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Started by Sal1981, January 28, 2020, 09:04:46 PM

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Hydra009

#1110
Quote from: GSOgymrat on April 13, 2020, 01:51:25 PM
A fee that is easily paid by the patient. I have no problem with partially funding a universal healthcare system with progressive fees based on the patient's income.
To add to that,  I would argue that healthcare costs that are beyond the patient's ability to pay without incurring massive debt (debt unlikely to ever get paid off) or results in medical bankruptcy are pretty clearly NOT affordable.

So is anything less than that affordable?  Is 50% of annual income too much?  How about 30%?  How about 20%?  I'm not an expert on this stuff, so I did some digging.  Afaik, the formal definition of affordable healthcare is less than or equal 8% of the individual's household income.  That seems like a reasonable definition to me.

So if someone's pulling down $50,000 a year and their insulin costs $360 a month ($4320 a year), that's 8.63% - just over the 8% threshold.  So that's unaffordable by the above definition and the government absolutely should examine how and why those prices are so high.  Btw, that above figure is not a hypothetical for a lot of Americans.

GSOgymrat

Quote from: Hydra009 on April 13, 2020, 02:21:02 PM
To add to that,  I would argue that healthcare costs that are beyond the patient's ability to pay without incurring massive debt (debt unlikely to ever get paid off) or results in medical bankruptcy are pretty clearly NOT affordable.

So is anything less than that affordable?  Is 50% of annual income too much?  How about 30%?  How about 20%?  I'm not an expert on this stuff, so I did some digging.  Afaik, the formal definition of affordable healthcare is less than or equal 8% of the individual's household income.  That seems like a reasonable definition to me.

So if someone's pulling down $50,000 a year and their insulin costs $360 a month ($4320 a year), that's 8.63% - just over the 8% threshold.  So that's unaffordable by the above definition and the government absolutely should examine how and why those prices are so high.  Btw, that above figure is not a hypothetical for a lot of Americans.

I think fees should be used not simply to fund healthcare but strategically to maximize the appropriate use of the system and promote good healthcare outcomes. A fee shouldn't be charged for maintenance medications, such as insulin, because it is in everyone's interest that people with diabetes, heart disease and other chronic medical conditions take their medications to avoid costly or debilitating complications. Similarly, medications to prevent transmission of disease, such as PrEP, should be free. Personally, I think 8.63% is too high-- my out-of-pocket maximum for my employer-based insurance is 3.5% of my income.

Hydra009

Subsidizing maintenance/preventative medications sounds like a dream come true.  It's such a shame that in this political climate (a climate subsidized in part by giant insurance and medical corps) that's basically impossible.  Think of all the lives that could be saved and rescue medical fees that could be avoided that way.  But that doesn't jive with the current business model, so that sort of thinking must be wrong.

As an aside, does anyone worry about the moral implications of one socioeconomic group essentially controlling the fees that another socioeconomic group has to pay?  In the wrong hands...

Baruch

Quote from: Hydra009 on April 13, 2020, 12:36:38 PM
It's probably coincidental that the most in need are usually poor people and/or minorities.

If it was mostly White males you would tell them to go to hell, right? (sarc).  Identity politics is all about creating electoral plantations ... per Dems.

We can all be equal, if we are all poor.  You can't make us all rich.  And BTW, we are all ultimately from Africa, so let me start speaking in Ebonics ...
Ha’át’íísh baa naniná?
Azee’ Å,a’ish nanídį́į́h?
Táadoo ánít’iní.
What are you doing?
Are you taking any medications?
Don't do that.

Baruch

#1114
Quote from: Hydra009 on April 13, 2020, 02:21:02 PM
To add to that,  I would argue that healthcare costs that are beyond the patient's ability to pay without incurring massive debt (debt unlikely to ever get paid off) or results in medical bankruptcy are pretty clearly NOT affordable.

So is anything less than that affordable?  Is 50% of annual income too much?  How about 30%?  How about 20%?  I'm not an expert on this stuff, so I did some digging.  Afaik, the formal definition of affordable healthcare is less than or equal 8% of the individual's household income.  That seems like a reasonable definition to me.

So if someone's pulling down $50,000 a year and their insulin costs $360 a month ($4320 a year), that's 8.63% - just over the 8% threshold.  So that's unaffordable by the above definition and the government absolutely should examine how and why those prices are so high.  Btw, that above figure is not a hypothetical for a lot of Americans.

That is why medical insurance exists, to cover catastrophic medical events.  Not to cover your usual medical appointments and pharmacy orders.  But even for catastrophic medical events, it doesn't work out mathematically (as insurance, see actuarial table).  With life insurance, you can't claim it twice.  With medical insurance, you can claim it again and again.  If you could do that with life insurance, it would fail immediately (or you gave cheap life insurance to sick and injured and elderly who are one day away from kicking the bucket).

If you want a nationalized system, it will either only cover catastrophic events, or will be very expensive .. unless you ration care to keep out the hypochondriacs and the self-abuse people (just about everyone).  Of course, you can limit costs by nationalizing the medical industry, drafting all the doctors and nurses into the Public Health army (they do have their own uniform).  And we need to establish mandatory control of diet and exercise on the whole population.  No more jelly donuts for you, comrade!

Power comes from the barrel of a gun, or at the point of a bayonet.  Right now, i don't have life insurance or medical insurance (until Medicare next January).  I would want all the wealthy media people in California to pay for me, but I don't think Hollywood will respond except by bad singing of a John Lennon dream sequence.
Ha’át’íísh baa naniná?
Azee’ Å,a’ish nanídį́į́h?
Táadoo ánít’iní.
What are you doing?
Are you taking any medications?
Don't do that.

GSOgymrat

Quote from: Hydra009 on April 13, 2020, 03:23:12 PM
Subsidizing maintenance/preventative medications sounds like a dream come true.  It's such a shame that in this political climate (a climate subsidized in part by giant insurance and medical corps) that's basically impossible.  Think of all the lives that could be saved and rescue medical fees that could be avoided that way.  But that doesn't jive with the current business model, so that sort of thinking must be wrong.

Good managed care companies give maintenance medications for free or very low cost. For example, my HIV medication, Biktarvy, costs $3000 a month. My insurance company required me to schedule an in-person appointment with a pharmacist to discuss the importance of taking this medication. After the appointment, the medication was free and not subject to the usual medication copay. My insurance company also reduces my fees if I do things like take an online health inventory and have an annual physical, which is free. They aren't doing this out of the goodness of their hearts but because they know preventative medicine saves money.

Quote from: Hydra009 on April 13, 2020, 03:23:12 PM
As an aside, does anyone worry about the moral implications of one socioeconomic group essentially controlling the fees that another socioeconomic group has to pay?  In the wrong hands...

Right now the wealthy have unfair influence in determining what taxes and fees everyone pays. I have no problem with limiting the influence of the wealthy through government regulation or progressive taxation. I don't consider flat taxes equitable and I don't believe in corporate personhood, despite the US Supreme Court ruling.

Baruch

#1116
Yes, unfortunately, some medications are genuinely very expensive (not per Mr Skreli).  Either some insurance policy covers that (and only because so few people need that medication) or you have to get Joe Taxpayer to pay on your behalf.  Private insurance is self funded, not public funded.  Where ACA goes wrong is it mixes those two up (to bail out the insurance companies I recall ... not to bail out patients).  That is why deductibles and monthlies for ACA went up and up, and in many districts there is only one ACA provider (called a government supported monopoly).

It isn't magic that makes expensive things cheap, you have to have a new process that is less complicated than the old one, to achieve real savings.  Back in the day, natural fertilizer came from harvesting bird guano from an island off of Chile.  This couldn't continue during WW I (for Germany at least) so Germany came up with a way of making artificial fertilizer.  This is so important, like 2% of all electricity world wide is used to make fertilizer.  All the rest is used to mine Bitcoin ;-)

Life is unfair?  Wahh.  Go complain to Kissinger and Gates.

https://www.youtube.com/watch?v=GBkT19uH2RQ

Humans medically are very close to lab mice.  The 1% are The Brain, and the 99% are Pinky ;-)  The 1% are different from you and I ... same as King Louis XIV was different from a back street boulangier.
Ha’át’íísh baa naniná?
Azee’ Å,a’ish nanídį́į́h?
Táadoo ánít’iní.
What are you doing?
Are you taking any medications?
Don't do that.

Baruch

"Morgan Stanley Publishes Full Timeline Of Upcoming Coronavirus Milestones; Sees Second Coronavirus Peak In December" ... if they know it this well, what is the plan to begin with?

"Governors Defy Trump By Releasing Regional Plans To Reopen Economy: Live Updates" ... Governors don't work for the President.  Governors who handle Covid well will get reelected, otherwise they won't.

""Perilously Close To Meat Shortfalls": World's Largest Pork Producer Shutters Key Factory After COVID-19 Outbreak" ... hmmm, China had to slaughter half of their pigs last summer, because of swine ebola ...

"Largest US Study Of COVID-19 Admissions Reveals Single Biggest Factor In Hospitalization" ... US people have been fat self abusing shits for decades

"China Obstructs Hunt For COVID-19 Cure By Canceling "Promising" Gilead Study" ... very strange, almost as if they don't want a cure ...

"IRS Deposits First Batch Of Coronavirus Stimulus Payments To Broke Americans" ... come to Papa, by Friday?
Ha’át’íísh baa naniná?
Azee’ Å,a’ish nanídį́į́h?
Táadoo ánít’iní.
What are you doing?
Are you taking any medications?
Don't do that.

Baruch

"Coronavirus has 'reactivated' in more than 100 South Koreans who recovered" ... experts say ... getting this a second time, after having extensive lung damage and auto-immune triggering, is more fatal ;-(
Ha’át’íísh baa naniná?
Azee’ Å,a’ish nanídį́į́h?
Táadoo ánít’iní.
What are you doing?
Are you taking any medications?
Don't do that.

PopeyesPappy

Quote from: GSOgymrat on April 13, 2020, 01:51:25 PM
A fee that is easily paid by the patient. I have no problem with partially funding a universal healthcare system with progressive fees based on the patient's income. Preventative medicine should be at no cost to everyone and there should be out-of-pocket maximums but I think fee-for-service could reduce taxes and encourage people to access care properly. For example, charging a fee if someone comes to the emergency department with a head cold rather than contacting their primary care physician or accessing telehealth would free up emergency department staff to treat actual emergencies. Universal healthcare can certainly be funded by entirely taxes but charging affordable fees can be useful. I'm open to different strategies.

Healthcare in the US is not affordable. Period. It costs too much. We can't have universal coverage until it becomes affordable. Rich people don't have enough money to fund universal care at it's current costs, and it would take a bigger piece of the middle class's income than we can afford. It would make us poor. Defunding the military, and getting rid of insurance and drug manufacturer, hospital profits wouldn't be enough even with huge tax increases. I've done the math. Uncle Joe and Bernie can promise it all they want. The rest of us can talk about how nice it would be. But everybody can't have it until it costs less.

Other countries do it doesn't address the problem. Other countries don't spend nearly as much on healthcare per person as the US, and all their people are covered. They can have it because their healthcare costs less than ours does. We can't until our costs come down.

How are we going to make that happen?
Save a life. Adopt a Greyhound.

Hydra009

Quote from: PopeyesPappy on April 13, 2020, 07:51:17 PMWe can't have universal coverage until it becomes affordable.
You have it backwards.  The current system is the unaffordable one.

QuoteOther countries don't spend nearly as much on healthcare per person as the US, and all their people are covered.
Weird how they can do it but we can't.

QuoteThey can have it because their healthcare costs less than ours does. We can't until our costs come down.
So, we can't implement a less expensive healthcare system because ours costs too much?  Is that the logic here?  Cause that's absolutely bonkers logic.

Munch

One thing we can certainly say about this event in history, is that it tests the real mantle of whoevers in charge, and what their decisions determine.

Say whatever you like about boris, at least he is repeating the message, stay at home, save the NHS, save lives.

I do feel very sorry for you over in the states, that your president is touting lines like 'staying at home is another kind of death', while thousands are dying and he doesn't have a clue what to do.

This event really does expose people down to their most base level, some are cowards, some are courageous. Some are selfish, some are selfless. Some are smart enough, some are thoughtless.

Just do yourselves a favor, stock up, stay at home, and get into that routine, since it looks like things will get worse before it gets better over there. As someone said in one of the UK covid-19 updates, the virus is rapid to expose, and slow to decline. Its gonna be some time before we can reach 'normal' again.
'Political correctness is fascism pretending to be manners' - George Carlin

Shiranu

#1122
QuoteHow are we going to make that happen?

Even if we kept a private insurance/out of pocket health care system, one single step would make an astronomical difference in our costs; give the government the ability to negotiate prices on medicines. As it stands, lobbyists have set up a system where the pharmaceutical companies are just about literally free to charge what ever they want for their product, which costs the individual paying for them hundreds, thousands of more dollars than the item would cost in other countries... as well as costing the federal government and insurance companies millions upon millions of dollars more.

But as Hydra pointed out, our system is already more expensive than a universal healthcare system anyways; economists, medical experts have all run those numbers and have concluded we pay far more per person as well as the state paying significantly more than it would under a universal program.
"A little science distances you from God, but a lot of science brings you nearer to Him." - Louis Pasteur

GSOgymrat

Quote from: PopeyesPappy on April 13, 2020, 07:51:17 PM
Healthcare in the US is not affordable. Period. It costs too much. We can't have universal coverage until it becomes affordable. Rich people don't have enough money to fund universal care at it's current costs, and it would take a bigger piece of the middle class's income than we can afford. It would make us poor. Defunding the military, and getting rid of insurance and drug manufacturer, hospital profits wouldn't be enough even with huge tax increases. I've done the math. Uncle Joe and Bernie can promise it all they want. The rest of us can talk about how nice it would be. But everybody can't have it until it costs less.

Other countries do it doesn't address the problem. Other countries don't spend nearly as much on healthcare per person as the US, and all their people are covered. They can have it because their healthcare costs less than ours does. We can't until our costs come down.

How are we going to make that happen?

We could have universal healthcare tomorrow. Congress could pass a law saying all healthcare providers must accept and treat patients regardless of their ability to pay or lose their license to practice. Tada! Universal coverage.

But seriously, the US can certainly afford to provide universal healthcare but there are trade-offs and different systems for delivering and funding care. You are correct that healthcare costs in the US are higher than in other countries. One reason is that the cost of treatment is artificially inflated through a net of disorganized programs designed to cover people who can't afford to just write a check to pay for their care, which is almost everyone. There is Medicare, each state has a different version of Medicaid, there are approximately 6000 private insurance companies, there are tax write-offs, community funding, medical trial reimbursement, direct billing, collection agencies, pharmaceutical payment programs... It's insanely inefficient and expensive.

The biggest problem with passing universal healthcare is no one wants to lose their current slice of the pie. Insurance companies, hospitals, clinics, physicians, pharmaceutical companies, medical equipment companies, universities, lobbyists, patients, politicians... Everyone is afraid they will get shafted. So we keep the status quo even though it's expensive and results in poor health outcomes.

PopeyesPappy

Quote from: Hydra009 on April 13, 2020, 09:09:29 PM
You have it backwards.  The current system is the unaffordable one.
Weird how they can do it but we can't.
So, we can't implement a less expensive healthcare system because ours costs too much?  Is that the logic here?  Cause that's absolutely bonkers logic.

No Hydra, I'm sorry but you have it backwards. Other countries spend less than we do because they pay less for services. We can't afford to provide everyone with healthcare until our costs are comparable to theirs. Just implementing a Medicare for all system without making fundamental changes to the way we do business won't get us there.

From the article you linked.

QuoteAdministrative savings from Medicare for All would be about $600 billion a year.

Administrative costs account for about 1/3 of US healthcare spending. In 2019 that would have been about $1.235 trillion dollars. That's $3,770 for each American, and many of us didn't have any healthcare. If we had the total would have gone up not down along with the cost each.

The $600 billion in savings number comes from this study. It assumes medicare for all would cut our administrative costs in half. The first problem with that is they count on most of the savings by reducing/eliminating private insurer overhead. So if we do away with private insurer overhead who is going to process all the paperwork? There is going to be about the same amount of paperwork because we didn't do anything to reduce the paperwork. It's just going to government now instead of to a private insurer. We are still going to need about the same number of people (i.e. overhead) to process it. We didn't get rid of the overhead. We just moved it from industry to the government, and the last time I checked our government can't take a dump efficiently so it isn't going to be any cheaper than industry doing it. The only thing we have accomplished is removed the insurance providers profit margins from the equation. Those margins account for less than 3% of overall costs. $100 billion not $600 billion, and we'll be lucky if we don't lose most of that back by turning the whole thing over to our less than efficient government.

One of the mistakes they are making is assuming the main driver of the US's higher administrative cost is the hospitals having to negotiate with each insurance provider separately. While I'm sure this contributes to our higher administrative costs it isn't the main driver. The main driver of the higher administrative cost in our healthcare system is the way healthcare providers bill for services and compliance with government regulations.

In the US when you go in for a procedure like knee replacement your insurance company/the government gets itemized bills from the hospital, the surgeon, the anesthesiologist, and who knows who else. The hospital bill includes lines for use of the surgery suite, room charges, charges for food, separate charges for changing bandages, charges for the nursing staff, ect... My understanding of the way it works in places like the UK is you get a bill that says "knee replacement surgery: £24,000". In the US it's 3 different bills with a total of forty line items totaling $60,000. It takes forty times the time to process on both payable and receivable end. This is the biggest driver of our higher administrative cost, and we won't start realizing real savings on our administrative costs until we change the way we do paperwork. None of the single provider plans I've seen even mention this. We have to get to that £24,000 point for knee replacement surgery before we can afford knee replacement surgery for everyone. That is going to take a lot more than just changing the system over to single payer. It is going to require making fundamental changes to the way hospitals and the government works before we can get there.

If we don't do that first what do you think is going to happen when the government steps in and tells our healthcare providers they are going reduce their expenses by a few points by cutting out the middleman, but also going to cut their income in half for the same amount of services? Oh and by the way. Volume is going to go up because everyone is going to be coming to you now.


Save a life. Adopt a Greyhound.