re: USA will have Socialized Medicine in 20 Years - It's Inevitable

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Acquisitions have also torn the sector apart. Like, when I started in PBM in 2000, we were Advance PCS. A merger between Advance Paradigm and PCS Health. Then, Advance PCS merged w Caremark in 2004. Then... Caremark PCS merged with CVS in 2007 to create CVS Caremark. Many here use Caremark PCS as your prescription benefit manager. With every merge, customers fell into a black hole and had less choices re: formularies, pharmacy network and coinsurance/copay structure etc. At the time, Merck Medco was the biggest competition.

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buddy of mine just got back from a three year contract in the UK for Lockheed Martin, his wife had two kids while they were there, think he said he was out of pocket for about 200 pounds for both

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re a lot of poor 12 year olds dying solely because of mediocre care from our healthcare system?

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dying? probably not

not getting a broken arm checked out by a doctor (just an example) because mom doesn't currently have insurance? probably a good bit

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OK, well kudos to you on this variation on a prior deflection, I guess. I'm a very open conservative, so pretending I'm hiding the ball on being opposed to your agenda is interesting, albeit pretty silly.

But I've also indicated that on a very localized level I'd be supportive of collective healthcare, so I do have some interest in breaking through the barriers to socialized HC among people resolute against the idea who are otherwise like minded (even if largely theoretical).

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The thing a majority of you conservatives seem to struggle understanding is that you already pay for collective care, that debate died with Reagan and EMTALA.

And conservatives in the rest of the developed world understand this as well.

And no one is opposed to promoting better personal and collective health, or using progressive taxation as necessary to pay for reforms, but that is a side discussion to the structural organizing of America's healthcare.

America simply organizes their collective care in the most expensive, wasteful, redundant, and freeloading way almost imaginable. Basically everything in healthcare is more expensive here than anywhere else, we pay more in taxes, more in private spending while leaving a large portion of the population underserved. Yet you seemingly defend it. How?

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Cant wait to have a severed arm and still have to wait in line behind 30 people with the common cold.

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Reminds me of a time going to the ER in Baton Rouge and I was having breathing issues while using oxygen. I'm a lung transplant patient now but was only chronic lung disease then. I had to stand mind you behind someone for several minutes who was there because "my back is sore."

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deeprig9

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I abstain from this thread

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I clearly said I didn't want to pay for shite for people I don't know.

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I totally misread you, I thought you were calling us out for that viewpoint.

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buddy of mine just got back from a three year contract in the UK for Lockheed Martin, his wife had two kids while they were there, think he said he was out of pocket for about 200 pounds for both

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At a public hospital, yes. Thats where you will never have the same doctor and be giving birth with other patients in the room.

My insurance is awesome. Gubment medicine would be a major step back for me.

It would be for anyone who has good insurance, because your favorite doctor will be flooded with people when it becomes "free." Long lines and rationaing.

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because the asymmetrical nature of the market and the often unexplainable variances in pricing from even hospitals nearly across the street from one another is a real problem. Not to mention one of the dynamics once thought true, that larger health insurers benefit from better negotiated reimbursement rates is often not true, and for inexplicable reasons. Economies of scale and competition, which is often a defense used by people defending for-profit private insurance, is completely broken in the employer insurance space specifically. The entire pricing dynamics in health care are incredibly broken and warped.

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You sound fairly knowledgeable about healthcare. You know that pricing doesn't equal payment or cost. Pricing generally makes zero difference in what the patient pays and it rarely impacts what the insurance company or Medicare pays. There are a handful of plans with stop loss provisions and also Medicare has Outlier payments for extremely high cost cases in which charges do have a small impact on payment. Many years ago, when Medicare 1st started, hospital payments were tied to actual costs, based on a cost to charge ratio and there was a settle up after the reporting year ended. Costs quickly escalated under that system, as there was incentive to spend more money, because Medicare paid for it. Now, pretty much every payor pays either a prospective or contracted rate and costs and charges have no impact whatsoever on your payment. The public doesn't understand this and focuses on the Aspirin that costs $5.00.

After 38 years in healthcare administration and audit, the insurance company adds nothing to the equation other than to limit services, something traditional Medicare does not do.

After all these years in healthcare, I'm completely convinced that we already have enough money in the system between Medicare, Medicaid, Obamacare, and insurance. We allocate our $$$ extremely poorly.

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The insurance did cover it, the total bill was over $10k and I'm now being billed an additional $600 by the hospital because the insurance does not want to cover the small biopsy they did of my stomach lining (I've had a history of gastritis, so it was a valid biopsy).

The same exact procedure was performed on my cousin, who has Medicaid, and she paid nothing.

Make it make sense, y'all. I'm having a hard time seeing where the government could do much fricking worse.

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You are correct. The government probably wouldn't do worse. It doesn't make sense, but basically Medicaid never pays anything...they aren't supposed to have money. Your insurance company has a contract with the hospital and also with you. Their contract with you is based on whatever you signed up with your employer. However, the huge problem is the insurance company gatekeepers. Insurers make it hard for physicians and hospitals to get things approved. That is the insurance company's job. They want to pay less. They try to pay less. The hospital is trying to get everything they can approved and so it the doctor's office.

In so many ways, our system is so unfair. It's all based on which insurance company your employer decides they can afford because some are definitely better payers than others. Some give everyone a hard time and we know we will have a hard time collecting from them.

The 2 biggest problems with a single payor system in the US are:
1. All those Senators and Reps that will want a plan set up a certain way to take care of this person and that company, etc. It's the reason that Obamacare is ridiculous...the fact that government decided that certain plans were "substandard" because they didn't offer certain types of care that people didn't want to spend extra money to buy. If it were just left to experts/industry/physicians/etc to design a plan and base rates on costs +, that could be done fairly easily! The info is readily available.
2. If people have coverage, they'd go to the doctor before a condition was emergent and not end up in the ER...the most expensive level of care. But, we do not have enough primary care docs to see those additional patients.

And for any of it to work and be affordable...we need people to take better care of themselves. Move, eat right, be a compliant patient.