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Ok in another attempt to stimulate discussion....

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  • #16
    Re: Ok in another attempt to stimulate discussion....

    We already have a total free market system available to us. It's called cash.

    Many of the elite in LA do NOT have health insurance, and they go to doctors who do NOT have malpractice insurance. It's an entire system of doctors who charge you 60% what it would otherwise cost and you sign all sorts of paperwork releasing the doctors of liability.

    As I understand it, you get fantastic service for the money, including house calls, etc. It is truly the best care money can buy. And money buys it.

    So what do you do if you don't have the $200,000 cash laying around to cover a serious illness or injury?

    You slum it with the rest of the people. And here's where the mess starts.

    Personally, I live above the 50% mark in America. (I'm not bragging, there's a point to this). As a small business owner, I have to buy my own insurance, and I have to buy the best insurance that I can afford. Even at my level of "comfort" I am ridiculously underinsured. In fact, it's $500/month with no outside help from employers or government, and if I go into the hospital, I have to pay $500/day out of pocket. That places me about 3 weeks in the hospital away from having 0 capital. Add to that lost wages (as a small business owner, I don't make money when I'm not working) and I soon won't be able to make my insurance payments.

    Because I am a small business owner and insurance companies will not allow me to "group" with other small business owners to get the best rates from health care providers, everything is much more expensive to boot.

    That's right, being a free-market entrepreneur places me at a severe disadvantage, yet when I talk to Republicans about how unfair the system is, they talk to me like I'm a welfare check cashing crack baby that needs to get a real job. It gets old fast.

    If the wealthiest people were allowed to buy cars for 50% off, there would be an uproar. But if we're talking about chemo, sliding pay scales for the exact same service is fine? Sounds like a scam. That's because it IS a scam.
    “Success is not final, failure is not fatal: it is the courage to continue that counts.” - Winston Churchill

    “If you can't be a good example, then you'll just have to serve as a horrible warning.” - Catherine Aird

    Comment


    • #17
      Re: Ok in another attempt to stimulate discussion....

      Long discussion in a short path:

      there is an amount needed for healthace minus insurance for lawsuits, minus the profit fo the hospitals involved minus the disgusting profits for the pharma industry (no, they are not returning that money into their product, though a seperate discussion, their research delivers patents, the patens deliver way over market(costprice) prices and allow them to make Billions of profit each year, hence they should pay for it themselves and be happy with "less" profit" and yes that also goes for oilcompanies)= a gross national cost for healthcare.

      this on general average will be around 2 - 3 % of the gross national income
      which in turn translates to approx 8 - 10% of the gross income of everyone counted over the first 50K

      I.E: The Dutch model (in depth studied by the former administration in a hope of implementing parts into the American society)
      No not the UK model, that has so many disadvantages (specially the whitecollar criminals running the system and bleeding it dry with yet another study, outdated system of seniority when it comes to "seeing patients" etc) that such a system is doomed anyway but a system where you pay X part of your salary, and the employer pays another part to in total cover that "base" above mentioned, and to those who make more (or are willing to pay for it) leave open insurance so they can "enjoy" shorter waitlists on breast implants, chin-lifts and other non-essential surgery, perhaps in private hospital, single person rooms instead of 4 person rooms etc.

      No need to ask what you make, no need for CC's ad admittance, nothing, you are taken care of, you want extra's, have insurance or pay, the entire cost include GP practise and (if available generic, otherwise branded) medicine.

      Meanwhile forbid the free trips/computers/cars/financing etc of for instance the GP's prescribing certain medicines which cuts the overhead for the pharma industry considerably and you have a sustainable system where no one has to be uncomfortable when sick or go bankrupt after a sporting injury,
      So Long And Thanks For All The Fish.

      If you've done 6 impossible things today?
      Then why not have Breakfast at Milliways!

      Comment


      • #18
        Re: Ok in another attempt to stimulate discussion....

        Originally posted by able View Post
        I.E: The Dutch model (in depth studied by the former administration in a hope of implementing parts into the American society)
        No not the UK model, that has so many disadvantages (specially the whitecollar criminals running the system and bleeding it dry with yet another study, outdated system of seniority when it comes to "seeing patients" etc) that such a system is doomed anyway but a system where you pay X part of your salary, and the employer pays another part to in total cover that "base" above mentioned, and to those who make more (or are willing to pay for it) leave open insurance so they can "enjoy" shorter waitlists on breast implants, chin-lifts and other non-essential surgery, perhaps in private hospital, single person rooms instead of 4 person rooms etc.
        Slightly off-topic, but I can certainly vouch for the Dutch medical system. I managed to break my hand whilst driving through Holland on my way to the World Cup. I found the whole process very reassuring - little paperwork, excellent care & minimum of fuss. Only problem was the bright orange cast that they were so keen to put on me

        As for the level of care when I returned to the UK... less reassuring. Not sure I got "11% of my salary" value there.

        Comment


        • #19
          Re: Ok in another attempt to stimulate discussion....

          Originally posted by Putnam View Post
          Jay, I'm not sure of the parentheses at the end of the quote indicates your preferred solution.

          Why should one's quality of health care depend on the ability of his or her group to exert leverage...to negotiate lower prices, or simply to obtain coverage at all? Just because a person works for a small employer with less leverage, why should they get less coverage or none at all?

          The only group that makes sense is the entire citizenry of the nation. There's a group with some leverage on the insurance companies.
          You're right, my parenthetical is "Step 1" toward the realization that the right way for "group" insurance is with the largest demographic group possible.

          Step 1 is still better than completely eliminating the employer from healthcare without an alternative "group" structure in place. Although, imagine the outroar if IBM, Ernst & Young, Eli Lilly, and JP Morgan all discontinued group healthcare for their employees and they all had to pay market, individual (not group) rates. We'd make the jump to your option in no time.

          The solution is messy, because it involves declaring the availability of healthcare as a "right", which conservatives don't want to admit because it means the the taxpayers are obligated to pay collectively for everyone's healthcare. However, there has not really been an acceptable alternative (to all interested parties) proposed by the left. Keep in mind, if we want people to go to all the hassle of medical school, they need to be compenstated well enough to pay off their enormous student loans and make an appropriate return on their investments. R&D companies need to be compensated well enough to make an appropriate return on their investements.

          If this becomes a cost-squeezing exercise, a la Canada, there will be a shortage of doctors, nurses, and innovation. And then, everybody loses.

          + + + + + +

          Bball, what you've described is actually a well-documented problem. The people that pay the most for medical care are the ones who can't afford insurance.
          Why do the things that we treasure most, slip away in time
          Till to the music we grow deaf, to God's beauty blind
          Why do the things that connect us slowly pull us apart?
          Till we fall away in our own darkness, a stranger to our own hearts
          And life itself, rushing over me
          Life itself, the wind in black elms,
          Life itself in your heart and in your eyes, I can't make it without you

          Comment


          • #20
            Re: Ok in another attempt to stimulate discussion....

            Originally posted by Jay@Section19
            Keep in mind, if we want people to go to all the hassle of medical school, they need to be compenstated well enough to pay off their enormous student loans and make an appropriate return on their investments.
            Why not figure out a way to reduce the size of student loans necessary to get through medical school?

            What percentage of practicing doctors are still paying on student loans anyway?

            It would also seem a good move to pay medical school interns more, or, at least, give them larger credit toward their tuition payments. Aren't interns notoriously used as slave labor by hospitals.

            Comment


            • #21
              Re: Ok in another attempt to stimulate discussion....

              This has been a wonderfull discussion. In fact one that is almost free of political preconceptions, which I find odd (fascinating but odd).

              Of course I have a lot of thoughts on the entire subject however I have very little time tonight to go over it.

              I will just make a few observations.

              1. As with many things in America we are not pure. We are not a pure democracy, we are not a pure Republic & we are not a pure free market health care system.

              As was asked of me earlier in this thread is Medicare a socialist system? Well you might as well throw in Medicaid as well when talking about this.

              The short answer is no.

              Why is it not socialized medicine? Simple, as a private health care provider you are not required by law to accept Medicare patients. Now you can't pick & choose what medicare patients you take so you either have to take all of them or none of them but you can choose to not take any federally subsidized health payor.

              Now in America you can not practice normal medicine without having older people use you in most cases so it is a hard system to avoid.

              However there are some providers than can get by without taking medicare. Dentist usually don't need the medicare money, plastic surgeons don't need it & there are others but most providers have to treat the elderly or disabled.

              Medicare at it's inception was a good idea however about 10 years ago, or so, Medicare became a monster that is killing our nations health care system.

              Why you may ask? At that point in time Medicare forced health care providers to accept assignment on all medical claims.

              To breifly explain what "accept assignment" means to those of you who may not know is this. You are forced to accept whatever Medicare decides you should recieve for your service no matter what special needs or problems that impacted your care.

              You only get 80% of what Medicare approves & you can only bill the patient the 20% that is not covered by Medicare.

              In simple terms as an example.

              You have a hospital bill for $1,000.00.

              Medicare approves $200.00

              Medicare will pay $160.00

              The provider can bill the patient for $40.00

              Now that is if the patient does not have Medicaid to go along with their Medicare. If the patient has Medicaid then you can not bill the patient a dollar & are forced to take $160.00 as your payment in full.

              That sounds great doesn't it? Well, for people on Medicare it is helpfull I will not deny that.

              However it's killing the rest of us & I'll tell you why.

              Let's go back & take that $1,000.00 bill. A Medicare patient will only bring the Hospital $200.00 of that bill.

              Hospitals cannot live on that kind of money at all, so how do you think that they make up for the defecits? They shift the cost to Insured patients & now Insurance companies are getting tired of being fleeced so they are negotiating with health care providers to accept a contracted rates. Why do Hospitals & others do this for insurance companies? Simple Insurers can tell their patients where they will & will not pay for their care.

              So again now the Hospital bill for $1,000.00 might actually get $500.00 from Insurance companies. In some cases you can bill the patient the balance, however some contracts prohibit you from doing this so you are forced to accept $500.00 for you $1,000.00 dollar bill.

              Again the Hospital can not lose this kind of money so where does the billing go? Now we go to the people who can least afford it, the uninsured.

              These poor souls get socked for the entire $1,000.00. If your an honest person & actually trying to pay your bills you can easily bankrupt yourself by using our health care system. However just as often as not health care providers can not collect on the claims, try as they might.

              Ok, I've got to stop now but I could go on & on about this.

              I haven't even gotten to the cost of health care workers, liability insurance, supplies, overhead, etc., etc.

              It's enough to make you insane.

              Also I want to point this out for anybody here in the states that wants socialized medicine. The health care industry is one of the largest employers in the U.S. with some of the highest paying wages in some parts of the field. Do you really think our economy would be the same if we turned over the system to the gov?

              I'll leave on this one last note & I hope to tackle this issue again tommorrow.

              Torte reform is the one single thing that we could do to begin to lower the cost of health care & stem the flow of red (no it's not blood either).


              Basketball isn't played with computers, spreadsheets, and simulations. ChicagoJ 4/21/13

              Comment


              • #22
                Re: Ok in another attempt to stimulate discussion....

                Originally posted by Los Angeles View Post
                We already have a total free market system available to us. It's called cash.

                Many of the elite in LA do NOT have health insurance, and they go to doctors who do NOT have malpractice insurance. It's an entire system of doctors who charge you 60% what it would otherwise cost and you sign all sorts of paperwork releasing the doctors of liability.

                As I understand it, you get fantastic service for the money, including house calls, etc. It is truly the best care money can buy. And money buys it.

                So what do you do if you don't have the $200,000 cash laying around to cover a serious illness or injury?
                I believe we need to enable everyone to be like the rich. That is what I mean by a more free market system. Through vouchers and healthcare savings accounts, we need to help people have "insurance" for the really serious stuff. But what you describe is the model we should go for

                Comment


                • #23
                  Re: Ok in another attempt to stimulate discussion....

                  Great summary, Peck. I look forward to the rest of your description of the problem.



                  And by the way, "What was Raymond doing with his hands?"
                  And I won't be here to see the day
                  It all dries up and blows away
                  I'd hang around just to see
                  But they never had much use for me
                  In Levelland. (James McMurtry)

                  Comment


                  • #24
                    Re: Ok in another attempt to stimulate discussion....

                    Originally posted by Unclebuck View Post
                    I believe we need to enable everyone to be like the rich. That is what I mean by a more free market system. Through vouchers and health care savings accounts, we need to help people have "insurance" for the really serious stuff. But what you describe is the model we should go for
                    This may surprise you, but that is the direction I would go for adults also. But unless nearly everyone is able to pay for needed health care coverage at affordable prices, the system will always be FUBAR.

                    The very first step is to initiate annual medical savings accounts for EVERY adult as part of our tax system. Every American should start each year with an account for medical expenses of, say, as much as a thousand dollars a year. The expansion of these accounts by contributions of employees and employers, beyond the thousand dollar limit for singles and two thousand for couples, would also be a priority.

                    Additional assistance for those who can't afford full health care coverage would also be necessary. We do that now in a major way anyway with Medicaid, charitable private programs, and other assistance at every level of government.

                    States would need to create statewide insurance pools where anyone could buy supplemental insurance at the best prices. If we want to be free, the work place or government must not be the only place where one can buy good health care coverage.

                    Make health care coverage part of the unemployment compensation system.

                    Subsidize and encourage non-profit community health care centers where consumers can purchase needed testing and medical services at fair prices.

                    Major medical, catastrophic health care for everyone is critical. Health care providers will then be paid for expensive services provided, avoiding a major source of cost shifting in our current system. Also, if every adult has annual medical savings accounts combined with automatic catastrophic health care coverage, health insurance coverage becomes dramatically more affordable and competitive. The risk for those who want to provide health insurance has suddenly been lowered substantially, increasing competition in the insurance industry. Self-insurance by large businesses and governments also becomes more possible.

                    Take the need for families to finance health care for dependent children out of the equation and out of the work place...Read this one twice...Certainly universal health care for young Americans is necessary. Cover every kid; Make sure health care providers are always paid for their treatment. Give every kid a chance to grow up healthy and with proper medical care, regardless of the family situation they were born into. This policy is moral, just, and a good investment for society. Give parents the right to choose the kind of health care program they want for their child. And give them a default program, if they don't choose.

                    Cut out the bureaucracy as much as possible. See that providers get paid at the time of service as much as possible.

                    Make it a goal that consumers will be placed in charge of their own spending as much as possible.

                    Focus the health care system more on prevention, diagnostics, and healthy life styles, and less on paperwork and the billing and payment of medical services that have already been received.

                    I don't think it is politically possible to initiate a single payer plan in this country, as some of my liberal friends often propose. Nor, do I think a single payer plan is the best answer. What matters is that we find solutions that will make health care more affordable and accessible to all, especially to middle income citizens who get the short end of the stick in health care right now in my opinion.

                    A fair health care system for my country is my passion (along with the Pacers) I am ready to work for a presidential candidate of any party who will have the guts to propose a reasonable comprehensible plan for making health care in America affordable and as good a system as any in the world...If he or she will also have the honesty to discuss ideas about how we will pay for it on an ongoing basis...I understand nothing is free here, and everything has to be paid for...but the good news (and bad news) is that Americans are being ripped off by their current health care system and most of us are probably spending more for health care than we would if the system was fixed.

                    Americans already spend, in taxes, out of pocket, and in the private sector, nearly twice per person what citizens of other industrialized nations pay. There is room to find a solution. Our current system is full of waste and inequities - and the results, compared to other nations, in nearly every area of performance comparison are unspectacular. We can do better, but it ain't going to be easy. This is a huge hot potato with billions of dollars and powerful special interests in play. Obviously, change will not be easy, but it doesn't mean we can't encourage those who are willing to try to make things better.

                    Apologies for the length of this post. And I know few will read it, but, as I said, health care reform for the U.S. is a passion. And, the subject is definitely one that can not be covered with one-liners.

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                    • #25
                      Re: Ok in another attempt to stimulate discussion....

                      Last things first,

                      Also I want to point this out for anybody here in the states that wants socialized medicine. The health care industry is one of the largest employers in the U.S. with some of the highest paying wages in some parts of the field. Do you really think our economy would be the same if we turned over the system to the gov?
                      Bingo. Where do you draw the line? I, personally, want the government out of the medical/ scientific research business. That has been successfully commercialized so there is no reason for government-funded research. But if you include pharma and biotech tech companies inside the boundary of a socialized health care system, who is going to do the research? Most imporantly, who is going to make rational decisions about which research programs to pursue?

                      And if you exclude those companies from the socialized health care system, how do you justify paying the premiums to support the large R&D efforts?

                      R&D becomes the first casualty of socialized medicine. That's one of the many reasons that nearly all the R&D takes place in just a few locations.

                      Frankly, we should make it illegal for our businesses to sell to other developed countries/ economies at lower prices than for domestic sales. The US economy is paying the burden of R&D for the entire world, whether developed or not. I can understand selling drugs to impoverished countries in Africa for cost (or, perferably, giving them away as 'charity'.) But why should the Canadians, or Germans, be excused from paying the full burden of R&D just because they've elected socialized healthcare and then discovered that it is expensive and ineffecient.

                      Maybe I'm just pissed off because I've got the "by country" income statements for a major life sciences company up in excel right now, and the selling prices outside of the US and Japan are significantly different.
                      Why do the things that we treasure most, slip away in time
                      Till to the music we grow deaf, to God's beauty blind
                      Why do the things that connect us slowly pull us apart?
                      Till we fall away in our own darkness, a stranger to our own hearts
                      And life itself, rushing over me
                      Life itself, the wind in black elms,
                      Life itself in your heart and in your eyes, I can't make it without you

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                      • #26
                        Re: Ok in another attempt to stimulate discussion....

                        Originally posted by Jay@Section19 View Post
                        Last things first,
                        Bingo. Where do you draw the line? I, personally, want the government out of the medical/ scientific research business. That has been successfully commercialized so there is no reason for government-funded research.
                        Do you have any experience in this area? I don't mean this to be offensive, but I can't tell from your post whether you're actually aware of how research is conducted.

                        Funding by the goverment, including the National Science Foundation and particularly the National Institutes of Health, right now accounts for such a massive amount of the research that goes on in this country that privatization would drastically redefine biomedical science as we know it. There is an incredible difference between research conducted by large private, pharmaceutical companies and that conducted by smaller entrepeneurial groups and academic institutions. Each has its advantages, but the latter (mostly academic) is largely dependant on the government. There are many studies that show the work done at these insitutions contributes greatly to biomedical science (perhaps more than the work done by pharmaceuticals); for example, most of the end-stage clinical trials are conducted at academic teaching hospitals sponsored by NIH grants (and you can see how having the pharmaceuticals pay for it might be a massive conflict of interest). If you actually know something about this and would like to propose an argument for cutting the NIH, I'd like to hear it, but I don't know how many people in the field would agree with you.
                        2010 IKL Fantasy Basketball Champion Baltimore Bulldogs

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                        • #27
                          Re: Ok in another attempt to stimulate discussion....

                          I don't know enough of this topic to say which system is better.

                          Here, we have a system that everyone is obligated to have a health insurance policy that's provided by commercial insurance companies. The range of how you want to insure yourself depends on what you want. However, health insurance companies are mandated by law on what to the very least should be included in their cheapest package. This makes sure that everyone atleast is insured for the most basic stuff.

                          We pay for health care in taxes and we pay for the insurance policy which as written above can be pretty wide ranging or more limited, depending on what you want. But, everyone needs to have an insurance. IF you don't have it, you are black listed. The hospital still has the duty to take you in if you need medical care, but you pay the costs or a large part of it as far as I understood (this system was introduced jan. 1st this year).

                          People who don't make a lot of costs get part of what they paid back through the government. It's not much, but it's meant to atleast stimulate people to not go to hospitals too fast or not to take medicine too fast (I heard that even before this system was introduced that on average Dutch citizens don't use a lot of pharmaceuticals compared to forexample other Europeans for relatively light stuff, head eaches, fever those sort of things).

                          I like the basis of our system, but there are somethings that need to be weeded out.

                          I heard that in the US, and I don't know if I'm correct about that, you can pay hundreds of dollars each month for health care insurancy. I pay about Eur 125.-- per month for one of the most extensive packages (extensive dental inc. and no own-risk). I don't know, maybe it has to do with beying obligated to have an health insurance here?

                          Different systems.

                          Regards,

                          Mourning
                          2012 PD ABA Fantasy Keeper League Champion, sports.ws

                          2011 PD ABA Fantasy Keeper League Champion, sports.ws

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