Single payer system

[vector2]

Ima just put this right here

We could easily afford a two-tier system like Australia where everyone is covered by some basic plan and physician income is still preserved if some of the massive private insurance administrative costs were funneled toward physician reimbursement under the new system.

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[acidbase1]

Silly argument. I won't volunteer my services for free, but I can accept less pay if it means drastically better outcomes for marginalized people. I think it's absolutely disgraceful and embarrassing that such a rich and powerful country as ours has people without health coverage. I'm willing to pay more in taxes and get less salary to achieve universal health coverage.

This guy has been studying up on liberal talking points on Facebook. Bravo

 

[deleted162650]

Would also help with the quantity and overhead of administrators.

Have you ever set foot in any kind of government run facility? Military, VA, Courthouse, DMV?????

Not exactly a beacon of efficiency and cost effectiveness. These places are littered with middle management admins. And to make matters worse, they actively try to be as unproductive as possible.

 

[pgg]

I think it's a great idea to base your political ideas and votes on what will affect you personally, without regard to how it will affect society at large and especially those far less well-off than yourself.

I say, we stick it to the 1%'ers and tax 'em at 60----no, 70%!

Since an American who earns $33,000/year is in the top 1% of the world's population, that will provide enough tax revenue to pay for clean water, education, and universal healthcare for everyone in Africa, India, China, southeast Asia, Indonesia, South America. A third of the planet lives on less than $2/day.[1] People who are clearly, far less well-off than any of us.

Who's with me? I know jonnythan is!



[1] Granted, the equivalent of "$2" goes further in Bangladesh than it does in Manhattan.

 

[el_duderino]

So you guys just don't care that we have millions of people who don't have health insurance. That's fine.

I think it's embarrassing, but if you guys are OK with it, I'm not going to be able to convince you there's something wrong with it.

 

[el_duderino]

Have you ever set foot in any kind of government run facility? Military, VA, Courthouse, DMV?????

Not exactly a beacon of efficiency and cost effectiveness. These places are littered with middle management admins. And to make matters worse, they actively try to be as unproductive as possible.

I used to work in a government agency. I know how it is.

I've also seen hospital billing departments, insurance contracts, and small clinic billing.

The amount of overhead we need for dozens or hundreds of insurance companies to each deal with hundreds or thousands of health care providers is enormous. It's far in excess of the administrative overhead of, say, the NHS.

 

[SolidWater]

So you guys just don't care that we have millions of people who don't have health insurance. That's fine.

I think it's embarrassing, but if you guys are OK with it, I'm not going to be able to convince you there's something wrong with it.

You're missing this point, and continue to miss the point even though numerous replies before have made it quite clear: we pay taxes.

Some of us >40% of our income is taken from us. That a large chunk of this already goes to social services like medicare/caid is a foregone conclusion. We already pay for healthcare for others, in addition to the "free" healthcare we provide to those we send bills to, but who never pay.

Additionally, we do have healthcare for all - it's called emergency room + EMTALA. People will get their care. Is it optimal? Hardly. But we as a nation allow a prioritization of our military over other things. The money is there. Don't tax me more, don't regulate me more. BE RESPONSIBLE.

Furthermore, it's possible to have universal healthcare and not have a single payer (e.g. Germany's system). There are elegant solutions for optimizing how we spend money on healthcare. Let's start with the simple things:
1) Cut out useless, bloated admins.
2) Deregulate (the bloated admins in #1 force me to write notes, spend time, and otherwise "treat" patients who don't need treatment.) I'm required to treat the drunk a-hole that comes into my ICU with benzos instead of a beer. He's more likely to go into DTs and die in the hospital. If I just cut the guy loose he'll self medicate for "free." Why does my hospital pay for people (plural) to walk around policing hand washing, not having drinks at a nursing station, etc? Useless. Show me the studies that it improves outcomes. I'll show you the graphs that it's increasing costs, though!
3) Incentivize productivity (like how capitalism automatically does). This is not the government way - ever been to DMV, post office, etc.?

As was pointed out earlier - these same people without health insurance DO have iphones, beer, food, entertainment, cars. We are all faced with decisions in life.

 

[acidbase1]

You're missing this point, and continue to miss the point even though numerous replies before have made it quite clear: we pay taxes.

Some of us >40% of our income is taken from us. That a large chunk of this already goes to social services like medicare/caid is a foregone conclusion. We already pay for healthcare for others, in addition to the "free" healthcare we provide to those we send bills to, but who never pay.

Additionally, we do have healthcare for all - it's called emergency room + EMTALA. People will get their care. Is it optimal? Hardly. But we as a nation allow a prioritization of our military over other things. The money is there. Don't tax me more, don't regulate me more. BE RESPONSIBLE.

Furthermore, it's possible to have universal healthcare and not have a single payer (e.g. Germany's system). There are elegant solutions for optimizing how we spend money on healthcare. Let's start with the simple things:
1) Cut out useless, bloated admins.
2) Deregulate (the bloated admins in #1 force me to write notes, spend time, and otherwise "treat" patients who don't need treatment.) I'm required to treat the drunk a-hole that comes into my ICU with benzos instead of a beer. He's more likely to go into DTs and die in the hospital. If I just cut the guy loose he'll self medicate for "free." Why does my hospital pay for people (plural) to walk around policing hand washing, not having drinks at a nursing station, etc? Useless. Show me the studies that it improves outcomes. I'll show you the graphs that it's increasing costs, though!
3) Incentivize productivity (like how capitalism automatically does). This is not the government way - ever been to DMV, post office, etc.?

As was pointed out earlier - these same people without health insurance DO have iphones, beer, food, entertainment, cars. We are all faced with decisions in life.

Never EVER speak logic to a liberal...

 

[el_duderino]

You're missing this point, and continue to miss the point even though numerous replies before have made it quite clear: we pay taxes.

Some of us >40% of our income is taken from us. That a large chunk of this already goes to social services like medicare/caid is a foregone conclusion. We already pay for healthcare for others, in addition to the "free" healthcare we provide to those we send bills to, but who never pay.

Additionally, we do have healthcare for all - it's called emergency room + EMTALA. People will get their care. Is it optimal? Hardly. But we as a nation allow a prioritization of our military over other things. The money is there. Don't tax me more, don't regulate me more. BE RESPONSIBLE.

Furthermore, it's possible to have universal healthcare and not have a single payer (e.g. Germany's system). There are elegant solutions for optimizing how we spend money on healthcare. Let's start with the simple things:
1) Cut out useless, bloated admins.
2) Deregulate (the bloated admins in #1 force me to write notes, spend time, and otherwise "treat" patients who don't need treatment.) I'm required to treat the drunk a-hole that comes into my ICU with benzos instead of a beer. He's more likely to go into DTs and die in the hospital. If I just cut the guy loose he'll self medicate for "free." Why does my hospital pay for people (plural) to walk around policing hand washing, not having drinks at a nursing station, etc? Useless. Show me the studies that it improves outcomes. I'll show you the graphs that it's increasing costs, though!
3) Incentivize productivity (like how capitalism automatically does). This is not the government way - ever been to DMV, post office, etc.?

As was pointed out earlier - these same people without health insurance DO have iphones, beer, food, entertainment, cars. We are all faced with decisions in life.

EMTALA is "healthcare for all"?

My lord.

 

[acidbase1]

EMTALA is "healthcare for all"?

My lord.

Better than anywhere else in the world

 

[zero0]

You're missing this point, and continue to miss the point even though numerous replies before have made it quite clear: we pay taxes.

Some of us >40% of our income is taken from us. That a large chunk of this already goes to social services like medicare/caid is a foregone conclusion. We already pay for healthcare for others, in addition to the "free" healthcare we provide to those we send bills to, but who never pay.

Additionally, we do have healthcare for all - it's called emergency room + EMTALA. People will get their care. Is it optimal? Hardly. But we as a nation allow a prioritization of our military over other things. The money is there. Don't tax me more, don't regulate me more. BE RESPONSIBLE.

Furthermore, it's possible to have universal healthcare and not have a single payer (e.g. Germany's system). There are elegant solutions for optimizing how we spend money on healthcare. Let's start with the simple things:
1) Cut out useless, bloated admins.
2) Deregulate (the bloated admins in #1 force me to write notes, spend time, and otherwise "treat" patients who don't need treatment.) I'm required to treat the drunk a-hole that comes into my ICU with benzos instead of a beer. He's more likely to go into DTs and die in the hospital. If I just cut the guy loose he'll self medicate for "free." Why does my hospital pay for people (plural) to walk around policing hand washing, not having drinks at a nursing station, etc? Useless. Show me the studies that it improves outcomes. I'll show you the graphs that it's increasing costs, though!
3) Incentivize productivity (like how capitalism automatically does). This is not the government way - ever been to DMV, post office, etc.?

As was pointed out earlier - these same people without health insurance DO have iphones, beer, food, entertainment, cars. We are all faced with decisions in life.

You, I like you.

 

[Monty Python]

Ima just put this right here

We could easily afford a two-tier system like Australia where everyone is covered by some basic plan and physician income is still preserved if some of the massive private insurance administrative costs were funneled toward physician reimbursement under the new system.

What happened circa 1992 to cause an explosion of admin types? Is that when DRGs hit full force and we needed paper pushers to keep up with it all?

 

[Twiggidy]

[1] Granted, the equivalent of "$2" goes further in Bangladesh than it does in Manhattan.

I think like a liter of beer cost 10c in Ghana

 

[SolidWater]

What happened circa 1992 to cause an explosion of admin types? Is that when DRGs hit full force and we needed paper pushers to keep up with it all?

That's likely part of it. I think that came about starting in the 1980's: Tax Equity and Fiscal Responsibility Act of 1982 - Wikipedia

The 1990's also brought HIPPA (which is more than just privacy laws):Health Insurance Portability and Accountability Act - Wikipedia

Not exactly light reading. This also probably helps account - at least in part - for the rising administrative costs. Can you understand the entirety of those laws? They're only a couple of the many that were enacted (and this isn't even covering their amendments, which are many). We better hire some administrators to help us sift through this.

 

[GravelRider]

Why does this thread get more hits than the one with the dude trying to get ripped by shooting sux and riding his dad’s cpap machine?

 

[acidbase1]

EMTALA is "healthcare for all"?

My lord.

A bum can walk into northwestern and get the same level of care as me. If that isn’t good I don’t know what is

For free I might add. Me on the other hand will be paying cash for the visit bc I have yet to meet my 5k deductible. ‘Merica

 

[Man o War]

Honestly both US and Euro style single payer systems have their downsides. I’ll take our downsides all day long though. I have an old friend in NHS system that’s been waiting on a list for a hip replacement for months- meanwhile his mobility gets worse and worse. So how do you think he’s going to recover now as opposed to having been able to get surgery when he was still more functional like he could’ve in the US?

 

[acidbase1]

ill do you one better. My sister is a PCP in Europe, (American trained but married a Brit) and she constantly tells me stories about how awful their system is. For example, all the docs draw blood on their patients. Additionally, they aren’t provided alcohol wipes prior to the stick. True story. It takes 6 months to get into see a rheumatologist. You have to wait for CABGs. There’s a reason why all the Canadians come to America for serious health matters

 

[Man o War]

ill do you one better. My sister is a PCP in Europe, (American trained but married a Brit) and she constantly tells me stories about how awful their system is. For example, all the docs draw blood on their patients. Additionally, they aren’t provided alcohol wipes prior to the stick. True story. It takes 6 months to get into see a rheumatologist. You have to wait for CABGs. There’s a reason why all the Canadians come to America for serious health matters

That’s awful. I think the average American thinks they’re going to have single payer, and nothing will change except now it’s “free”. Same service, no cost.

 

[Money Moniker]

Here's some white pills for once:

Millenials are beginning to turn away from the left, which would just about spell doom for the democrats for the foreseeable future:

The online survey of more than 16,000 registered voters ages 18 to 34 shows their support for Democrats over Republicans for Congress slipped by about 9 percentage points over the past two years, to 46 percent overall. And they increasingly say the Republican Party is a better steward of the economy.

Exclusive: Democrats lose ground with millennials - Reuters/Ipsos poll

Even black men are increasing their support for Trump. It's probably a flash in the pan, but the democrats simply have no pathway to victory on the national level if their share of the black vote dips significantly below the absurdly lopsided 90%+ they have historically enjoyed, and Trump is uniquely positioned to appeal to black men.
The Kanye Effect -- Black Male Approval For Trump DOUBLES In Just One Week

None of this is to say we can keep the socialpocalypse at bay forever, but it's by no means inevitable the left will have consolidated the political power needed to pass it during the next couple of election cycles in the 2020's. The trick isn't to stop it, but to keep it at bay long enough to financially decouple our fates from the American healthcare and tax systems by the time it rolls around. My dream vision is to watch the socialist debacle unfold, but from the safety of my foreign legal residence, my assets securely ensconced in an impenetrable fastness beyond the reach of bloodsucking socialists like jonnythan and his ilk.

 

[Man o War]

Here's some white pills for once:

Millenials are beginning to turn away from the left, which would just about spell doom for the democrats for the foreseeable future:



Exclusive: Democrats lose ground with millennials - Reuters/Ipsos poll

Even black men are increasing their support for Trump. It's probably a flash in a pan, but the democrats simply have no pathway to victory on the national level if their share of the black vote dips significantly below the absurdly lopsided 90%+ they have historically enjoyed, and Trump is uniquely positioned to appeal to black men.
The Kanye Effect -- Black Male Approval For Trump DOUBLES In Just One Week

None of this is to say we can keep the socialpocalypse at bay forever, but it's by no means inevitable the left will have consolidated the political power needed to pass it during the next couple of election cycles in the 2020's. The trick isn't to stop it, but to keep it at bay long to financially decouple our fates from the American healthcare and tax systems by the time it rolls around. My dream vision is to watch the socialist debacle unfold, but from the safety of my foreign legal residence, my assets securely ensconced in an impenetrable fastness beyond the reach of bloodsucking socialists like jonnythan and his ilk.

I could retire tomorrow, I just really like what I do.
I’m more concerned about my health care in old age and the health care of my children. I want all of you young docs to have the same kind of career I did....because then I don’t need to worry about the best and brightest still choosing medicine.
I won’t retire to the country because I’m scared to death of ending up at some BFE hospital with a bunch of noctors screwing the pooch because some hospital is too freaking cheap to hire doctors.

 

[anonperson]

Silly argument. I won't volunteer my services for free, but I can accept less pay if it means drastically better outcomes for marginalized people. I think it's absolutely disgraceful and embarrassing that such a rich and powerful country as ours has people without health coverage. I'm willing to pay more in taxes and get less salary to achieve universal health coverage.

Speak for yourself.

I'm not willing to pay a cent more than I need to in taxes or take any less in compensation.

Healthcare isn't perfect in this country but it's pretty damn good. I've had patients come in from Mexico at 35 weeks pregnant, get emergency medi-cal (medicaid) and deliver at a pretty nice hospital with reasonably good care. What other country allows $hit like this to happen?

Giving up more money won't solve the problem as the government (federal, state) is a black holes that will always ask for more money. The VA barely functions as it is. Why would I want that to expand?

 

[caligas]

Why would I vote to support the social program freeloaders isn’t this country? I worked hard to get where I am and pay 40% of my income in taxes.

I agree we pay a lot, but is it really 40%?

Doctors don't pay 50% of their income in taxes | The White Coat Investor - Investing And Personal Finance for Doctors

 

[VA Hopeful Dr]

I agree we pay a lot, but is it really 40%?

Doctors don't pay 50% of their income in taxes | The White Coat Investor - Investing And Personal Finance for Doctors

I used this website: Free Income Tax Calculator - Estimate Your Taxes | SmartAsset

For a single physician in CA who doesn't save for retirement or do anything to lower tax burden other than take the standard deduction, if you earn $400,000/year you're likely to end up owing 41% in total income taxes.

Increase income to 600k but add in marriage, 2 kids and full 401K you're still looking at 37%.

So yeah I doubt most are paying 40% but I bet lots are in the 30s if not upper 30s.

 

[Man o War]

I agree we pay a lot, but is it really 40%?

Doctors don't pay 50% of their income in taxes | The White Coat Investor - Investing And Personal Finance for Doctors

My accountant always figures my net income tax rate after he is done; after all deductions are taken, AMT applied, etc. You also have to include local taxes. I also lived in a state for a while where we had another layer of regional taxes which bumped up my percentage quite a bit for those years. Between fed, state and local I'm always between 35 and 40 percent. I've never paid more than 40. My CPA is projecting my taxes to be lower under the new tax plan, but i'll have to let you know how it washes out next April and I know how much I made this year.
I understand we are strictly talking income tax here, but this doesn't even include the misc taxes we all pay- property, sales tax(huge in no income tax states), registering cars, the list goes on and on. All these taxes are also generally higher in states that have no state tax, so this article does a pretty poor job of looking at the whole picture. I bet most of us would be shocked if we added it all up and looked at our real effective tax rate after all that.

 

[acidbase1]

I agree we pay a lot, but is it really 40%?

Doctors don't pay 50% of their income in taxes | The White Coat Investor - Investing And Personal Finance for Doctors

Between state and federal taxes, yes it’s 40%

 

[acidbase1]

Once I’m finished paying: disability insurance, life insurance, medical malpractice insurance, auto/home etc etc. I’m lucky to make it home with 40%. But hey, let’s get Berne’s sanders elected and kick up the rate to 60%

 

[sleepallday]

A bum can walk into northwestern and get the same level of care as me. If that isn’t good I don’t know what is

For free I might add. Me on the other hand will be paying cash for the visit bc I have yet to meet my 5k deductible. ‘Merica

Not entirely true. Life or death emergency care, yeah sure you'll probably get that. But anything else, if the patient does not have insurance, they can get shipped out to another hospital. I see it all the time- at least a couple open fractures get transferred to my hospital daily. And they never have insurance coincidently. But, yes, eventually you'll get the care.

Our pain docs also talk about all the spine surgeons that seem to always recommend "non-surgical treatment" for patients with no insurance or low paying insurance.

 

[VA Hopeful Dr]

Not entirely true. Life or death emergency care, yeah sure you'll probably get that. But anything else, if the patient does not have insurance, they can get shipped out to another hospital. I see it all the time- at least a couple open fractures get transferred to my hospital daily. And they never have insurance coincidently. But, yes, eventually you'll get the care.

Our pain docs also talk about all the spine surgeons that seem to always recommend "non-surgical treatment" for patients with no insurance or low paying insurance.

So those patients actually get appropriate care from the spine surgeons while people with good insurance don't?

I should point out this is me being snarky.

 

[Perrotfish]

Not entirely true. Life or death emergency care, yeah sure you'll probably get that. But anything else, if the patient does not have insurance, they can get shipped out to another hospital. I see it all the time- at least a couple open fractures get transferred to my hospital daily. And they never have insurance coincidently. But, yes, eventually you'll get the care.

Our pain docs also talk about all the spine surgeons that seem to always recommend "non-surgical treatment" for patients with no insurance or low paying insurance.

Yeah that's the argument for universal healthcare. We basically have universal care, but only for insanely expensive things of limited utility. We pay for the teenager's delivery but not her birth control. We pay for the asthmatic's ICU stay but not for his flovent. We pay for the diabetic's Kidney transplant but not the insulin.

It seems like a pretty simple, low cost change would to give everyone a healthcare spending accounts that can only be used for primary care visits and preventative meds. Make the low cost, high yield stuff universal.

 

[VA Hopeful Dr]

Yeah that's the argument for universal healthcare. We basically have universal care, but only for insanely expensive things of limited utility. We pay for the teenager's delivery but not her birth control. We pay for the asthmatic's ICU stay but not for his flovent. We pay for the diabetic's Kidney transplant but not the insulin.

It seems like a pretty simple, low cost change would to give everyone a healthcare spending accounts that can only be used for primary care visits and preventative meds. Make the low cost, high yield stuff universal.

OCPs are $9/month, insulin can be had for $25/vial, there's an off-brand Advair that's $50. We don't need insurance for this stuff.

 

[aneftp]

I believe some combination of 40% of American are already on single payer Medicaid/Medicare/children’s Medicaid/tricare

The problem is 60% have commercial insurance. And those on Medicare (15% of the population) have similar access to the same networks as those with commercial insurance.

So true 100% single payor involves a more restrictive network to save costs. Can politicans lie to the American public like Obama did when he said you can keep your same doctors with the Aca exchanges??

If politicans are straight up with the public. Say. Single payor will work this way. Where you have similar access to networks as those on Medicaid. And the similar public wants true single payor. Than accept that this will involve compromise.

But I have a feeling politicans will lie like they did with Obamacare.

Something has to give. Only cost savings will involve sacrifices

 

[el_duderino]

I believe some combination of 40% of American are already on single payer Medicaid/Medicare/children’s Medicaid/tricare

The problem is 60% have commercial insurance. And those on Medicare (15% of the population) have similar access to the same networks as those with commercial insurance.

So true 100% single payor involves a more restrictive network to save costs. Can politicans lie to the American public like Obama did when he said you can keep your same doctors with the Aca exchanges??

If politicans are straight up with the public. Say. Single payor will work this way. Where you have similar access to networks as those on Medicaid. And the similar public wants true single payor. Than accept that this will involve compromise.

But I have a feeling politicans will lie like they did with Obamacare.

Something has to give. Only cost savings will involve sacrifices

That adds up to 100% of Americans covered by insurance. Might want to check the numbers.

 

[Twiggidy]

My accountant always figures my net income tax rate after he is done; after all deductions are taken, AMT applied, etc. You also have to include local taxes. I also lived in a state for a while where we had another layer of regional taxes which bumped up my percentage quite a bit for those years. Between fed, state and local I'm always between 35 and 40 percent. I've never paid more than 40. My CPA is projecting my taxes to be lower under the new tax plan, but i'll have to let you know how it washes out next April and I know how much I made this year.
I understand we are strictly talking income tax here, but this doesn't even include the misc taxes we all pay- property, sales tax(huge in no income tax states), registering cars, the list goes on and on. All these taxes are also generally higher in states that have no state tax, so this article does a pretty poor job of looking at the whole picture. I bet most of us would be shocked if we added it all up and looked at our real effective tax rate after all that.

And now sadly, all those deductions are gone.

 

[acidbase1]

Not entirely true. Life or death emergency care, yeah sure you'll probably get that. But anything else, if the patient does not have insurance, they can get shipped out to another hospital. I see it all the time- at least a couple open fractures get transferred to my hospital daily. And they never have insurance coincidently. But, yes, eventually you'll get the care.

Our pain docs also talk about all the spine surgeons that seem to always recommend "non-surgical treatment" for patients with no insurance or low paying insurance.

There are exceptions to every rule. 99/100 times they’re treated as equals. At least that was I saw all through residency

 

[Perrotfish]

OCPs are $9/month, insulin can be had for $25/vial, there's an off-brand Advair that's $50. We don't need insurance for this stuff.

Yes, we do

1) 2/3 things you just listed are crappy alternatives to good medications. We don't want patients on NPH/regular insulin and we don't want them on OCPs. We want them on Lispro/Lantus and wee want them on Nexplanon
2) 2/3 prices you just gave are not trivial for most people. Anything that more than a full percent of someone's budget is a non-trivial expense, and a lot of low income patients survive off of less than 20K/year. If you're asking someone to spend 3% or more of their budget on a preventative medicine you're going to get a significant noncompliance rate.

And again, it might make a kind of sense to me if we were committed to just letting these patients die. That would be evil, and I would be against it, but I could at least see where a certain kind of person would care more about their tax dollars than their community. However when we're committed to paying for every bad health outcome then cheaping out on primary care is just bad math. If you're going to commit to repairing someone's car whenever they crash it, are you really going to try to save money by not fixing their breaks?

 

[VA Hopeful Dr]

Yes, we do

1) 2/3 things you just listed are crappy alternatives to good medications. We don't want patients on NPH/regular insulin and we don't want them on OCPs. We want them on Lispro/Lantus and wee want them on Nexplanon
2) 2/3 prices you just gave are not trivial for most people. Anything that more than a full percent of someone's budget is a non-trivial expense, and a lot of low income patients survive off of less than 20K/year. If you're asking someone to spend 3% or more of their budget on a preventative medicine you're going to get a significant noncompliance rate.

And again, it might make a kind of sense to me if we were committed to just letting these patients die. That would be evil, and I would be against it, but I could at least see where a certain kind of person would care more about their tax dollars than their community. However when we're committed to paying for every bad health outcome then cheaping out on primary care is just bad math. If you're going to commit to repairing someone's car whenever they crash it, are you really going to try to save money by not fixing their breaks?

We absolutely do not want them on Nexplanon, it is a terrible birth control method. OCPs are far superior.

If you make that little money, I'm pretty sure you qualify for Medicaid and none of this is an issue.

70/30 certainly isn't ideal but it's a fine insulin and can do a pretty decent job if you know how to write it.

 

[Perrotfish]

We absolutely do not want them on Nexplanon, it is a terrible birth control method. OCPs are far superior.
.

Huh? Nexplanon has a 0% failure rate. A typical sexually active women using OCPs has a 9% unplanned pregnancy rate per year of use.

 

[VA Hopeful Dr]

Huh? Nexplanon has a 0% failure rate. A typical sexually active women using OCPs has a 9% unplanned pregnancy rate per year of use.

Patients hate it though. I take out about 10 for every 1 I put in.

 

[parcus]

2) 2/3 prices you just gave are not trivial for most people. Anything that more than a full percent of someone's budget is a non-trivial expense, and a lot of low income patients survive off of less than 20K/year. If you're asking someone to spend 3% or more of their budget on a preventative medicine you're going to get a significant noncompliance rate.

Let us assume te government is able to provide those medications consistently (which at least here doesn’t happen). Most patients would still be non compliant with their medications because they don’t see any value in them (that is why they claim they can’t afford it). They pay for their cigarettes, but they don’t pay for for their meds when gov doesn’t provide them.

 

[Perrotfish]

Let us assume te government is able to provide those medications consistently (which at least here doesn’t happen). Most patients would still be non compliant with their medications because they don’t see any value in them (that is why they claim they can’t afford it). They pay for their cigarettes, but they don’t pay for for their meds when gov doesn’t provide them.

So I work for the military health system and see mainly dependants (the families of the guys who fight). Many of my patients establish care with me after previously being underinsured or uninsured. When plugged into a good healthcare system where preventative medicines are available without copay they generally are usually compliant (no worse than the average Kaiser patient) and they get much healthier.

I do think that it does require more than a free medication to get patients to be compliant, the other half of the equation is adequately funding primary care itself. For example I do have a good number of asthmatics who were, in the course of a 5 minute Medicaid appointment, told to start a daily steroid inhaler. Since the recommendation came without any context or follow up they, shockingly, didn't comply with the recommendation to take a daily medication for the foreseeable future. After a standard 1 hour new asthmatic intake in our clinic (20 minutes with the physician, 40 minutes of asthma teaching with a respiratory therapist) they become, and stay, compliant patients and they stop getting admitted for asthma.

 

[dannyboy1]

Yes, we do

And again, it might make a kind of sense to me if we were committed to just letting these patients die. That would be evil, and I would be against it, but I could at least see where a certain kind of person would care more about their tax dollars than their community. However when we're committed to paying for every bad health outcome then cheaping out on primary care is just bad math. If you're going to commit to repairing someone's car whenever they crash it, are you really going to try to save money by not fixing their breaks?

Really? So the 300 pounder who eats 10000 calories a day from McDonald’s is the fault of lack of primary care. What about the 2ppd smoker? The poly substance abuser? You don’t need a medical degree to know that these things are bad for your health. Some people just don’t give a damn. There is no preventing that, you can only pick up the pieces

 

[VA Hopeful Dr]

So I work for the military health system and see mainly dependants (the families of the guys who fight). Many of my patients establish care with me after previously being underinsured or uninsured. When plugged into a good healthcare system where preventative medicines are available without copay they generally are usually compliant (no worse than the average Kaiser patient) and they get much healthier.

I do think that it does require more than a free medication to get patients to be compliant, the other half of the equation is adequately funding primary care itself. For example I do have a good number of asthmatics who were, in the course of a 5 minute Medicaid appointment, told to start a daily steroid inhaler. Since the recommendation came without any context or follow up they, shockingly, didn't comply with the recommendation to take a daily medication for the foreseeable future. After a standard 1 hour new asthmatic intake in our clinic (20 minutes with the physician, 40 minutes of asthma teaching with a respiratory therapist) they become, and stay, compliant patients and they stop getting admitted for asthma.

Amazingly neither Medicare nor Medicaid pays for that kind of intensive therapy, and we all know one of those would be the model for single-payer

 

[Perrotfish]

Really? So the 300 pounder who eats 10000 calories a day from McDonald’s is the fault of lack of primary care. What about the 2ppd smoker? The poly substance abuser? You don’t need a medical degree to know that these things are bad for your health. Some people just don’t give a damn. There is no preventing that, you can only pick up the pieces

Again, I have a lot of these patients establish care with my health system, and they do get better. Sometimes its just relieving the financial and time stress enough for them to make changes. Sometimes its the effect of good primary care. Sometimes its easy access to medications. They don't all get better, but they do get better on average.

The smoking thing is a particular pet peeve of mine, BTW. We know the rate of permanent smoking cessation, per attempt, with people who just try to quit (5%). We know the rate of permanent smoking cessation for people who quit under a physicians supervision, taking both Zyban and Chantix, and who are in a weekly mental health professional led support group (50%). Its one of the strongest examples how things do in fact get better when you invest in primary care. And yet every physician points to their patients smoking as a reason why they don't deserve access to healthcare.

 

[Perrotfish]

Amazingly neither Medicare nor Medicaid pays for that kind of intensive therapy, and we all know one of those would be the model for single-payer

There's no reason that has to be the model. They could easily just run a healthcare system, like they already run the military, VA, and Indian healthcare systems. Or they could split the difference and fund healthcare but only for HMO style plans like Kaiser. Or they could have some basic catastrophic insurance (Medicaid) plus an annual healthcare spending account that lets people pay cash to see good primary care physicians and pay for medications. There are lots of possibilities.

 

[deleted50478]

Yeah that's the argument for universal healthcare. We basically have universal care, but only for insanely expensive things of limited utility. We pay for the teenager's delivery but not her birth control. We pay for the asthmatic's ICU stay but not for his flovent. We pay for the diabetic's Kidney transplant but not the insulin.

We pay for an illegal immigrant’s interpreter, obstetric care, epidural, possibly c section, and a few days in the hospital (and we usually pay for all that with several pregnancies) but we don’t pay for a bus ride across the border.

It seems like a pretty simple, low cost change would to give everyone a healthcare spending accounts that can only be used for primary care visits and preventative meds. Make the low cost, high yield stuff universal.

 

[VA Hopeful Dr]

There's no reason that has to be the model. They could easily just run a healthcare system, like they already run the military, VA, and Indian healthcare systems. Or they could split the difference and fund healthcare but only for HMO style plans like Kaiser. Or they could have some basic catastrophic insurance (Medicaid) plus an annual healthcare spending account that lets people pay cash to see good primary care physicians and pay for medications. There are lots of possibilities.

I'm not sure the VA or IHS are models we want either.

There's a DPC guy who put together a fascinating national health model. Warning, very lengthy read.

A radically patient-centered proposal to fix health care in America

 

[nimbus]

I have a regular clientele of homeless meth and heroin addicts. They all get care and follow up when they chose to show up so I don’t know who is not getting healthcare.

 

[doctalaughs]

I have a regular clientele of homeless meth and heroin addicts. They all get care and follow up when they chose to show up so I don’t know who is not getting healthcare.

I agree. In this country if you are poor, homeless or likely even illegal and you care to make any effort then likely you are getting healthcare.

I’ll tell you who isn’t getting good care anymore - the middle class working people under obamacare that used to have decent employer plans but now have a 10k deductible because they don’t quite qualify for a subsidy. Thats all fine if you you make 350k as a physician - you can pay that deductible. Different if you make 65k while supporting a family and watching the medicaid patients get prescriptions for free. Those people are basically forgoing care because they can’t pay, and only now realize that obamacare was a redistribution scheme.

 

[Man o War]

I agree. In this country if you are poor, homeless or likely even illegal and you care to make any effort then likely you are getting healthcare.

I’ll tell you who isn’t getting good care anymore - the middle class working people under obamacare that used to have decent employer plans but now have a 10k deductible because they don’t quite qualify for a subsidy. Thats all fine if you you make 350k as a physician - you can pay that deductible. Different if you make 65k while supporting a family and watching the medicaid patients get prescriptions for free. Those people are basically forgoing care because they can’t pay, and only now realize that obamacare was a redistribution scheme.

Yep. Even prisoners get better health care than many people who do to work and do what they’re supposed to every day.