I agree, which is why part of this larger "mess" may perhaps be paid forOriginally Posted by Dreadnaught
I agree, which is why part of this larger "mess" may perhaps be paid for
"One day, we shall die. All the other days, we shall live."
Humor me. Explain how employer health insurance subsidies became an employment perk in the beginning. Then explain which became important first, and why---higher wages to buy our healthcare outright, or employer perks to buy health insurance. In your own words and all.....
Wait, I'm not sure I follow your point here.
I'm not going to write-out the history for you of how employers, seeking to get around WWII wage controls, included health insurance as a perk.
Right. Would it be too much to ask for you to state when insurance became a common model for paying for our health care?
Yes, because we both know the answer, you're baiting me and I'm tired of it. If you have a point about why forcing large numbers of people onto the government dole for their healthcare is a good idea, please let me know.
Not baiting you at all. Just asking you to explain the origins of your beliefs, and how it translates into forcing large numbers of people onto the government dole for their healthcare.
I don't believe in forcing large numbers of people onto the government dole. This is why I think Obamacare is flawed...perhaps more flawed than originally imagined.
And how would those wonderful employer packages be funded? Taxcuts per chance? I always love it when people argue against re-distrubution in defense of a system of reverse re-distribution. Steal from the poor and give it to the somewhat less poor.
Congratulations America
My whole point is our employer-based system is a distortion created by government tax cuts. And now that system seems to be the target for replacement by a large government-subsidized system.
Your assertion that a national system is more expensive is not supported by any evidence. The experiences of countries in Europe suggest the opposite from your claims.
Congratulations America
Do you make a distinction between less expensive and untenable?
From a business perspective this would be like a tax-break toward businesses. So we should expect more people being hired and higher wages.By mission accomplished you mean Obama and co wanting to make even more people/citizens dependent on the government (and hence continue to vote in his crap), then yes.
I for one have always supported a national healthcare, I think if done right, it'll be a great step in efficiency for our country, and for overall health and lifespan of our populace. This is a law that benefits strongly the middle class and below, unless your upper middle class you should support this. I think it's good overall regardless, but just for yourself you should support it if you fall in where the vast majority of Americans fall.
You know, it would be nice to see some real numbers.
- how much more will the addition of workers to "the government dole" cost the government during their working years?
- how much will it save the employers, and what would be the effects of that?
- how much would you get back (or lose) in productivity from workers and employers?
"One day, we shall die. All the other days, we shall live."
Well we know the government won't do it more cheaply, and the private sector already spends trillions on health care...it's not hard to see that the amounts are potentially quite large.
Yes but we've been going on and on about how most of the spending is in the last few years of life etc etc, so how much more will the addition of healthy people of working age cost and what would the gains be?
The private sector spends a great deal on healthcare in large part due to 1. the large number of people responsible for different aspects of a very fragmented healthcare system and 2. defensive medicine (although to the latter I suppose we can add unnecessary procedures that are driven purely by financial motives eg. fee for service models). Never mind the gains that might be had from applying good research on comparative effectiveness and best practices, or the gains that might be had from expanding and improving your primary healthcare system.
How much of a burden is healthcare coverage on small/medium employers? How does that burden compare to the one on large profitable employers?
"One day, we shall die. All the other days, we shall live."
We do? How much is wasted by the insurance industry today? They have duplicated the administrative structure required many times over, they require an ever increasing profit, they each have unique and different requirements, different procedures they will cover, different drugs they will cover, different proofs to head off fraud from doctors so offices have to duplicate their own procedures and processes. You think this situation is more efficient than a single payer?
YOU have faith the government can't do it more cheaply. That's the conservative mantra that so many people embrace as the truth with or without evidence and all have concluded it MUST be true now and forever so attempting to use the government to do what it is supposed to do is hopeless and nobody should try. Do you not see something wrong with that thinking????
Does anyone know why the price of health care keeps rising so much faster than inflation?
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
Rapid technological change.
Hope is the denial of reality
Here you go:
http://www.newyorker.com/reporting/2...a_fact_gawande
(it's in English)
"One day, we shall die. All the other days, we shall live."
long read, great article.
Congratulations America
The timing of those two posts made me lol pretty hard just now.
Interesting article.
This is a bit disingenuous. You don't need to be a car expert to get a good deal on a car. Business competes with each other to get consumers to go with them. You don't need to be an actuary to get a good price on insurance. You can compare rates, you can look at the reputation of the company, look at reviews and tons of other ways. Why couldn't we do this with hospitals and doctors?He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
Lets look at another medical procedure that is not typically covered by private insurance or Medicare.
http://abcnews.go.com/2020/Stossel/story?id=8026098
Insurance, whether private or a government Ponzi scheme like Medicare, means third parties pay the bills. When someone else pays, costs always go up.
Imagine if you had grocery insurance. You wouldn't care how much food cost. Why shop around? If someone else were paying 80 percent, you'd buy the most expensive cuts of meat. Prices would skyrocket.
That's what health insurance does to medical care. Patients rarely even ask what anything costs. Doctors often don't know. Often nobody even gives a damn. Patients rarely ask, "Is that MRI really necessary? Is there a cheaper place?" We consume without thinking.
By contrast, in areas of medicine where most patients pay their own way, service gets better, while prices fall.
Take plastic surgery and Lasik eye surgery: Because patients shop around and compare prices, doctors work hard to win their business. They often give customers their cell-phone numbers. Service keeps increasing, but prices don't. "In every other field of medicine, the price is going up faster than consumer prices in general," says John Goodman of the National Center for Policy Analysis. "But the price of Lasik surgery, on average, has gone down by 30 percent."
This shouldn't be a surprise. What holds costs down is patients acting like consumers, looking out for themselves in a competitive market. Providers fight to win business by keeping costs down and quality up.
You didn't read the article did you. Admit it, you haven't actually read a single source or a single serious essay on this topic in the years we've been discussing it.
You keep forgetting that the most important thing to become more efficient at--for most private practitioners in the US, as well as for every other player in the healthcare game--seems to be the taking of as much money as possible from patients. Patients will pay that money. The more they earn, the more they will pay, regardless of whether or not they need to, whether or not they should. That doesn't increase efficiency in the sense of improving the quality of healthcare per dollar. It's a system heavily biased in favour of bad, fearmongering, inefficient medicine.
"One day, we shall die. All the other days, we shall live."
I'm glad you liked the article, but you picked out among the least relevant passages in it. With that said, comparing complex life-and-death matters with relatively simple trivial procedures such as lasik and then running a "thought experiment" is, as you put it, disingenuous.
Can you reasonably be expected to shop around for every single test associated with a given emergency hospital admission and treatment? What if the competitors are far away from one another? What if they don't have compatible journal systems?
It's relatively easy to "act like a consumer" with something like lasik.
"One day, we shall die. All the other days, we shall live."
Most medical care isn't ER care. Obviously you aren't going to price shop as your being wheeled in from the ambulance. And just because you won't necessarily make the best decision doesn't mean someone else should make the decision for you.
There is no "perfect" solution to rising medical costs. Part of the problem is that as society grows older with medical advances costs will rise even under optimal situations. HSA and having "skin in the game" gives choice to the individual as opposed to choice to the state. It creates incentives to be aware of costs. Eventually care *must* be rationed. Not everyone can get the 'best' care. Even if the rationing is waiting lines, or the rationing is fewer new medicines in some form or fashion something has to give.
We both have very different systems that emphasize different types of care. Your system is more focused on primary care and regulated drug prices. Our system is more geared towards specialized care.
You also barely spend any money on your military, so you can blow money on things like national socialized healthcare.
I agree, insurance companies haven't been truly competing. They can't because of the backwards incentives and regulations they work under. But they also have very low margins. It's a highly imperfect system.We do? How much is wasted by the insurance industry today? They have duplicated the administrative structure required many times over, they require an ever increasing profit, they each have unique and different requirements, different procedures they will cover, different drugs they will cover, different proofs to head off fraud from doctors so offices have to duplicate their own procedures and processes. You think this situation is more efficient than a single payer?
YOU have faith the government can't do it more cheaply. That's the conservative mantra that so many people embrace as the truth with or without evidence and all have concluded it MUST be true now and forever so attempting to use the government to do what it is supposed to do is hopeless and nobody should try. Do you not see something wrong with that thinking????
Does anyone know why the price of health care keeps rising so much faster than inflation?
But I think it's naive to think the government will do a better job.
And its cynical, cruel, and lazy to conclude the best solution to the Medicare and Medicaid cost problem is to simply cut the amount the government will spend on it. That 'solution' doesn't even pretend to try and address the real problem which is the rising cost of healthcare for everyone. That cost is still going to rise and the myriad of resulting problems are still going to get worse, they will just get worse faster for older and poorer Americans. Whatever is driving the cost increase has to be addressed. And I don't believe for a second the driver is simply fast changing technology; as stated by Loki above, that explanation doesn't even make any sense (Loki: I am interested in a more detailed explanation, however).
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
It's the sane approach. It's actually insane to suggest that the solution is a blanket government subsidy followed by prayer that policies will also lower costs. Demonstrable cost reductions have to happen first, otherwise you're basically committing a sort of Fannie Mae/Freddie Mac fallacy that will inflate costs further.
Most of our large and steadily expanding healthcare industry isn't life-and-death though *even with the way expenses are currently end-loaded* and even a fair bit of the stuff that is isn't immediate. I realize you're very attached to the idea that money and medicine can't mix, but perhaps your biases are rejecting that there might be some validity to Lewk's alternate approach?
Last night as I lay in bed, looking up at the stars, I thought, “Where the hell is my ceiling?"
How many people do you know would (or could) thoroughly research something like mitral valve repair/replacement, comparing surgeons and hospitals by state, coordinating transfer of care from referral to second opinion to practitioner, pre and post-op care, insurance coverage in/out of network, charges for Anesthesiology or a Hospitalist, in-patient room rates, levels of care, extras for pharmacy or respiratory therapy....plus getting family or SO to take time off work and travel with them, air fare and hotel rates....in order to "find the best care at the best price"?
Most of my family, but that's purely anecdotal. And people already do that sort of research *not necessarily on cost but on their doctors, the recommended treatments, the time-frames and scheduling involved etc.* Not usually across state lines but at a regional level. What's more, doctors and the health-care system "assume" people do this, as fundamental to the concept of informed consent. Further, the health insurance industry is already itself a proxy for everything you've said above.
Last night as I lay in bed, looking up at the stars, I thought, “Where the hell is my ceiling?"
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