"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
"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
John Kasich: End the Partisan Warfare on Health Care
https://mobile.nytimes.com/2017/03/1...m.facebook.com
He's right.
"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
This is from the conservative National Review and discusses some unpleasant facts about the yawning gap between what people want, on the one hand, and recognition of what it all costs, on the other.
*****
The Congressional Budget Office Is Very ‘In’ Right Now
If you want health-care reform to cost the U.S. government less than the status quo, that requires less money to go out the door to pay for other people’s health care and/or health insurance. This means someone else has to pay more, or someone else has to pay for their care or insurance entirely by themselves.
This is the core conflict of all health-care debates. Some pleasant-sounding voices claim they can get “somebody else” to pay for your health care, and imply that it is free to you. The cost is actually spread to everyone, which results in either higher spending by the government (and at some point, higher taxes or higher borrowing) or higher premiums by everyone who did purchase insurance. For the vast majority of us, you’re going to pay one way or another. Pick your poison: premium, co-pay, deductible, or tax penalty for not having insurance.
Everybody screaming “Medicaid for all!” basically means, “I don’t want to pay anything for my health care.” They think of themselves as being generous.
The “Medicaid for all” crowd also usually hand-waves away the fact that a lot of doctors don’t take Medicaid. As of 2015, only 67 percent of doctors take Medicaid, and only 45 percent of doctors take new patients on Medicaid. The “Medicaid for all” fans usually answer that this can be resolved by forcing doctors to see Medicaid patients, even if they don’t like the limited reimbursement rates.
There’s also the inconvenient fact that the best study we have shows that Medicaid doesn’t
actually improve people’s health. It makes them feel better by self-reported measures, and less financially stressed. But it also had “no statistically significant effects on blood pressure, cholesterol, or cardiovascular risk” and “found no evidence that Medicaid caused new enrollees to substitute office visits for [emergency room] visits; if anything, Medicaid made them more likely to use both.”
Yesterday’s big news was the Congressional Budget Office studying the text of the Republican health-care plan, the “American Health Care Act,” and concluding that it would reduce federal deficits by $337 billion over the next ten years, but also that in the coming ten years, 24 million people would join the ranks of the uninsured.
Our Dan McLaughlin:
The whole thing is a silly system, given that CBO scores are thus classic “Washington facts” that have power totally unrelated to whether or not they are accurate. The CBO has been wrong every time in the past it has tried to project the number of people with health insurance, including being off by 24 million people when it updated its projections after the Supreme Court struck the mandatory nature of its Medicaid expansion in 2012. But rules are rules even if they require you to declare that the sun’s not yellow, it’s chicken. The projections of who will and won’t be insured don’t actually mean anything. But the projections of deficit reduction mean a lot, whether or not they are accurate – because they give the bill the procedural green light to go forward.
Avik Roy goes back and checks the numbers:
In 2010, when the Affordable Care Act was passed, CBO estimated that 21 million people would enroll in the ACA exchanges in 2016. The actual number was closer to 10 million. Even now, CBO believes that 18 to 19 million people will soon be enrolled in the exchanges, when in fact enrollment is degrading under current law, and will likely end up stabilizing at about 10 to 11 million.
Roy has offered his share of criticism of the bill, but he gives it credit for including “the most significant effort at entitlement reform in American history” and “reduc[ing] federal spending by more than $2 trillion over the next 20 years.”
I think Megan McArdle may have the most politically sound approach, which is to try to pass a set of reforms but fail, and have Democratic obstructionism as a convenient excuse for everything that follows:
I foresee two potential futures for the current status quo. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance. Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.
In either case, the Republicans’ best option is to wait. Why? Because what they can do now -- hastily, without touching the underlying regulations that have destabilized the individual market -- is worse than either of those outcomes. The partial-reform structure they think they’ll be able to get through the Senate is likely to make the problems in the individual market worse, not better. And the fact that they’ve tinkered with the program means that Republicans will take 100 percent of the blame.
So I’d wait to see if the long-feared disaster comes at the end of this year, and if it does I’d make sure that Democrats own as much of the blame as possible. If they want to block reform, make sure the public knows they did: Throw up a comprehensive bill that they can filibuster. Appoint a blue-ribbon commission to come up with a unified Republican plan. Stop the funding games the Democrats were using to prop up the exchanges. And if the exchanges collapse, say to the public: “Hey, look, we didn’t touch the individual market. It was the garbage program Democrats rammed down your throats. We tried to save it, but they wouldn’t let us.”
The Republican focus then becomes what kind of reforms will create affordable insurance options for people when the exchanges collapse and no insurance company is willing to sell insurance on them, because too many of the remaining patients are sick and not enough customers are healthy.
http://link.nationalreview.com/click...baab1B9c9b9137
*****
Ugh.
Last edited by LA Ute; 03-14-2017 at 10:41 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
Last edited by pangloss; 03-14-2017 at 11:51 AM.
"It isn't what we don't know that gives us trouble, it's what we know that ain't so"
- Will Rogers
"Cyberspace is - or can be - a good, friendly and egalitarian place to meet. "
- Douglas Adams
When the ACA was passed it included the expansion of Medicaid to the near-poverty segment of the population nation-wide. The CBO estimates assumed expansion to every state. When the Supreme Court shot that down and let the states choose, it caused a great many people to go without. Nineteen states didn't expand. Conservatively, about 680,000 people in Texas and 460,000 in Florida would have been covered. That does not explain the entire difference, but it's a lot of it.
And just to remember, the ACA made a dramatic impact on the number of our fellow citizens without insurance. Personally, I think it is outrageous that anyone in the US should have to go broke to get well (paraphrasing Pres. Ford)
7451-12-figure-2.png
Last edited by pangloss; 03-14-2017 at 11:50 AM.
"It isn't what we don't know that gives us trouble, it's what we know that ain't so"
- Will Rogers
"Cyberspace is - or can be - a good, friendly and egalitarian place to meet. "
- Douglas Adams
So LA, you probably have forgotten more about this subject than any of us know (if I understand your expertise correctly). In your perfect world, right now as things are, what would you do and/or what would you change? So in other words, if you could do anything you want towards the goal of making healthcare more affordable and also accessible to everyone. It could be "trash ACA completely and go back to the way we were" all the way to "Keep ACA with some minor tweaks."
I hope I'm making sense in what I'm asking - and yes I know it is a broad subject, so maybe top 2 or 3 things you'd do.
By far the biggest problem with health care is that only insurance companies want to address the costs of services. My daughter just had a minor surgery. Total charges were 43k... after insurance adjustments 19k. Her surgery was 2 hours she stayed a night in the hospital. The doc who did the surgery made 1000 per hour.
Until we address as a country provider costs the access stuff ain't going to matter
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"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
You didn't ask me but I'm some what knowledgeable in this arena. What I would do is this:
1. Children are completely covered. Providers paid at 80% of current Medicare rates.
2. Everyone 19 and older has high deductible plan of say 6k and 10% co- insurance till 10k. this includes free preventive visits and after you reach your deductible providers are paid 80% of the current Medicare fees.
3. We let the states decide on how to help the seniors or indigent in their state
4. No income limit on Medicare tax. Employees match double their employees amount.
5. Restaurants get a 10% national sales tax
6. Gasoline gets a 10 cent national tax
7. We give a $500 credit towards your deductible if you belong too a gym/run club etc.. or can prove you worked with a dietician
8. Every adult can put tax free into a hsa up to $6,400 per year.
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Last edited by Mormon Red Death; 03-14-2017 at 01:13 PM.
"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
You should've received two bills: one from the doctor and one from the hospital.
My guess is the doctor's bill isn't that outrageous. My experience is that the hospital's bill is the majority of that cost and if you look at the itemized list, the time spent in the surgical room cost is far and away the highest. Although all of their items are overpriced by 2x-4x the OTC cost.
That's been my experience anyway.
I was including both professional and facility in my analysis. The facility was paid on a drg basis (one payment for all facility services). The professionals: surgeon and anethsiologist were paid based on fee schedule. The surgeon received a little over 2k for his services. The procedure took about 2 hours
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Last edited by Mormon Red Death; 03-14-2017 at 01:30 PM.
"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
FiveThirtyEight breaks down the CBO and the AHCA.
https://fivethirtyeight.com/features...-the-cbo-says/
This was my experience as well, similar situation (minor surgery, overnight stay). On top of that it took them (meaning the hospital, providers and insurance) with me on the phone for 27 hours (yes I timed it) a full year to sort out all of the billing related to it.
Excellent suggestions above by the way.
They should have passed this when they had the chance:
https://en.m.wikipedia.org/wiki/Healthy_Americans_Act
It was sponsored by Ron Wyden (liberal Democrat) and Bob Bennett (not-conservative-enough-for-Utah Republican). It had broad bipartisan support. It was aborted by the sausage-making machine in 2009 and we got the ACA instead.
Last edited by LA Ute; 03-14-2017 at 07:47 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
I'm 100% convinced our politicians, left and right, have their hands too deep in their lobbyist's pockets to ever make real change.
None of them have the balls to do what is right.
Here is my idea, and it is what Germany does:
Everyone making $72,000 or less is covered by a "sick fund". 100%.
If you make over $72,000, you can opt out and go get private insurance. There is no "for profit" insurance. If you opt out of the public option, there are still "fees" you need to pay into the system. You are a part of the country, you benefit more than most (especially the more you make. The more you make, the more you benefit from public benefits, you should not be getting so much corporate welfare. It's a joke here).
You pay 15% into the sick fund of your income...kind of. You pay about 7%, your employer pays the rest.
The fees are negotiated between the government and the physicians groups.
Done. Simple, easy, affordable.
Will never happen because insurance companies make WAAAAYY too much money right now.
Go look at the boards of the AMA, ADA, etc. They are all ex-insurance people.
I lifted this off jazzfanz:
We Americans have been so duped by fear and rhetoric from insurance companies and the uber rich when it comes to healthcare that we have no clue how poor our healthcare delivery is compared to everyone else. We think our system is good.Originally Posted by LogGrad98
We made extensive use of the German medical system. My son had some problems due to his epilepsy and they discovered my wife has hip dysplasia and probably has since birth.
The funny thing about that was in the states she has gone to at least a dozen doctors including specialists about her constant hip pain. They invariably tell her to lose weight and don't really do anything else, besides prescribe drugs for the pain, which she really does not tolerate well. In germany she brought it up again because their beds SUCK SUCK SUCK there (everything is a solid foam mattress unless you want to spend 3k euros), and the pain was getting much worse, and her doctor immediately sent her to a specialist. He ordered an MRI, which we scheduled for 2 weeks later, which would have likely been the case in the US too. She went in for the MRI and they decided to do a few more tests after they reviewed the results. It came back as hip dysplasia and they immediately started her on physical therapy. She went to PT for 3 months twice a week, and her pain was greatly diminished.
So we come back to the states. She has now been to 3 different doctors here trying to get her hip dysplasia treated. First, they didn't want to do the testing and told her, again, to lose weight (yeah she has weight to lose, but not some 600 pound life kind of thing, good hell). Finally they ordered an MRI. Then they wanted to do physical therapy but our insurance told us they would only cover it if the doctor said it was debilitating. It isn't, so they refused. We appealed and they approved 10 visits total. They also denied a request for surgery since it isn't full-on debilitating. The fight with now 2 different insurance companies has taken the better part of a year and she is back to taking medication for the pain instead of getting help for it.
The kicker? In Germany they just did what the doctor recommended. The total cost of her visits and tests and treatments, out of pocket anyway, was just under 500 euros, which included in the end 2 MRI, an overnight stay in the hospital for observation and another kind of sleep test, as well as some minor medication and full PT for 3 months. Here she hasn't received ANY treatment yet, other than drugs, and it has cost us over $3000 just for the insurance to say they won't pay for the treatment that we already know will work (gotta pay that mother****ing deductible first, right?), so we are looking at another $1000 for PT as we negotiated that with the PT provider ourselves since we pay it out of pocket. That is for an anticipated 6 months of treatment, once or twice a week as needed. A decent rate really for that many visits, but all on our own dime.
Verdict? Absolute ridiculous *********.
If we really knew what it was like in other countries, we'd revolt. That's how bad we are being screwed over.
Not completely, but I have to largely agree. I've had way, way too many reports of people in different countries getting pretty darn good care, definitely not what the stereotype we're fed would predict.
But the US is going to struggle with healthcare, regardless, for two big reasons:
1. We're hopelessly divided. The GOP itself is divided. We're politically paralyzed, in no position to do something as big as comprehensive healthcare reform. Any proposal - or even limited insurance reform, like ACA - can be attacked from multiple angles.
2. Americans have very, very high rates of unhealthy lifestyles. Forget booze and drugs (which are significant issues), our addiction to comfort food and the couch is killing us, and driving healthcare costs through the roof, regardless of what kind of system we had.
ACA stood no chance, because it's based on private insurers - who in a market model, fight each other for healthy customers and try to shed unhealthy customers - and because a lot of our healthcare problems are based on stress, economic anxiety, etc.
Situations like this don't help in us trying to find a solution.
fv5lnghpbhly.jpg
I'm going off topic here, but I saw in the Tribune today that Utah has a physician shortage and rank at the bottom of the US in # of Dr's per capita. Yet, Utah has drastically underpaid their Dr's for a long, long time.
Why is this? Do we have enough Dr's or not enough? Why are the Dr's getting paid so little here?
I think there are many factors that make our system so different from that of Western Europe. A big part of that is the public's expectations. A good friend of mine is general counsel to a large health care system and knows the American health care system very well. She is married to a Frenchman and recently spent a year there with her husband and two young daughters. (They have a house in the country where they spend a month every year.) She says the French health care system is excellent. Coverage is universal, costs are very low, the hospitals are excellent. I asked her why she thought that was so, and she responded that pharmaceutical prices are strictly controlled; physicians are satisfied with much lower incomes than in America (but most French people do too -- the cost of many things is subsidized; all education is free, including college; retirement pensions are universal; everyone takes a month off every year; they have nothing comparable to our medical malpractice $$$ lottery; and so forth). All of that would be impossible to duplicate here, at least for another generation or two.
"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
It'sbecaus
It's because in the US, medicine is a HUGE profit center. The profit margins on medicine are disgusting.
Elsewhere, most medicine is run as a non profit.
I'm ok with Dr's making a large amount of money. What's crazy is when Dr's are making millions off treating patients. That's a little messed up. And the corps see the Dr's making millions and they step in, grow the costs, and they in turn make millions.
It's crazy.
This column encapsulates the current turn in the healthcare debate: https://www.washingtonpost.com/posteverything/wp/2017/03/17/should-healthy-people-have-to-pay-for-chronic-illnesses/?tid=pm_opinions_pop&utm_term=.24
Here's the fascinating part of making the sick pay for their chronic illnesses: It's the less religious liberals who see it being moral to ease the burden of the less fortunate, chronically ill.
Christian conservatives are more inline with Darwinism.
Right after Hillarycare was vanquished, I went to Toronto for a week for some Unix sysadmin training. I was the only American in the class, and being the debating type, asked my classmates what they thought of their healthcare system. At the time I was working for IHC (now Intermountain) and based on everything I'd heard, I expected them to have a litany of complaints. Their responses surprised me.
They were very honest, but in general, they were pretty satisfied, and were happy to pay higher taxes to get pretty high quality care. They also said they felt it was important to make sure other members of society were getting taken care of, too. At the time, there was a scandal in Ontario province about poor Americans sneaking over from Buffalo, New York and getting the health security cards that enabled them to get healthcare.
"Why don't you Americans take care of your own?" It wasn't a snarky comeback to my question, but a serious curiosity. They pointed out the donation jars at convenience stores for expensive treatment for children as something else they just can't fathom. I really didn't have an answer. (I wasn't going to embarrass myself by citing "freedom" as the reason.)
About the low pharmaceutical costs in Canada, Europe, and other single payer or socialized systems - it's long been thought in the US healthcare industry that Americans essentially subsidize a big chunk of the R&D costs because these nations negotiate drug prices at a fraction of ours, but when more money is spent on marketing than on R&D, that argument loses steam.
"We need to pay Big Pharma a lot of money so they can attract the talent that creates new medications." Also partially true, but also a fair amount of sheer bullshit. Two nations that are doing some impressive research and cancer treatment development reveal this idea as mostly fiction: The UK, which is the poster child for western healthcare systems spending very little GDP on healthcare, and Cuba. You read that correctly - little, backward, fundamentally screwed up Cuba has cancer clinical trials going on within the United States. Everything we've been taught over the decades suggests this is an impossibility... but it's true.
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?
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"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