Now, President Trump and the Republicans have the “going second” problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered – does not compare favorably with Obamacare. The contrast is fatal.
२३ जून, २०१७
"Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival."
"Any skilled persuader would see that," says Scott Adams.
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«सर्वात जुने ‹थोडे जुने 298 पैकी 201 – 298My company has 300+ employees and our out-of-pocket and employer contribution have basically been flat for a couple of years now.
One more time, folks: my proposal for a radical new health care plan: If you need medical attention, you pay for it yourself--or if you can't afford it, you get "liberals" to pay for it. They've obviously got the money (look how the Hollywood Left poured millions into the Ossoff campaign in Georgia), and we know they're compassionate and generous because they keep telling us they are. And then--the beauty part for us in the pro-freedom camp--they leave the rest of us THE HELL ALONE. I call this radical plan "liberty." Some regular posters here (you know who they are) need to look that word up in the dictionary.
"I remember when 'liberal' meant being generous with your own money."--Will Rogers.
"The level of medical coverage provided by most other western countries."
You mean the ones where people leave to come and get better faster care here, or at least used to? The ones where people pay much higher taxes and then have to also get self-bought coverage for when they really need care? The ones constantly in the news for sub-human care, and requiring constant tax increases as well as reductions in patient care. The national health care agencies are a constant source of bitching and horror stories in Europe. It may be different, but it's not a solution. It's just a different kind of bad. It's the same as V.A. system we currently have here. Even as they wait in line to die, they will still tell you they would hate to lose it, becuase it's all they know.
Here's a simple proposal with immediate benefits:
"Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof."
A One-Sentence Bill To Force The Health-Care Issue
The only reason for group benefits is because of the Fannie/Freddie effect (i.e. redistributive change, perpetual smoothing/debt functions) through the government regulated insurance industry. The benefits of which do not confer to individual doctors, nurses, technicians, and other service providers; or to realizing affordable and available medical care, let alone health care.
There are good options for reform. I made a study of it about 8 years ago. Obamacare was not one of them.
R/V for example, has no clue about what reform would look like.
"My company has 300+ employees and our out-of-pocket and employer contribution have basically been flat for a couple of years now."
Sorry, but I just don't believe you. Even it that was true, the government is now spending huge on subsidizing. So it's still costing much more, but like I said, I don't believe it's not increasing. I know lots of business owners and spend many hours with insurance companies and brokers in multiple states. I never hear of a single case that is close to level since the ACA.
AReasonableMan said...
wwww said...
I don't really understand what people want.
The level of medical coverage provided by most other western countries.
6/23/17, 1:37 PM
You continue to say that but I don't think you understand what that means.
The US had (maybe still does) the best medical system in the world. Folks from other countries come here for treatment. No one goes to Spain for brain surgery, nor Canada, nor Italy. It was great! Was it "fair" no but nothing is "fair". We had (and still do) the best medical care you could afford.
You prefer other country's care? Do you know what that is like? Think the VA. People die on waiting lists for cancer treatment. People die because someone somewhere decided that treatment is not covered.
Yest those things can and do happen here too but not as often, not as frequently, and (cold comfort) there was/is recourse when things go south. People can sue insurance companies, etc. Try fighting the NHS. So please, it is easy to say we could be better (and we could) but stop holding up failures as "fairer" models to emulate just because in those systems everyone suffers equally.
Jives
A very apt example. But I will pick up yours as well. You would be in favor of being able to buy life insurance on your spouse after she dies? You don't want insurance you want a system that will bail you out of your failure to insure yourself. You would rather spend the money on a new bass boat.
bagoh20 said...
You mean the ones
Have you ever lived in another country and used their health care? I have, in both Australia and Italy. It works fine. And, we are talking about Italy here, where very little works fine. You are just making stuff up about how bad health care is in other countries. People in other countries complain about how bad health care is in the US. People come to visit and are bankrupted by minor illnesses. There are regular benefit concerts for some poor musician who had the misfortune to fall ill while touring in the US.
You are overstating the problems with other systems and understating the problems with our system. No large system will be perfect but ours is both unusually expensive and only mediocre in performance.
In a way it is possible that a company can level out it's costs for health insurance that is happening, but it is by lowering what the employee gets. Many employees and employers are accepting much poorer coverage to control costs.
Our typical plan before the ACA was a Cadillac. No deductibles, copays around $10 or nothing. Now the average is a $5,000 deductible, copays of $50, $100, or more, and most striking is that it's near impossible now to find a doctor to take the plan or to get in to see him when you do. Still the plans cost double. We got conned, lied to, and ripped off.
Adams is probably correct. Laws are enacted by Legislators. Legislators vote on laws based on how they perceive their vote will affect their retention of position and power.
There are about 324 million souls in the U.S.A. At some point the cost of locating and signing up (or jailing for refusal to sign) the next "uninsured" person will become a significant portion of the overall program cost.
Yeah, it's costing more bagoh20, but millions more people have coverage that didn't have it before! Geez, any poor people on this blog?
There is an interesting reverse 1% effect. First, they forced Obamacare to purportedly help 1%. Now, they are clinging to the status quo in order to appease the 1% who were not harmed by Obamacare's distortions.
Jives,
Your example seems to be that of employer provided health insurance which was not the core problem Obamacare was meant to address. How are the Obamacare exchanges and what's left of the individual market faring in your state. BTW, what is your state?
"People want the level of coverage provided by other western countries"
1) if that myth were true, medical immigration to America wouldn't have been a thing
2) look at the teeth of the average Brit. Even their actors have poor dental.
3) Americans don't want the required Socialism that must accompany such health "care"
4) Americans don't want the accompanying death panels and medical rationing.
5) Americans don't want to out-source their national defense to another global power and redirect the savings to create a Welfare State of incompetence and dependency.
In a way it is possible that a company can level out it's costs for health insurance that is happening, but it is by lowering what the employee gets. Many employees and employers are accepting much poorer coverage to control costs.
this was happening before the ACA too, from my vantage point in a much more uncontrolled manner. It all kinda sucks don't it?
Todd said...
No one goes to Spain for brain surgery, nor Canada, nor Italy.
This is not technically true. There are excellent surgeons in most western countries.
I have a friend who visited Italy, her niece, who was travelling with her, severed her finger in a sliding door. It was reattached by a local Italian surgeon. My friend and her cousin were uncertain about the quality of the surgery, since it was essentially free, so the took the niece to a local surgeon when they returned to the US. He basically told them that he was not sure that he could have done as good a job.
Yes there are some very specialized treatments available in the US that are not generally available elsewhere, which is why some people travel for care, but this is also true in Australia, for example.
Fen said...
4) Americans don't want the accompanying death panels and medical rationing.
The AHCA is rationing. Fewer people will have access to health care. There are a lot of different ways to ration access to health care.
"You are overstating the problems with other systems and understating the problems with our system. No large system will be perfect but ours is both unusually expensive and only mediocre in performance."
I read the news from Europe, and the problems with healthcare there are front and center, and more common than here, except for the VA system story, which is another single payer, and thus has the same complaints as there. Here the bitching is political, and costs. There, the bitching is about the waiting, the abuse, the quality of care, and lack of it.
You are spot on that any large centralized system is going to have large, widespread and cold-hearted problems. That's why we should be more open-minded and think outside the tiny box of government will fix it. They broke it.
To compare your personal experience there with mine here: I had cancer twice under the old system, and required a liver transplant 11 years ago. It cost over $500,000 and still counting. Many surgeries, regular doctor visits, tests, MRIs, etc for years. I didn't even have a copay, and my premiums were under $200/month. My current plan with a $5,000 deductible and huge copays is $1100/mo. I have not seen a doctor for over a year. It's just too hard now, and I have to pay anyway for 5 minutes of his time. I used to be able to get same day appointments, free. Maybe all that change is not due to the ACA, but it sure is a coincidence.
I'm starting to think that the problem is not with the ACA, so much as the whole insurance company model. Way back in the beginning, Blue Cross was a non-profit. Now they're huge money makers, being little more than paper-pushing middle-men. Why do we need these corporate insurance behemoths? what do they add?
Bagoh @ 1:30
But Bagoh - the left have a media link that says you are imagining the whole thing. The ACA is really wonderful.
Yeah, it's costing more bagoh20, but millions more people have coverage that didn't have it before! Geez, any poor people on this blog?
Everybody got care before, and it was faster. There were no poor people dying from lack of treatment if they asked for it. I've had many destitute and homeless friends over the years. If they got sick they went to the county hospital and got great care. It was that simple. Those of us who paid insurance subsidized their cost, but it was far more efficient that way without all the bureaucratic crap and government employees, and cubicles, and seminars, and forms, and websites, and rules, and reporting, and paychecks, and pensions loaded up on top now through Obamacare. It was mostly a government jobs program that is unsustainable, and gums up the works.
I know people in in UK who detest the government run system there. It's horrid.
But I'm sure they are lying. Lets buy what the leftists are selling- they would never lie.
"I have, in both Australia and Italy. It works fine. And, we are talking about Italy here, where very little works fine. "
Says the person who did not have to use the system.
Australia had a great system 30 years ago. Then the Labour party screwed it up badly for ten years. I have two friends, GPs, who live and practice in Queensland. I know how it works. I suspect you don't.
People who know nothing about healthcare write about "other countries" knowing nothing about how all those system differ.
I personally like the French system. We could discuss it if you knew anything but you don't.
Maybe you know more than you seem.
Explain the differences between the German and French systems.
I've used the Italian system. Have you ?
"The AHCA is rationing" says ARM - towing the lefty line.
Bullshit.
There is no AHCA. It's only a bill. It hasn't passed nor has it been implemented.
bagoh20 said...
To compare your personal experience there with mine
I have also had outstanding care in the US for a major illness. I am not suggesting that the US medical care is not good. It is too expensive. I also have excellent health insurance. As a patient I have no real complaints about the system here other than that there is a very large variation in the quality of individual physicians, which is easy to navigate if you know the system, not so easy if you don't.
I've heard horror stories about the German system, too.
"Explain the differences between German and French systems"
Sam: Why did you have to go and do that?
John: Do what? Ask him a question?
- Crastor's Keep, Game of Thrones
"You are spot on that any large centralized system is going to have large, widespread and cold-hearted problems. That's why we should be more open-minded and think outside the tiny box of government will fix it. They broke it."
It was broken way before the ACA.
"Why do we need these corporate insurance behemoths? what do they add?".
Maybe we don't. Is anyone in Washington talking about that? Of course not - they are the hammer that only sees nails.
There should be hundreds of options to choose from on a private market: Hospitals that have their own plans, doctors who have their own, or are part of a group, insurance companies, private alliances, and other things never imagined. Eventually the best ideas will get most of the action. Different ideas will compete and improve to get your dollars.
Would you want people in D.C. supplying the only cars, or ice cream, or entertainment? The big centralized idea has little incentive to improve either costs or quality, and they sure are not going to innovate. Do you trust the politicians in D.C. to provide good quality or value in anything? Do really trust them with your health, your life, your personal choices about what is best for you. Do they know you, do they even care? Personally, I would trust you, a complete stranger, to decide for me before them. I know them, and their record.
@R/V So Obamacare blew up the health insurance market to insure 6 million people (out of a population over 300 million). That's what your quote says. Hell of an effort! How many are going to be left without access to insurance because of the withdrawal of major insurance companies from several states? Will someone count those people?
Those that are pointing out that individual premiums are up over 100% since the inception of Obamacare are more accurate than those who claim premiums are now at or below the rate of inflation. My answer to Jives is find me one state where that is true.
There was not a thing wrong with high risk pools. They worked very well to provide INSURANCE to those with prior conditions. The higher premiums were irritating but coverage was available.
@ARM As many have said medical service is not medical insurance. We all want good medical service. I am certainly glad that if I need medical attention I do not live in Great Britain. In rural areas of MN we run the risk of having local clinics close because they do not generate adequate profits for their supporting hospitals. Those rural customers will then have to travel up to an hour just to make a doctors visit. Is that really what we want to encourage?
Way back in the beginning, Blue Cross was a non-profit. Now they're huge money makers, being little more than paper-pushing middle-men.
Sorry but they were always money makers. I don't think you understand what "non-profit" actually means especially in the commercial space.
"It was broken way before the ACA.".
I described my story above, and before that happened, I believed the system was broken.
Afterward I was just amazed how lucky I was to have a $200/month expense that could save my life, twice. Still, I thought there were problems, but now I know what real health insurance problems look like. Complaining about the old system is like college students complaining about how unfair life is for them. Wait till you get out.
khesanh0802 said...
I am certainly glad that if I need medical attention I do not live in Great Britain. In rural areas of MN we run the risk of having local clinics close because they do not generate adequate profits for their supporting hospitals. Those rural customers will then have to travel up to an hour just to make a doctors visit.
This is somewhat inconsistent. If you have to travel an hour to see a doctor you probably would be a lot better off in the UK if the only criteria is access to health care. Rural areas are getting squeezed along a lot of different axes, but that is due to broader changes in economics, cities are outcompeting rural areas economically.
Heath Care was not perfect, but it was a million times better before the lie that is the ACA wrecked it.
That's what lies do. Wrecking ball.
But the Chocolate Jesus(D) was doing the lying, so it's all good. "If you like your plan you can keep your plan."
No ARM - the UK system is horrible, especially if you are sick or in need of a specific treatment or surgery. The wait time might kill you before you even get to the crap care.
"There should be hundreds of options to choose from on a private market: "
Look at plastic surgery and LASIK, both totally uninsured.
"Sorry but they were always money makers."
Actually, Blue Cross was a real non-profit in the beginning. It was a creature of hospitals paid them according to their annual expenses and the number of patents served. That was how hospital accounting got so screwed up. It had nothing to do with individual prices.
I have a book chapter on it.
"cities are outcompeting rural areas economically."
Actually, rural areas were doing better many years ago. When I was a student, an intern I worked with (black) had had his medical school tuition paid by a small town in, I think, Michigan, in return for agreeing to practice there as a GP for a number of years.
My uncle was a GP in a small South Dakota town (Milbank) for many years. He had four sons and all went into medicine.
When my father died, a group of nuns from the town came to represent him at the funeral. He was in the hospital himself with a broken hip. The nuns had fixed his hospital room so he could see his patients there.
Government medicine wrecked small town practice.
I met a woman doc who is the only fully trained gerontologist in central Iowa. A lot of her patients are home bound and she was being threatened by Medicare because she was seeing them too often. SO SHE QUIT MEDICARE !
Now, she practices for Visa and Mastercard and was making a decent living when I met her a few years ago.
I contacted Grassley's office about her.
A lot of rural problems are because those people are on Medicaid and Medicaid pay is crappy and takes two years to come. The bureaucracy is incredible and a GP's overhead in such a place must be 75% and all for Medicaid.
Medicare is very little better.
Jives
Under the current system, and the reason costs will continue to skyrocket, is that everyone does have insurance to the degree that even if they don't they can get it when they get expensively sick. This is a program designed for smart young people to game the shit out of the system for twenty or thirty years.
Inga said...
Bad LT. I understood your question and chose not to answer it at the moment, because I had more important things I wanted to address first.
OK, just wanted to be sure I hadn't missed you answering me.
As far as the numbers of doctors we'll need, we can make going to med school less expensive or free in exchange for some community health care service in exchange. Several European countries have free medical school education. There are also plenty of foreign doctors that would love to practice here.
OK.
1) I think it would be better if the US could create more doctors and nurses and aides and techs, if more children could be nurtured and educated to be at that level, if more brilliant minds would go into medicine instead of law or hedge funds. But that's just me. By all means you can say it's better, or just as good, for us to bring in or create more Ayman al-Zawahiris, George Habashes and Wadi Haddads. Just like we could import more Mohammed Attas instead of training our own scientists and engineers. Americans don't want or need those jobs, maybe? I think not.
1a) Don't doctors created in foreign countries just have to get recertified here? You can't walk into Beth Israel with an MD cert from Russia or India or even the UK, you have to do a residency at least all over again.
2) Just checking, all that is possible to do maybe, but you agree that so far, OCare has done nothing to address this problem? I am not aware the new plan does, either, so it's not a gotcha.
As far as hospitals go, I don't know about there actually being a shortage. If you have info about hospital shortages , I'd be interested in seeing it.
Hospitals closing, shrinking as outpatient care grows.
6/23/17, 12:46 PM
Not the hill I want to die on, but it seems consolidation is impacting people. There's a big hospital complex in my town that has been disused for some time - in fact a kid just fell through a roof while playing there.
I can't be bothered to recapitulate everything I say in every post, but while some facilities may be in surplus or misallocated, it seems that many resources are needed in some areas. I suppose you would say abortion clinics. I am thinking MRIs, gamma knives, things like that; if there were more MRIs they would cost less and there would be less waiting, right?
In any case, again, these things now serve the insured. To add the uninsured to the users of these things, makes them even more in demand, which by market rules will increase the price, and which by actual rules are not so easy to add to meet the demand (can't throw up another medical school like putting another shrimp on the barby).
Inga, anyone interested - the TL,DR - please agree, disagree, debate:
* More people having access or "access" to care does not mean more care. Everybody can have a bus pass, but only so many people can fit on a bus.
* One thing Bill Clinton did, that I thought was an effective tactic, was these "100,000 new teachers" or "100,000 new cops" plans. Why not "100,000 new nurses" or "10,000 new doctors?"
** More agents and instruments of care would increase the supply of care.
** More agents and instruments of care would lower the price of care.
** Lower price of care would increase access to care.
the UK system is horrible, especially if you are sick or in need of a specific treatment or surgery. The wait time might kill you before you even get to the crap care.
The UK isn't the best example from what people have told me. Germany, Japan, even France.
I'm in Canada for work, and the system works fairly well. Medical services are paid for through the state and my company pays for a drug plan, dental, travel insurance and even 12 massages per year.
For some reason there's zero co-pay with medicine, which is fairly common for company-funded drug plans here. No co-pay for blood tests, X-rays (broke a bone in my foot) or ultrasounds. Have a friend who came down with testicular cancer here. He needed surgery but is cancer free. It's not perfect, but from what I've experienced it's as good as my experience in the States. The medical system makes it easier to start businesses here or free lance.
But it doesn't matter if you want these other systems. We all know it's not going to happen in the States.
What's on the table is Obamacare or Mitch's plan.
The real question is what's better? Or can the Congress put together something better then either of those?
Republicans hold the Senate, House and Presidency. It's not going to get better then this. If the Congress wants to repeal Obamacare, it needs to be now. If a better plan can be put together, it needs to be now.
The parties have demonstrated they are unwilling to work together. As soon as it's a divided House/Senate/Presidency nothing gets through forever.
It is not possible to "cover more people" since ObamaCare made it illegal for anyone to not be involved.
The NUMBER ONE major problem of ObamaCare was that it covered people who did not want to be, nor needed to be, "covered." This is especially so since "coverage" was and is a complete fraud, farce, and illusion. The only "coverage" provided is a premium bill, period. That's it. There was and is no guarantee of actual medical treatment being provided -- and to the extent that it was/is, you still had to pay for the care out-of-pocket because the deductible is higher than the cost of the treatment.
People who are otherwise healthy would be a fool to buy such a policy. It makes more financial sense to keep their money and save it since they would have to pay out-of-pocket anyway.
I have not seen a doctor for over a year. It's just too hard now, and I have to pay anyway for 5 minutes of his time. I used to be able to get same day appointments, free. Maybe all that change is not due to the ACA, but it sure is a coincidence.
What? Why is this happening? This shouldn't happen with GPs. And ultrasound checks should be easy and regularly scheduled. Is it because of all the mergers? I know hospitals have been merging and my mother had to choose a different GP because of changes.
You're the second person who can't get into a doctor same day.
When I lived in the States I got into the doctor same day or the next day all the time. It was easy to be seen.
It's also easy in Canada. I found a good practice here w/ good organization and they can get me in same day or next day. Was with another GP who couldn't figure out how to organize his schedule for convenient appointments, so I changed my GP. It's also easy to get an ultrasound here. MRIs take longer scheduling, but you can pay for a private screen. Much less expensive then in the States.
"People who are otherwise healthy would be a fool to buy such a policy."
The problem with the policies is not the structure you describe, which would be true of catastrophic-only plans. There's nothing wrong with insurance that doesn't give you anything 99% of the time. That's true of most insurance against catastrophic events. The problem is that under the ACA these plans have to cover all sorts of non-catastrophic stuff, and are overpriced for younger age groups. That's why they're bad deals and have to be forced on people.
I don't really understand what people want.
The level of medical coverage provided by most other western countries.
They're not willing to pay for it. They don't want to pay the taxes that would be needed for it.
I would have thought they'd be happy with Mitch's plan, but they're not.
wwww said...
They're not willing to pay for it.
This is the thing that bugs me, we are already paying for it. The US spends a relatively high percentage of GDP on health care. We just don't get our dollars worth.
"My company has 300+ employees and our out-of-pocket and employer contribution have basically been flat for a couple of years now."
I work for a hospital system. Our premiums have stayed the same for 8 years. The CEO is proud.
However, our deductibles have gone from $1200 to $6600 and our copays have increased dramatically. I shelled out of pocket nearly $9,000 last year for two simple outpatient procedures (arthroscopy and lithotripsy). Is it a coincidence that this happened during Obamacare?
Note that I changed to a "catastrophic" coverage policy when I was self employed and turned 50. I halved my monthly premium, but it was a $5,000 deductible. In other words, Obamacare has been worse that catastrophic coverage.
This is the thing that bugs me, we are already paying for it. The US spends a relatively high percentage of GDP on health care. We just don't get our dollars worth.
Yes, a lot of $$ is going to insurance companies or is wasted on stuff like an overabundance of MRI machines and other technologies. Everything is decentralized. Not efficient and a bunch of waste.
Americans seem to prefer to pay insurance companies rather then pay it outright in taxes. Or are willing to pay the overcharge in, say, MRIs that cost $3,000-4,000 USD rather then 1,000$ for a private MRI in Canada.
But people seem pretty unhappy on this threat with the costs to insurance agencies. Premiums sound uncontrolled and high.
And 2 people on this thread said they can't get into doctor's for same day appointments, which seems odd.
It's an issue that needs expertise and smart, practical, bi-partisan compromise.
I read something the other day that compared American maternal deaths to those in other industrialized western countries. It's rising. I don't know why, but that's extremely problematic. The American system should be in line with Canada, Germany, Italy.
I read something the other day that compared American maternal deaths to those in other industrialized western countries. It's rising. I don't know why, but that's extremely problematic.
Well the first item in a Google search brought me this. And there are lots more pages still out there!
"Recent news stories have passed over the real reason behind the unconscionable rise in deaths among child-bearing women in the United States – American obstetric practices. As a board-certified obstetrician-gynecologist, I see firsthand that pregnant women are subjected to multiple unscientific physician and hospital protocols – inductions prior to 42 completed weeks; continuous electronic fetal monitoring; refusal of food and drink in labor; drugs and procedures to speed up labor; cesarean delivery for “non-reassuring fetal tracings” and labor that “takes too long”; and vaginal birth after cesarean section policies that discourage or deny women the right to a vaginal birth. ...
The American College of Obstetricians and Gynecologists and its peer review journal, Obstetrics & Gynecology, initially denied the rise, then blamed it on women (who are too old, too fat, too unreasonable) and now blame it on regressive politics, pre-existing conditions such as heart disease and the opioid epidemic.
Great Britain has a maternal mortality rate that is a fraction of ours in the United States. Britain has the same problems with diet, obesity and opioids, but it does not have a 25 percent induction rate or a 40 percent cesarean section rate."
http://buffalonews.com/2016/09/10/letter-american-obstetric-practices-increase-maternal-death-rate/
Here is the bill the Senate could propose:
Obamacare rules and regulations will, in effect, be repealed for an American citizen if that citizen opts out of the Obamacare law by 12/31/17. By doing so, they affirm they do not want to regulated by Obamacare. The repeal will be effective on 1/1/2018.
Every American business will have the same option.
By 9/30/17, the social security administration will issue "opt out" forms to every American and every business.
This is the thing that bugs me, we are already paying for it.
I heard this during the formulation of Obamacare. Then premiums went up. Then copays went up.
All this after taxes went up, and government expenditures to insurance companies went up.
I have yet to hear a single cost coming down to make up for all the goings up. So I have to seriously question the "we're already paying for it" line. We certainly were already paying for some. But we most assuredly were not already paying for "it".
ARM,
It's a small thing but indicative of your last comment about costs. My monthly BC/BS bill used to be a single page plus the return envelope. But since Obamacare, it is now four pages due to translating instructions on how to get foreign language help into no less than 15 languages. You'd think they could do this annually or at most quarterly - but no - the same extra identical three pages are added to every monthly bill. Not to mention the need for BC/BS to hire or contract the translators trained as customer services reps and proficient in one or more of those 15 languages. As I said, it's a small thing but one wonders how many added costs are hidden away in federally mandated activities on top of those already in place.
WWWW,
I was giving your comment serious consideration right up to -
"It's an issue that needs expertise and smart, practical, bi-partisan compromise."
I was giving your comment serious consideration right up to -
"It's an issue that needs expertise and smart, practical, bi-partisan compromise."
well, it's not likely, but I'm allowed to wish for it.
It's more likely health care becomes a partisan hot potato that gets tossed back & forth between the two major parties. Meanwhile premiums keep going up, HMOs give people annoying care, and everybody gets frustrated.
In my alternative universe 2.0 my president doesn't tweet, Kasich v. Biden run for President, and boring people who understand medicine and the insurance markets put together a competent policy that passes.
I get that is not going to happen.
MRIs that cost $3,000-4,000 USD
I got a $100,000 bill from the hospital last year. BCBS paid them ~$9k, I paid $3k. Costs are fungible.
No one has brought up tort reform on one side or price controls on the other.
The American College of Obstetricians and Gynecologists and its peer review journal, Obstetrics & Gynecology, initially denied the rise, then blamed it on women (who are too old, too fat, too unreasonable) and now blame it on regressive politics, pre-existing conditions such as heart disease and the opioid epidemic.
This was the first article I read. Young nurse who worked in a neo-natal center dies of HELLP syndrome while in the hospital. Her husband was a doctor, but the OB/GYN didn't catch the syndrome fast enough. Mistakes were made. It's horrific -- there's a clip of her smiling and holding her baby. She never made it out of the hospital due to not receiving adequate care for the syndrome including simple meds for high blood pressure.
"Just after midnight, her blood pressure about to peak at 197/117, Lauren began complaining of a headache. As Larry studied his wife’s face, he realized something had changed. “She suddenly looks really calm and comfortable, like she’s trying to go to sleep.” She gave Larry a little smile, but only the right side of her mouth moved."
https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system
Then I read a couple of articles comparing the US maternal death rate to the death rate in other countries. What's going on to cause this? "U.S. average has slipped from 12 deaths to 14 per 100,000 live births over the past 25 years, while Canada's is where it was in 1990, at seven."
http://www.cbc.ca/news/health/un-maternal-mortality-survey-1.3315309
"Health care" is not the same thing as health insurance. I have lived for the last 20 years just down the road from a guy who has not had a regular job or insurance in all that time. He works pretty much full time as a general purpose freelance handyman, gets paid in currency only, and, I suppose, reports very little of his income. Despite his lack of insurance or documented employment,he has had a triple bypass, a knee replacement with months of physical therapy, and treatment for extensive injuries he sustained when he ran his car off the road. He has no assets or income to garnish, so I guess his medical bills are being paid by those of us who spend our earnings on insurance. I don't think I believe that anybody will be losing their health care if Obamacare goes away.
Lots of TV ads here in Las Vegas which suggest that if the health care bill passes the Senate, the City will have to buy snow plows to clear the piles of rotting corpses from the streets.
@ARM Remember someone has to grow the stuff that people in cities eat. Of necessity those people will always live in rural areas. Are you suggesting that we shouldn't be concerned about their healthcare because they are being phased out? I thought not. I suspect that the UK system faces the same rural/urban problem in addition to its other problems.
WWWW,
Sorry. You misunderstood me. You lost me at the notion the problems you enumerated would be improved, much less solved, by outside experts and federal intervention.
"The US had (maybe still does) the best medical system in the world."
For those who can afford, or who can afford insurance that will cover it.
For the many who don't, it's not so wonderful.
"Our typical plan before the ACA was a Cadillac. No deductibles, copays around $10 or nothing. Now the average is a $5,000 deductible, copays of $50, $100, or more, and most striking is that it's near impossible now to find a doctor to take the plan or to get in to see him when you do. Still the plans cost double. We got conned, lied to, and ripped off."
How do you know the increased costs to you and the diminished coverage are a consequence of ACA? How do you know this isn't the normal progression of American health insurance--raise costs, cut coverage, increase profits--and wouldn't have happened if ACA had never been a gleam in The Heritage Foundation's think tank?
Cookie: "How do you know the increased costs to you and the diminished coverage are a consequence of ACA?"
Lol
How do we know it wasn't the Russians?
khesanh0802 said...
Remember someone has to grow the stuff that people in cities eat.
As I understand things, farmers themselves aren't doing that badly, it is everyone else that is losing ground. It is the same all over, London has become very distanced from the rest of the UK. In China only those who moved to cities really benefit from the new economy. The 'knowledge economy' which people initially thought would result in decentralization seems to have strongly favored the cities, probably because of better education available in the cities
"'People want the level of coverage provided by other western countries'
"1) if that myth were true, medical immigration to America wouldn't have been a thing"
How big "a thing" was it, ever? Sure, people with money will travel to get the best care, wherever it may be, but did the proles of nations outside the U.S. flood American hospitals by the millions or even hundreds of thousands to get American care?
"2) look at the teeth of the average Brit. Even their actors have poor dental."
I'm sure there are many reasons for that, and one can't assume it's because of their medical system.
"3) Americans don't want the required Socialism that must accompany such health 'care'"
No one knows what the system would like like, and you don't know that Americans don't want single-payer. We do know the politicians in Washington who are financially beholden to health care industry dollars don't want it...because their paymasters tell them not to want it.
"4) Americans don't want the accompanying death panels and medical rationing."
They've already got that with the insurance company administrators who get paid bonuses and receive raises for denying treatments and rejecting risky applicants from purchasing insurance care. (Or did, before ACA required insurance companies to sell insurance to people who had the temerity to get seriously ill at some point in their lives.)
"5) Americans don't want to out-source their national defense to another global power and redirect the savings to create a Welfare State of incompetence and dependency."
What "national defense?" Our military is an aggressive force, not a defensive one. When was the last time we actually fought in real defense of our country? Not in my lifetime, (and I was born when Eisenhower was President). We spend more on our military budget than most of the rest of the countries in the world combined. We could slash half or more out of the budget and still have a higher military budget than any other single nation, and probably more than multiple combinations of other nations.
We absolutely need to slash our War Department budget and funnel that money into productive uses for the American people, including funding for medical care.
"How do we know it wasn't the Russians?"
It's not. Take my word for it.
Yep...it's all the fault of Obamneycare.
Britain has the same problems with diet, obesity and opioids, but it does not have a 25 percent induction rate or a 40 percent cesarean section rate."
May we assume that these are for scheduling convenience reasons?
Moral of the story: perception matters. Redistributive change is good. Medical care has incidental value. Health care begins with sexual education (e.g. Planned Parenthood/abortion rites).
Blogger Robert Cook said...
Yep...it's all the fault of Obamneycare.
What has Romney to do with your foreign named orthopedist ?
Scams are more common with foreign medical graduates.
Boy, the lefties are going nuts on this topic. Good night.
but it does not have a 25 percent induction rate or a 40 percent cesarean section rate.
In addition to more bureaucratic rules and tight budgets, they have loser-pays lawsuits, so less defensive medicine.
How do you know the increased costs to you and the diminished coverage are a consequence of ACA?
Because Obama promised healthcare costs would go down by $2500 per family under Obamacare.
Michael K said...
Scams are more common with foreign medical graduates.
6/23/17, 9:18 PM
I take it you don't think importing doctors/nurses/medtechs is the answer?
I take it you don't think importing doctors/nurses/medtechs is the answer?
If that is the answer, what is the question ?
How to get yourself killed ?
For those who can afford, or who can afford insurance that will cover it.
For the many who don't, it's not so wonderful.
Cookie, where were you all those nights when I was operating on illegal aliens ?
Asleep, I assume.
Blogger AReasonableMan said...
wwww said...
I don't really understand what people want.
The level of medical coverage provided by most other western countries.
Without having to be lied to and manipulated and forced to participate. Other than that sure.
Average wait time for hip surgery in Canada 86 days. For a knee 104 days
In the UK it is 18 weeks.
Mine? 4 and a half weeks. I had to lose ten pounds first otherwise it would have been two weeks.
So yeah. Let's imitate other western countries. Good idea.
I'm willing to bet you have a primo health insurance scheme courtesy of your public sector job.
So yeah. Let's imitate other western countries. Good idea.
On this thread Americans have complained of not being able to get into a doctor for a month and sky-rocketing premiums. It's not a good advertisement for the American health care system.
Anyways, it doesn't matter. The German or Israeli health care system is not available to Americans.
The choice in front of Americans is Obamacare or the plan put forward by Mitch McConnell.
wwww said...
On this thread Americans have complained of not being able to get into a doctor for a month and sky-rocketing premiums.
This is the thing, in the minds of many, everything is bad about our system except that is much better than the socialist rubbish devised by all those foreigners.
Actual real world experience with other national health systems suggests that they have their advantages and that there are serious problems with our particular setup, yet we seem unwilling to learn from the experience of others.
Well, sure, except Michael K is an actual expert not just an internet commenter flapping his fingers.
Actual real world experience with other national health systems suggests that they have their advantages and that there are serious problems with our particular setup, yet we seem unwilling to learn from the experience of others.
Yeah, people are biased to their own experience. And the UK/Canadian systems are not the best run in respect to wait times for certain non-essential operations. Germany is much better. But I've known 2 people with cancer here, and they were treated promptly with surgery.
Something else is at work -- health care quality in the rest of the world hasn't held static since 1985. East Germany is no longer exists. Israel has a booming tech industry. The US is no longer the only game in town for top quality health care.
For surgeries like knee replacements -- India now has many quality private hospitals and medical tourism is a thing. Twenty years ago I wouldn't have wanted to set foot in an Indian hospital.
Getting into a GPs in a timely fashion and keeping maternal death rates low are important signs of a good health care system. That indicates a problem with quality of care.
But if you don't screen something important because you can't get into your GP, that's a problem. If daughter dies after giving birth, she's gone.
After reading the NPR piece I calculated the number of women dying after birth. It's appalling.
I'm intensely curious about what is causing such a steep increase of maternal deaths. It's gone up sharply since 1990 in the US. It can't be advanced maternal age, because it's holding steady or going down in other developed countries.
wwww said...
The US is no longer the only game in town for top quality health care.
I recently discovered that Dental Surgery tourism has become a thing, and my wife found it cheaper to take one of our dogs to Italy for veterinary surgery than to have the surgery done here. US veterinary costs here are a total scam, by the way.
Not sure how much international competition for medical care will affect the inflated prices here. Presumably it will have some effect on elective surgeries, unlikely to affect oncologists.
Michael K said...
I take it you don't think importing doctors/nurses/medtechs is the answer?
If that is the answer, what is the question ? How to get yourself killed ?
My Indian GI Dr, an older man whose lovely daughter is now also in practice with him, seems to know his business, but I can't see why Americans shouldn't get those jobs. Obviously not there just for the taking, but again, why aren't there more doctors? Not enough med school seats, right? So is that an answer, more seats? More schools, or grow the ones we have? More medical schools, more nursing schools? How can you have more care if you don't have enough carers? You'd think with all the people souring on law careers and law schools, there would be some medical quality brains to be picked off.
The best wai times for hip surgery in Europe is tied with Sweden and Denmark both being approx 60 days. Which is some comfort when your hip feels like broken glass every step you take.
ARM
Dog aren't people.
veterinarians are out of network.
Let's come up with a market based idea that has none of the inefficiencies and rationing of "other western countries"
"wwww said...
I don't really understand what people want.
"The level of medical coverage provided by most other western countries." And paid for by someone else!
William Chadwick said...
And paid for by someone else!
The US pays more not less for no better care.
That there is more than one country outside the US with a unique health system, might surprise some whose rhetoric suggests a vast wasteland of a series of Soviet style medical gulags. OECD data shows that waiting times are a problem in some countries, but only about half of those in the OECD. The others are like the United States in lack of significant waiting times, but unlike us they manage to do this with their entire population covered, and at significantly lower costs.
www says: "I don't really understand what people want. There ain't no such thing as a free lunch. Medical care is much more expensive then it was 30 years ago."
AReasonable[sic]Man* replies (leaving out half the above quote): "The level of medical coverage provided by most other western countries."
So I guess ARM thinks that, yes, there IS a free lunch! Yeah, he's "reasonable" all right. A regular Aristotle.
"The US pays more not less for no better care." And that fact (provided it is a fact) gives you the right to force Peter to pay for Paul's health care . . . how?
It's true that the overall systems tend to be less expensive and more efficient in Israel, France, Germany, Australia, Canada and Japan.
Sweden and Denmark have the shortest wait times in all of Europe and that is still a two month wait. To have to wait for care is neither cheap nor efficient.
The message from the pro ACA types is that universal health care is worth it even though it will be slow and mediocre.
Notwithstanding the fraud and outright lies it took to get it.
You keep rambling on about wait times for elective surgery but you haven't demonstrated that this is a particularly important measure relative to all the other measures of health care system performance and, even more problematically, you fail to note that the US is not the world leader in even this measure.
"One thing Bill Clinton did, that I thought was an effective tactic, was these "100,000 new teachers" or "100,000 new cops" plans. Why not "100,000 new nurses" or "10,000 new doctors?"
Always read the fine print.
Offer (Feds pay salaries) good for a limited time only.
Then it's on the locals, 100%.
Time's up? Absorb costs or fire them.
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