Fixing Healthcare

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It's the ACA not HCA FWIW

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You are right. Was editing a draft of a contract this AM and got HCA on my mind. Will edit.

Bingo^^^

As long as basic lab work, x-rays, mri, etc costs thousands of dollars just because....

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Insurance is just how we pay for the overpriced care. Drive down the actual costs of healthcare and insurance costs will follow.

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Insurance paying for routine care is what started this mess. Going to the doctor shouldn’t involve an insurance claim. If it didn’t it wouldn’t cost so much.

I will never understand how insurance companies can be for-profit companies.
By making them all nonprofit organizations that essentially function as nothing more than a pay pool, you eliminate the need for these companies to screw the markets so much.

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So how do we address healthcare reform?

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Acknowledge that it is futile to continue to figure out ways to fund delivery systems for “sick” care (all paths lead to bankrupting the country).

No “policy” will fix that.

Instead, a paradigm shift is required to address the root of the problem (establishing health by choices made /exposures by the individual)

Prior TD thread giving actionable examples

Technology can also be used in clever ways:

NY Times

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Tackling Weight Loss and Diabetes With Video Chats

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Instead, Ms. Collier and her husband entered a study sponsored by a company called Virta Health, one of a new crop of high-tech companies that have designed programs aimed at helping people prevent or even reverse their diabetes.

On the program, patients video-chat with a remote Virta doctor, who consults with their primary care doctor, reviews their blood tests and medical history, and makes diet and drug recommendations. While studies show that a variety of different diets can benefit people with Type 2 diabetes

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“People with diabetes have to manage their diabetes 24 hours a day, seven days a week, 365 days a year,” he said, but most Type 2 diabetics see a doctor four times a year at most. In between those visits, they are largely left on their own — and many end up struggling with their diets, their blood sugar and other complicated aspects of their care.

“When you think of the amount of time they actually spend in a health care professional’s office getting counseling and support, it’s negligible. “Developing remote care models is going to be the key if we’re going to have some sort of impact on improving glucose control for the millions of people with diabetes,” he said. “It’s a much more scalable model than seeing people in a doctor’s office.”

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This is a major driver of chronic disease (and events that lead to abuse of acute care services = $$$$)

It's no fun, but discussing healthcare needs to start around 1900. I've studied this in the past and hopefully my memory is still accurate.

~1900 - very primitive, basically no technology involved, HC pretty much an after thought. People paid with cash, in full, for anything medical. Medical profession not highly respected.

~1930 - some tech slowing coming in such as x-rays; medical profession getting respected as a professional field, skills increased, people start seeing layers in medicine beyond just seeing the town doctor. Prices begin to increase. Begin seeing discussions and words like insurance cropping up. People start having difficulty paying for all services rendered in a timely manner. There was even movements for socialist approach. The AMA strongly opposed anything aimed at cost control, such as HMO's and they lost an anti-trust action because of it iirc.

~1945 - coming out of WWII the country was transformed. Industrial and economic boom and a change to how workers were thought of. Workers were seen as more valuable than just 'machines with a heart beat' and vital not only to a company but to a country. Insurance plans become more common, worker benefits etc. Tech in medicine increased and so did costs. As medicine became more specialized, hospitals became major players because doctors needed a place to work beyond just a home town office setting. The era of big medicine begins. Major, major, major factor was the AMA being at the top of the lobbying forces in the nation in terms of effort and dollars. Also, the AMA essentially got to determine how many medical schools the nation had and thus how many doctors the nation had. They purposefully kept this number very low. Couple this to the growing need for doctors and demand for increasing developments in medicine. Doctors = monopoly.

~1955 - Medicine really starts to become unaffordable on grand scale, and major health issues ruin people financially. Still too few doctors. AMA is steering this ship. People are complaining to Congress. Virtually everything suggested in order to help with costs is lobbied against by the AMA. They also viciously lobby for limits on malpractice claims. Basically the AMA made it so that most Americans had few choices, no bargaining power while doctors had no competition because their offices would be full no matter what, and the AMA always went to bat to lessen any penalty for being a bad doctor. Medicare Act was initiated in this era but was repeatedly defeated mostly because of the efforts of the AMA.

~1965 - Medicare Act. Perhaps the worst legislative act in the history of the country. Sounded great during briefings. What it did, however, was instantly create massive increases in demand for medical care. What does that do to prices? Makes them go sky high. What did the AMA do to help any of this? Nothing. The AMA campaigned against the Act because it would be cost control of sorts. However, because the AMA refused to allow the nation to have more doctors, it was still a windfall for doctors. However, they have steadily paid a price in the administrative burden that has resulted.

Since 1965 prices continue to go up and quality of care continues to rank very low compared to other nations that manage to spend far less. Medicare keeps getting expanded and it's the volume of business that keeps medicine going. It's unsustainble, as the ACA has shown us.

There is rampant fraud, a good deal of it by necessity. For example, nursing homes get reimbursed by formulas from the govt that are inadequate. This puts enormous pressure on them and profit margins are low. If they don't commit fraud they won't last. A person with Medicare generally gets 20 days coverage for a rehab stay iirc. So, what happens if you need 14 days - you'll end up being there for 20. If they don't keep the beds full, they can't survive. They also cook the books on ADL scores and so forth to bump people into higher categories of care for higher reimbursement rates. If they played it honest they'd all go out of business. It's a racket brought on 100% by the federal govt's intrusiveness.

A by product of all of this is the deplorable number of medical errors. Part of this is due to doctors having too many patients and too much admin work. Look up how many deaths and injuries are caused each year by medical errors. Only CVD and cancer are knocking off more people. That's a hell of a statement - go into medicine, "first do no harm" kill people in numbers that only CVD and cancer are surpassing. The medical errors part is probably a surprise for most people. Ask yourself why that information isn't out in the open as it should be.

Unless we trace how we got to where we are, I don't think we'll be able to identify prudent solutions.

I think as goals we should immediately begin addressing medical errors and demand the AMA stop limiting the number of doctors so much. We must have a system where a doctor can make similar wages they make now while seeing 25% fewer patients.

I would like to see the govt set aside $1000 for each child born and mandate that parents add another $1000 before a child's 2nd birthday. If you have that in compounding interest over 50 years, you get close to $250k if you can pull between 9% and 12% compounding interest rate each year. At 55 years you'll have about $100k more. By 65yrs old you're about one million. That should be sufficient to cover the nation's medical bills in the last half of the lifespan. It's the back half, especially the last 3-5 years of life that generally cost the most. The first 50 years should be insurance through the free market with virtually no govt involvement. I think that's a decent place to start.

TLDR - at least the mandate is now gone.

We lived in the U.K. for 3 1/2 years. Took part in their healthcare system and it was working fine but was getting stressed because of immigration. It is now very common for people to have an additional private insurance plan because wIt times are so long for a number of healthcare services. Increasingly citizens are turning toward private insurance as a backup.

In the US, Obamacare or ACA can not possibly succeeds it is now. The primary reason is because we have a huge profit taker between us and the healthcare system... INSURANCE companies. Approximately 50% of what you pay goes to insurance companies. Obamacare allowed the insurance companies to raise prices to privately insured Americans, kept restrictions in place to severely curtail competition in the US by limiting insurance choices for you and U, but it also guaranteed insurance companies a certain level of profit for Obamacare enrollees. The insurance companies get paid by Fed govt at end of year in the form of taxpayer money... subsidy.

As long as insurance companies are in between people and medical care, the ACA cannot possibly reduce costs. It is inherently inefficient at controlling costs. Never designed to do that.

FYI... in the U.K. if you go to the hospital or go see a doctor, there is no cashier. They don’t take money, they don’t take insurance, etc... you walk in, sign in, see the doctor, and then you leave. They have no mechanism to accept any kind of payment. This is true single payer.

What the ACA tried to do is not even in the same ballpark as single payer systems. It’s idiotic beyond belief. Cannot possibly make healthcare any cheaper. Laughable that anyone thinks the ACA as written was a good idea cause it is not.

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You do realize that what insurance companies consider “pre-existing” is sometimes complete and utter bull shite.

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Nope. Insurance companies don’t make money by turning down customers with low payout risk. They know the risks far, far better than you do.

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So how do make it fair

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The purpose of insurance is to manage risk, not make life “fair” for everyone.

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So working off your debt or earning debt reduction is indentured servitude?

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As described.. yes.

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PA’s and NP’s that choose to work for the BIA or rural settings to reduce their student loans are really “serfs”?

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is not what you described.

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What are your thoughts?

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That you are good at revisionist history..