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re: Why does the healthcare debate essentially revolve around like 4% of Americans?
Posted on 9/21/17 at 12:33 am to mahdragonz
Posted on 9/21/17 at 12:33 am to mahdragonz
quote:no.
Because its closer to 90 percent of people who would be considered having a pre existing condition
Posted on 9/21/17 at 12:39 am to Taxing Authority
My point was exactly that my works, good or not, don't dictate markets as you mention. If we had single payer, my hospital system wouldn't turn people away based on ability to pay at it does now. They'd be turned away based on severity of illness or something else medically more rational. We'd still need more providers to meet the demand, but that could be addressed through providing additional incentives that could be addressed through incentivizing training additional MD's and DO's in my field and reducing regulations for NPs and PA's, foreign medical grads, additional incentives for underserved areas, etc.. Those things would reduce my salary but it would be better for patients and I'd support it (although maybe I'd like my kids to get through college first ).
What I believe is not all that incompatible with your ideas in your longer post. Americans' expectations are absolutely unrealistic and OPM systems that don't deny a lot of bad care continue to feed that.
But enough about me - you don't like Graham-Cassidy. Why not? It gives states freedom to set the markets loose. Good, right?
What I believe is not all that incompatible with your ideas in your longer post. Americans' expectations are absolutely unrealistic and OPM systems that don't deny a lot of bad care continue to feed that.
But enough about me - you don't like Graham-Cassidy. Why not? It gives states freedom to set the markets loose. Good, right?
This post was edited on 9/21/17 at 12:45 am
Posted on 9/21/17 at 12:46 am to HailHailtoMichigan!
quote:
Look, I have sympathy for those with pre-existing conditions, but why must they get priority over the 85%+ of Americans who simply want lower premiums and costs?
Healthcare reform should be based on helping the most people lower their costs, rather than helping a select few at the expense of all others
Why are we only in it together when a crisis happens?
Posted on 9/21/17 at 12:56 am to TigerDoc
quote:that was my point as well. Just like all but an insignificant minority of providers... you still expect to be paid (rightfully so).
My point was exactly that my works, good are not don't dictate markets as you mention.
quote:Are you sure? If.. say.. the government said: no more hip replacements for anyone over 65 years of age... your hospital would still provide hip replacements to 70 year old patients -- because the system is single payer? I'm sorry but I don't believe that.
If we had single payer, my hospital system wouldn't turn people away based on ability to pay at it does now
Going to single payer won't make providers suddenly become charitable givers. They could do that now.
And to a more patient-centric perspective... how would making a government-run payer change demand for services? You know anyone turning down SS because they don't need it?
quote:Thanks. You proved my point for me.
We'd still need more providers to meet the demand
quote:It's still cost-shifting. Just relocates it. Frankly, I'm unlikely to be impressed by any legislative effort.
But enough about me - you don't like Graham-Cassidy. Why not?
As I said above, this isn't a legislative problem. The math doesn't work politically. The only possible legislative solutions that work fiscally will be so unpopular--they will be political suicide for anyone proposing it. Nothing practical has any hope of passage as long as voters believe in Santa Claus.
Realistically, to implement single-payer and maintain our current standard of care we would need to see tax rates double across the board and have taxable income extend down to the $30k level. Think a political party proposing taxing a "working family" making $30k/yr at 45% (inclusive of FICA) of their gross income will get re-elected?
I don't.
This post was edited on 9/21/17 at 1:02 am
Posted on 9/21/17 at 1:19 am to Taxing Authority
quote:
Are you sure? If.. say.. the government said: no more hip replacements for anyone over 65 years of age... your hospital would still provide hip replacements to 70 year old patients -- because the system is single payer? I'm sorry but I don't believe that. Going to single payer won't make providers suddenly become charitable givers. They could do that now.
I wasn't arguing that they'd provide the same kind of care. In fact, I was arguing that having a single payer would likely change the kind of care for the better (tying payment to outcomes, denying certain kinds of treatments/tests outright in certain clinical situations). Ortho's not my field but there are plenty of fields that over-operate compared to other kinds of care. I think we're saying sort of the same thing in different ways, actually.
As for the politics, I agree with you, at least in the short-term. Most people are mostly ok with the health care they have and are awfully fearful of change. Getting rid of employer-based health insurance would raise wages considerably eventually, but not quick enough to cover the sticker shock of new taxes (I don't think they'd do a payroll tax, but would opt for a VAT instead, though). If the government used debt initially to finance it and deferred new taxes a bit that might make it more palatable.
Still, I think the Dems would be smarter politically to run on a medicare buy-in or public option.
Posted on 9/21/17 at 1:30 am to TigerDoc
quote:As a doc, I'm surprised you think that congress and bureaucrats. can better determine appropriate care than you can. Perhaps in your case you're right? But most docs (and patients) don't believe that.
I was arguing that having a single payer would likely change the kind of care for the better (tying payment to outcomes, denying certain kinds of treatments/tests outright in certain clinical situations).
And nothing prevents docs from making those determinations now. It's not like you need permission from the government to make appropriate treatment decisions.
quote:emplyer-based plans are almost universally loved by employees. You think congress is going to take that away?
Getting rid of employer-based health insurance would raise wages considerably eventually
quote:Except that would undermine any increase in wages and negate what employers would save from eliminate healthcare benefits. Squeeze the balloon however you like. There just isn't enough money.
I don't think they'd do a payroll tax, but would opt for a VAT instead, though
quote:like how congress paid off the military debt with savings from "peace dividend" when the USSR failed?
If the government used debt initially to finance it and deferred new taxes a bit that might make it more palatable.
quote:.OF Course!! As long as they don't talk about who will be paying for it.
Still, I think the Dems would be smarter politically to run on a medicare buy-in or public option
This post was edited on 9/21/17 at 1:33 am
Posted on 9/21/17 at 1:39 am to Taxing Authority
You might look into NICE in the UK. It's bureaucratic, but run by public health specialists and physicians and their health outcomes are excellent. I also know that personal experience can be flawed and good data should trump it.
You're a smart guy - go back and read that Gawande article. It demonstrates nicely how much worthless care exists and how physician hubris feeds into it.
Politics is the art of the possible. A lot of people dismissed the chances of the ACA going through. I agree with you about the cost-shifting of the Cassidy-Graham but it does a lot more than that since it radically reduces Federal spending that will almost surely not be picked up in a lot of states - and if enacted, I think it would do more than anything the Democrats could do to help bring about a Democratic majority willing to vote in a single-payer.
You're a smart guy - go back and read that Gawande article. It demonstrates nicely how much worthless care exists and how physician hubris feeds into it.
Politics is the art of the possible. A lot of people dismissed the chances of the ACA going through. I agree with you about the cost-shifting of the Cassidy-Graham but it does a lot more than that since it radically reduces Federal spending that will almost surely not be picked up in a lot of states - and if enacted, I think it would do more than anything the Democrats could do to help bring about a Democratic majority willing to vote in a single-payer.
Posted on 9/21/17 at 2:20 am to HailHailtoMichigan!
quote:
Healthcare reform should be based on helping the most people lower their costs, rather than helping a select few at the expense of all others
Which Republican proposal lowers costs?
Posted on 9/21/17 at 2:36 am to TigerDoc
quote:We're going the opposite direction here. The ACA removed much of insurer's ability to assess and tie reimbursement to medical appropriateness. The ACA did a lot to discourage physician owned facilities. And some of the proposals since.. are even more draconian.
run by public health specialists and physicians and their health outcomes are excellent.
I see nothing into indicate creation of a single payer system would decrease this trend. In fact, I can see it worsening it.
quote:Again you've setup the false choice. Single-payer is not the only... nor even the best way to reduce this. Patients paying out-of-pocket are far more unlikely to pay for unnecessary care then subsidized PTs. Government... well... look at defense contracting and tell me they are good at making good purchasing choices. And I'd reckon that defense needs assessments are far clearer, more objective, and far less individualized than medical needs assessments.
You're a smart guy - go back and read that Gawande article. It demonstrates nicely how much worthless care exists and how physician hubris feeds into it.
quote:In the short term... sure. But when people lose their freebies, they'll be back demanding more. They are still demanding more at today's level of spending. Cutting won't cure the collective greed.
does a lot more than that since it radically reduces Federal spending that will almost surely not be picked up in a lot of states
This post was edited on 9/21/17 at 2:38 am
Posted on 9/21/17 at 3:17 am to HailHailtoMichigan!
quote:
Why does the healthcare debate essentially revolve around like 4% of Americans?
You do realize that 4% of Americans is about 13 million people? Also that people are rarely alone but are in families. So often, those 13 million have parents, sons, and daughters willing to go bankrupt for them, so you have to multiply that number by 2 or 3 to see the total number affected.
Posted on 9/21/17 at 3:55 am to TigerDoc
quote:
We'd still need more providers to meet the demand, but that could be addressed through . . . reducing regulations for NPs and PA's, foreign medical grads
quote:It would be better for patients?
Those things would reduce my salary but it would be better for patients
Perhaps your observation calls for a bit of introspection.
Seriously.
When you note NPs and PA's, foreign medical grads would improve care for your patients, it seems to imply more about your own opinion of care quality you provide than you'd probably intended to air.
Either that, or you've really not thought this out . . . at all.
So for example, would a patient who in our current system sees you, be somehow better of seeing an NP, PA, or foreign medical grad, independent of your oversight?
Would your patient-care decisions best be made by a committee of actuaries, politicians, and/or administrators instead of being made by you in concert with the individual human being you are treating?
Those are the endpoints you're moving towards ... unintentionally I'd suspect.
quote:Are they?
Americans' expectations are absolutely unrealistic
Really?
or is that simply your impression based on what you've been told?
A couple of points.
(1) "Single-payer" is a compensation mechanism. That's it! It is one single third-party payer, who by virtue of a granted monopoly, unilaterally decides who to pay and how much to pay them.
"Single-payer" is not a care system. That is until the "payer" who is neither medically informed nor clinically compassionate refuses to pay for care. Even then, single-payer is no care provider. It simply hamstrings or bankrupts those who are.
(2) Fee-for-quality medicine works very well. We see that best exemplified in the world of plastic surgery where fees are set based on quality, and unfettered by third party payers. But there are many other examples of fee-for-quality efficiencies ( e.g., Surgery Center of Oklahoma). Each dramatically saves money over ANY 3rd party payer model. Each incentivizes quality. There is inherent competition based on quality, price, and outcome. Pricing in some instances runs as little as 20% of third-party payment competitors.
Regarding your perception of unrealistic "expectations", in fee-for-quality models those "absolutely unrealistic" expectations are consistently met.
So no, single-payer is not the answer. To further hammer that home, the "payer" we'd be addressing is Medicare-for-all. Medicare runs roughly twice the cost of European Models, is more expensive than fee-for-quality, and would afford poorer results.
Posted on 9/21/17 at 3:56 am to Tyrusrex
quote:4% is 4%. Period. There is no family multiplier.
Also that people are rarely alone but are in families
Posted on 9/21/17 at 4:08 am to NC_Tigah
Are you sure? Let's see what you think when it's your parent or child who is sick.
Posted on 9/21/17 at 4:13 am to Tyrusrex
quote:Yes.
Are you sure?
Just as 1% means 1%.
quote:That's an argument path you'd do better to avoid.
Let's see what you think when it's your parent or child who is sick.
Posted on 9/21/17 at 4:56 am to Tyrusrex
quote:No.
So in this case 1% means 25%.
But it brings up a salient point. The Kaiser Family Foundation, on whose information you've based your claim, is an oft quoted source on these matters. Unfortunately, it is about as trustworthy a source as the National Enquirer. Which is to say it is occasionally right, and often FOS.
Here are the numbers by insurance category (From Kaiser BTW):
Employer 49%
Medicaid 19%
Medicare 14%
Other Public 2%
Uninsured 9%
Non-Group (including ACA Exchanges) 7%
So, as the 25% of people with preconditions would be applied to some of the 7% in non-group insurance, and a fraction of the Medicaid pool, 4% actually seems a quite generous estimation.
Posted on 9/21/17 at 5:39 am to NC_Tigah
The Kaiser Family Foundation are the biggest pro-obamacare hacks there are, except maybe aarp because they make money off it.
Covering pre-existing conditions is not "insurance", it is welfare.
Insurance mitigates risk. It does not pay for something you already have.
Covering pre-existing conditions is not "insurance", it is welfare.
Insurance mitigates risk. It does not pay for something you already have.
Posted on 9/21/17 at 6:07 am to NC_Tigah
quote:
Here are the numbers by insurance category (From Kaiser BTW):
Employer 49%
Medicaid 19%
Medicare 14%
Other Public 2%
Uninsured 9%
Non-Group (including ACA Exchanges) 7%
So lets say that 25% of the entire population has something that can be classified as a precondition. You're assuming that the only people hat would be affected would be the people in the NOn Group 7%. But that's not he case. If Graham-Cassidy passes, States will be able to define who they want to cover, as everything is going to be changed from Medicaid/Medicare to State Block Grants. So potentially, this number could be 51% and only the 49% already who have employer insurance would be unaffected. And god forbid if you lose your job or decide you want to change your career.
Posted on 9/21/17 at 6:52 am to gthog61
Hog 61 is correct.
Previously existing condition, if it is to be covered, should be covered by "the state", not by a for profit company.
Dems aca forces company to pay. Aca was set up to assure profitability though.
Republican "plan" just ignores the people with priorly identified issues.
Graham plan may pass. If it does, dems will roll in 2018. Graham plan should go into effect after 2018 election to escape blame.
Previously existing condition, if it is to be covered, should be covered by "the state", not by a for profit company.
Dems aca forces company to pay. Aca was set up to assure profitability though.
Republican "plan" just ignores the people with priorly identified issues.
Graham plan may pass. If it does, dems will roll in 2018. Graham plan should go into effect after 2018 election to escape blame.
This post was edited on 9/21/17 at 6:55 am
Posted on 9/21/17 at 6:55 am to Tyrusrex
quote:No nitwit! They won't.
States will be able to define who they want to cover
Again, with the exception of a fraction of medicaid patients, the affected group is a portion of the 7%.
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