least among us. If we decide that it should (I happen to believe so), then how do we go about it. If it is decided that it is something that you should only get if you pay for it, then be up front about it.

  29. #269
    Quote Originally Posted by jrj84105 View Post
    Healthcare can't be fixed. There is no solution.
    I agree, and it goes beyond insurance. Complete complicated mess. Regular doctors (not surgeons) can make more than half a million dollars per year.

    I do think it's amusing how news folks are suddenly trying to pretend that Obamacare was a complete success.

  30. #270
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    Quote Originally Posted by sancho View Post
    I agree, and it goes beyond insurance. Complete complicated mess. Regular doctors (not surgeons) can make more than half a million dollars per year.

    I do think it's amusing how news folks are suddenly trying to pretend that Obamacare was a complete success.

    While it wasn't a complete success, it wasn't a complete failure either.

    Frankly, I'm just happy something happened because it was better than not doing anything. It was a forcing function to explore what the right answer is.

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