Current Status of Healthcare and its Challenges

[Wolverines83]

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Healthcare should not be treated as a commodity, should not be viewed as a product set for exchange. Rather it is a right which morally should be available to every individual whatever their risk just like every child in the U.S has a right to a public school education. Thus in my eyes the individual mandate has been long overdue.

Until the government forces all physicians to accept patients on the public option, nothing really will change. The crazy overhead costs which come from a privatized system also has not been solved. Salaries for mid-levels and PCPs might go up, procedural specialties might see salaries go down since it appears the focus of the Affordable healthcare act will be more on prevention. just my 2 cents.

I see where you're coming from. I think we have slightly different opinions on the same eventual problem/solution. The problem with the comparison to education is that if my son doesn't study, it doesn't drive up the tuition for your daughter who does. Healthcare is different because it depends on people proactively maintaining themselves. You don't study in school? You fail...I don't. You don't take care of yourself in healthcare? We all pay.

A single payer system puts too much power in the government's hands (yes, I said that). I am of the opinion that when given power, the government never gives it back and continually grabs for more...it's in its very nature. It's the only competitor that can make laws...think about it. Plus...talk about overhead costs! The government has to be the least efficient entity in the country...it takes years and billions of dollars to do anything....and that's only if the special interest groups don't get involved. Yikes...that's a long conversation. But, I do think the government could play a beneficial role in providing preventative care which in the end would benefit everyone.

Overhead costs get reduced by the competitor offering better pricing. Company A has better prices? See ya, company B! Government is too expensive? Too bad, it's taxes and the IRS is the most powerful being in America, pay up!

I believe the current system as a whole is trashed but I don't think the pieces of the machine should be completely throw out....maybe rearranged.

Yes, you can probably tell my political side from that last post but please don't take it as me saying "This is America, if you can't survive you die." I'm all for helping people, I think healthcare should be part of the benefits of being in our club; but I also think we have a responsibility not to abuse that benefit at the cost of our fellow members.

And I'll say it again...tort f-ing reform. The money for the malpractice doesn't come out of doctor's pockets, it comes out of patients. So just remember that...the patients are paying the lawyers....if anyone should be angry about this malpractice crap it should be the patients.

Also, kudos to everyone for not lashing out at each other on this thread and having a legit conversation.

 

[donkeykong1]

I see where you're coming from. I think we have slightly different opinions on the same eventual problem/solution. The problem with the comparison to education is that if my son doesn't study, it doesn't drive up the tuition for your daughter who does. Healthcare is different because it depends on people proactively maintaining themselves. You don't study in school? You fail...I don't. You don't take care of yourself in healthcare? We all pay.

A single payer system puts too much power in the government's hands (yes, I said that). I am of the opinion that when given power, the government never gives it back and continually grabs for more...it's in its very nature. It's the only competitor that can make laws...think about it. Plus...talk about overhead costs! The government has to be the least efficient entity in the country...it takes years and billions of dollars to do anything....and that's only if the special interest groups don't get involved. Yikes...that's a long conversation. But, I do think the government could play a beneficial role in providing preventative care which in the end would benefit everyone.

Overhead costs get reduced by the competitor offering better pricing. Company A has better prices? See ya, company B! Government is too expensive? Too bad, it's taxes and the IRS is the most powerful being in America, pay up!

I believe the current system as a whole is trashed but I don't think the pieces of the machine should be completely throw out....maybe rearranged.

Yes, you can probably tell my political side from that last post but please don't take it as me saying "This is America, if you can't survive you die." I'm all for helping people, I think healthcare should be part of the benefits of being in our club; but I also think we have a responsibility not to abuse that benefit at the cost of our fellow members.

And I'll say it again...tort f-ing reform. The money for the malpractice doesn't come out of doctor's pockets, it comes out of patients. So just remember that...the patients are paying the lawyers....if anyone should be angry about this malpractice crap it should be the patients.

Also, kudos to everyone for not lashing out at each other on this thread and having a legit conversation.

I understand the neclassical, chicago school of economics type argument you're trying to make for healthcare. I hear it all the time from Ron Paul lol. Privatization and the invisible hand are G-d. But when you think about it pragmatically its never going to work in reality. We're already in too big of a whole. To change one facet of our economic life that is in healthcare involves overhauling everything from our tax code to education. Tort reform is something the Republicans float around but when you actually look into peer reviewed research tort reform will bring only about a 3-5% decrease to overhead. Its just not enough. Neither is what Obama has done.

Getting back to my education analogy. You're right in a fully privatized system where the government plays absolutely no role in the economy, and there is no regulation, heck there isn't any licensure of physicians we shouldn't really care about the sick if they can't afford healthcare coverage then just like that kid who chooses not to study and fails out of school we should just let them live in their own misery which they actively chose. Besides for what is morally wrong with the picture of leaving a sick guy to die without offering him/her healthcare coverage and letting that kid fail out of school, there is something else that you should understand here. These individuals will eventually become a burden on the society us 300 million americans share together. That kid who failed out most likely will start going on the wrong path, possible becoming a thief, drug dealer, murderer, or another type social degenerate that will eventually be a threat to all of us, poor or rich, 99% or the 1%. That sick dude whom in a 100% privatized system w/o medicare/medicaid who cannot afford healthcare coverage is also a burden. That's one less person in the work force, one less employer, one less baker, teacher, farmer, engineer, store clerk. On the larger scale this loss will become more apparent.

That's how I view it. I think we should try and not look through the lens that our politicians, media establish for us. Think about it pragmatically. Life is irrational, and sometimes public policy needs to match that. I also enjoyed this thread very much!

 

[Wolverines83]

I understand the neclassical, chicago school of economics type argument you're trying to make for healthcare. I hear it all the time from Ron Paul lol. Privatization and the invisible hand are G-d. But when you think about it pragmatically its never going to work in reality. We're already in too big of a whole. To change one facet of our economic life that is in healthcare involves overhauling everything from our tax code to education. Tort reform is something the Republicans float around but when you actually look into peer reviewed research tort reform will bring only about a 3-5% decrease to overhead. Its just not enough. Neither is what Obama has done.

Getting back to my education analogy. You're right in a fully privatized system where the government plays absolutely no role in the economy, and there is no regulation, heck there isn't any licensure of physicians we shouldn't really care about the sick if they can't afford healthcare coverage then just like that kid who chooses not to study and fails out of school we should just let them live in their own misery which they actively chose. Besides for what is morally wrong with the picture of leaving a sick guy to die without offering him/her healthcare coverage and letting that kid fail out of school, there is something else that you should understand here. These individuals will eventually become a burden on the society us 300 million americans share together. That kid who failed out most likely will start going on the wrong path, possible becoming a thief, drug dealer, murderer, or another type social degenerate that will eventually be a threat to all of us, poor or rich, 99% or the 1%. That sick dude whom in a 100% privatized system w/o medicare/medicaid who cannot afford healthcare coverage is also a burden. That's one less person in the work force, one less employer, one less baker, teacher, farmer, engineer, store clerk. On the larger scale this loss will become more apparent.

That's how I view it. I think we should try and not look through the lens that our politicians, media establish for us. Think about it pragmatically. Life is irrational, and sometimes public policy needs to match that. I also enjoyed this thread very much!

See I'm not advocating leaving anyone out to dry. There's a line in my post that says I'm against the idea of "if you can't survive, you die." I think you took my message to an extreme. What I'm saying is that there is a role for each "side" here. Should the government run health care singlehandedly? No, they suck at everything they do, government is a black hole of spending. Should private companies bent on reaping massive profits run it singlehandedly? No, they'll take everything for themselves with the same eventual outcome. Each side has its benefits and what we need to do is set aside partisanship and realize that there is a positive role the government can play as well as a positive role for the private sector.

With regards to what I bolded above...if you read one of my earlier posts I explicitly stated that people should receive basic health care but should also bear some responsibility for their own actions. I absolutely believe that someone who chooses to destroy their body should be the one who bears the burden for their actions. Welfare isn't designed for those who don't want to work. It's designed for those who can't...but that doesn't stop people from abusing it. Same goes for disability insurance. Disability fraud is what drives up costs of disability insurance for the entire risk pool. Again, that's everyone paying for one person's actions.

In short, if you get sick you should get help. But if you just love your ho-hos, refuse to follow your physician's advice and now you're a 400 pound diabetic...well buddy, you're going to be on the hook for at least some of the cost because we did our part.

 

[FrkyBgStok]

A single payer system puts too much power in the government's hands (yes, I said that). I am of the opinion that when given power, the government never gives it back and continually grabs for more...it's in its very nature. It's the only competitor that can make laws...think about it. Plus...talk about overhead costs! The government has to be the least efficient entity in the country...it takes years and billions of dollars to do anything....and that's only if the special interest groups don't get involved. Yikes...that's a long conversation. But, I do think the government could play a beneficial role in providing preventative care which in the end would benefit everyone.

I am not going to address this entire paragraph while I largely disagree, but I will address the bolded sentence as it is involved in healthcare. Medicare is one of the most efficient forms of providing healthcare in the world. I am not saying that it is good, right, the best, or any other positive or negative thing that one can think of, but it is very efficient.

 

[donkeykong1]

See I'm not advocating leaving anyone out to dry. There's a line in my post that says I'm against the idea of "if you can't survive, you die." I think you took my message to an extreme. What I'm saying is that there is a role for each "side" here. Should the government run health care singlehandedly? No, they suck at everything they do, government is a black hole of spending. Should private companies bent on reaping massive profits run it singlehandedly? No, they'll take everything for themselves with the same eventual outcome. Each side has its benefits and what we need to do is set aside partisanship and realize that there is a positive role the government can play as well as a positive role for the private sector.

With regards to what I bolded above...if you read one of my earlier posts I explicitly stated that people should receive basic health care but should also bear some responsibility for their own actions. I absolutely believe that someone who chooses to destroy their body should be the one who bears the burden for their actions. Welfare isn't designed for those who don't want to work. It's designed for those who can't...but that doesn't stop people from abusing it. Same goes for disability insurance. Disability fraud is what drives up costs of disability insurance for the entire risk pool. Again, that's everyone paying for one person's actions.

In short, if you get sick you should get help. But if you just love your ho-hos, refuse to follow your physician's advice and now you're a 400 pound diabetic...well buddy, you're going to be on the hook for at least some of the cost because we did our part.

Definitely agree with you in wanting to strike a balance between the role of the government and the private sector. In any system or dynamic which is theoretically possible to propose for healthcare there are going to be people that abuse the system: greedy insurance companies jacking up deductibles, individuals that are not concerned with their health, people that use unnecessary doctor visits, docs that order unnecessary tests etc...Yet, even with that I'm all for a regulation of healthcare that is based in its core on scientific reasoning/research, and more importantly what is morally right and less on what will give you the most return on your investment. Morally right for me is defined on the values of justice, human life and liberty.

 

[Wolverines83]

Definitely agree with you in wanting to strike a balance between the role of the government and the private sector. In any system or dynamic which is theoretically possible to propose for healthcare there are going to be people that abuse the system: greedy insurance companies jacking up deductibles, individuals that are not concerned with their health, people that use unnecessary doctor visits, docs that order unnecessary tests etc...Yet, even with that I'm all for a regulation of healthcare that is based in its core on scientific reasoning/research, and more importantly what is morally right and less on what will give you the most return on your investment. Morally right for me is defined on the values of justice, human life and liberty.

I agree. I'm just saying I think it's immoral for people to abuse systems that others are paying into. In other words, in addition to taking care of the sick, we also have a responsibility to ensure that the people who maintain their health are not taken advantage of by those who don't. I'm not sure if you're referencing anything I said when you say "return on investment." I'm not considering it as such....it's just that our system right now is in trouble because of money running out so we need to ensure a future system is financially viable, that's all.

FrkyBgStok: When I say efficient I mean cost effective and able to adapt to changing conditions. Maybe I need to read up on the cost effectiveness of medicare. My time in the military showed me one thing...it takes FOREVER for the government bureaucracy to do anything. If we needed something while we were Iraq we went to the civilian contractors because they got it done better and faster. Not because they were better at their job but their system had less red tape.

 

[donkeykong1]

I am not going to address this entire paragraph while I largely disagree, but I will address the bolded sentence as it is involved in healthcare. Medicare is one of the most efficient forms of providing healthcare in the world. I am not saying that it is good, right, the best, or any other positive or negative thing that one can think of, but it is very efficient.

Here's some stats to back you up Frky. Straight out of my thesis:

In an article published in The New England Journal of Medicine, entitled “Costs of Health Care Administration in the United States and Canada,” the authors report that 31 percent of the cost of healthcare in the U.S is based just on administrative costs. This is compared to the 3 percent administrative cost in Europe and not surprisingly in U.S government subsidized Medicare and Medicaid.

 

[Wolverines83]

Here's some stats to back you up Frky. Straight out of my thesis:

In an article published in The New England Journal of Medicine, entitled “Costs of Health Care Administration in the United States and Canada,” the authors report that 31 percent of the cost of healthcare in the U.S is based just on administrative costs. This is compared to the 3 percent administrative cost in Europe and not surprisingly in U.S government subsidized Medicare and Medicaid.

Interesting. Just curious if that accounts for the drastically different amounts that are paid out by each. Private insurers generally don't pay as much in claims as medicare. If medicare is paying crazy amounts in claims for their (presumably) older and sicker patients...isn't that just causing the administrative costs to be a smaller part of a larger pool of expenses? In other words...is that apples to apples?

Don't take that as a hostile response, just playing devil's advocate....plus, aren't you required to defend your thesis anyway? lol

 

[donkeykong1]

I agree. I'm just saying I think it's immoral for people to abuse systems that others are paying into. In other words, in addition to taking care of the sick, we also have a responsibility to ensure that the people who maintain their health are not taken advantage of by those who don't. I'm not sure if you're referencing anything I said when you say "return on investment." I'm not considering it as such....it's just that our system right now is in trouble because of money running out so we need to ensure a future system is financially viable, that's all.

FrkyBgStok: When I say efficient I mean cost effective and able to adapt to changing conditions. Maybe I need to read up on the cost effectiveness of medicare. My time in the military showed me one thing...it takes FOREVER for the government bureaucracy to do anything. If we needed something while we were Iraq we went to the civilian contractors because they got it done better and faster. Not because they were better at their job but their system had less red tape.

Yup, government bureaucracy does slow down everything it touches. look at the DMV, applying for student aid etc...This is however where the private sector can come in as champions of convenience and become a much faster access point for healthcare. See those cheap time efficient Walmart clinics that's what these guys are working off of.

Also people like Jon Stewart (whom i seriously admire) and other liberals like Pelosi, Reid like to make the comparison to Europe and Canada and note their efficiency. Yet, there is one flaw to this argument. You cannot compare healthcare among nations without considering their demographics. In general we are old, fat, diabetic...while Canadians and most European nations are younger, leaner,and in better shape which means that more individuals don't need to visit their physicians more than their annual check ups when compared to americans. Once there is universal healthcare in the U.S and eventually like in 20 yrs when maybe all Physicians will be required to accept the public option, the waiting time in the E.D, or your PCP office will get longer. To say that well its not that long in Canada or Europe is nonsense.Its like comparing apples to oranges!

 

[donkeykong1]

Interesting. Just curious if that accounts for the drastically different amounts that are paid out by each. Private insurers generally don't pay as much in claims as medicare. If medicare is paying crazy amounts in claims for their (presumably) older and sicker patients...isn't that just causing the administrative costs to be a smaller part of a larger pool of expenses? In other words...is that apples to apples?

Don't take that as a hostile response, just playing devil's advocate....plus, aren't you required to defend your thesis anyway? lol

Haha, yah its good practice to talk this out. The thing is that medicaid/medicare might take on a larger number of claims than private insurers but they don't cover as much thus their expenses are less than private insurers, also they reimburse physicians/dentists or whatever at a lesser rate. With a lesser amount of expenses then, they can afford to promote smaller co-pays, don't have deductibles, don't need a large administrative structure,...

This thread really makes it seem like getting an M.H.A is really not necessary (not that i'm planning on getting one ha ha). When you have a thread with a network of intelligent people talking healthcare why sit in on countless boring lectures and pay a steep tuition lol!

 

[FrkyBgStok]

Medicare also has other problems that I addressed earlier in the thread, but it goes back to socialized medicine. Medicare costs can be low because of paying physicians less, and physicians hate taking medicare for the same reason anyone else would. If you were a waiter and you had two customers come in every single day, one of them giving a 25% tip and one giving a 5% tip, the waiter will grow to loathe the 5% tipper regardless of how easy the person might be in addition to the fact that 5% is better than nothing.

And because the government pool is so large, the government says, "here is what we are paying, period." Like the occ-med example I used. With options, it is going to piss people off. This is why I think a single payer is bad. But it isn't worth bringing up again.

A public option is better, but it is just going to cause more separation and eventually, most physicians will be private practice saying "we won't accept the public option." Government could force people to, but there will be ways around it and when people aren't accepting, we have the same problem now.

So we have the nonprofit basic care and the for profit extended care idea that I proposed. Because everyone is represented in the basic care, it would be fair all around. Sure physicians would want the for profit patients, but because reimbursement is fair, they aren't going to loathe the basic patient. Tort reform would be attached, so they wouldn't need to practice defensive medicine. People would also be forced to purchase coverage. Poor people wouldn't get free coverage, but it could be subsidized. All companies would be required to offer the basic coverage. It could continue to be attached to employers, but everyone has a choice. If I want to use my employers plan that they help with, cool. If not, I can go over here and purchase this one. The government could also provide basic coverage services so if someone loses their job, they can still get coverage, but because the basic plan is universal, you won't get any drastic difference in care than you had before. And any premium would be based on health outcomes. If you smoke and are overweight, X amount. You lose weight, X drops. You quit smoking, X drops. That way people are not only rewarded for getting healthy, but people that are already healthy aren't paying for everyone. Lots of logistics, but I personally think it would be the closest thing to a perfect system that we could achieve. Yes, there would be tiered care, but we do live in a capitalist society.

 

[Wolverines83]

Medicare also has other problems that I addressed earlier in the thread, but it goes back to socialized medicine. Medicare costs can be low because of paying physicians less, and physicians hate taking medicare for the same reason anyone else would. If you were a waiter and you had two customers come in every single day, one of them giving a 25% tip and one giving a 5% tip, the waiter will grow to loathe the 5% tipper regardless of how easy the person might be in addition to the fact that 5% is better than nothing.

And because the government pool is so large, the government says, "here is what we are paying, period." Like the occ-med example I used. With options, it is going to piss people off. This is why I think a single payer is bad. But it isn't worth bringing up again.

A public option is better, but it is just going to cause more separation and eventually, most physicians will be private practice saying "we won't accept the public option." Government could force people to, but there will be ways around it and when people aren't accepting, we have the same problem now.

So we have the nonprofit basic care and the for profit extended care idea that I proposed. Because everyone is represented in the basic care, it would be fair all around. Sure physicians would want the for profit patients, but because reimbursement is fair, they aren't going to loathe the basic patient. Tort reform would be attached, so they wouldn't need to practice defensive medicine. People would also be forced to purchase coverage. Poor people wouldn't get free coverage, but it could be subsidized. All companies would be required to offer the basic coverage. It could continue to be attached to employers, but everyone has a choice. If I want to use my employers plan that they help with, cool. If not, I can go over here and purchase this one. The government could also provide basic coverage services so if someone loses their job, they can still get coverage, but because the basic plan is universal, you won't get any drastic difference in care than you had before. And any premium would be based on health outcomes. If you smoke and are overweight, X amount. You lose weight, X drops. You quit smoking, X drops. That way people are not only rewarded for getting healthy, but people that are already healthy aren't paying for everyone. Lots of logistics, but I personally think it would be the closest thing to a perfect system that we could achieve. Yes, there would be tiered care, but we do live in a capitalist society.

OK, you must have been the one above that I was talking this out with. I think that's a great way to do it. Like you said, lots of logistics to work out but no one said something like this would be easy.

 

[ManBroDude]

Here's some stats to back you up Frky. Straight out of my thesis:

In an article published in The New England Journal of Medicine, entitled “Costs of Health Care Administration in the United States and Canada,” the authors report that 31 percent of the cost of healthcare in the U.S is based just on administrative costs. This is compared to the 3 percent administrative cost in Europe and not surprisingly in U.S government subsidized Medicare and Medicaid.

Your claim is actually only true for the private sector. Would you wanna guess what the overhead administrative costs are for one of the largest government entities, which commands a staggering 555 billion dollar budget and goes by the name of Medicare?

7 billion, or 1.2%. The private sector is commonly quoted at 30% due to investor payouts, executive pay, administrative costs, and EMR systems, but this number is more squishy as it changes between private problems.

http://www.politifact.com/truth-o-m...a-boxer-says-medicare-overhead-far-lower-pri/

 

[donkeykong1]

Your claim is actually only true for the private sector. Would you wanna guess what the overhead administrative costs are for one of the largest government entities, which commands a staggering 555 billion dollar budget and goes by the name of Medicare?

7 billion, or 1.2%. The private sector is commonly quoted at 30% due to investor payouts, executive pay, administrative costs, and EMR systems, but this number is more squishy as it changes between private problems.

http://www.politifact.com/truth-o-m...a-boxer-says-medicare-overhead-far-lower-pri/

In academia the number "floating" around for overhead is 3% for medicaid/medicare and 30% for private insurers. That number is the average, and I'm sure there are some states which sponsor quasi-private insurers that have overhead closer to 11% like the article says.Sure its a take a huge sum of money to subsidize medicare/medicaid, yet there's no product out there that's quite as efficient right now in the U.S.

Also thanks for the article but it ends in a really weird way it seems like its implying that the same individuals that are on medicare/medicaid have a choice on whether to be on those subsidized plans as opposed to being privately insured at this time:

"But for most plans and patients, the difference between Medicare overhead and private-sector overhead is not as great as she suggests. So we rate her statement Half True."