re: Why isnt the GOP out hammering on what a dumpster fire Obamacare is?

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If you can't see the difference between an item not essential for survival and a heart surgery to save your life, you may not be qualified to discuss this, even on a message board.

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This is the exact point where any objective discussion on healthcare goes out the window. It's 100% emotional. If something is essential for survival... why the hell would anyone expect it to be cheap, or even free? What's your heart surgery worth to you? Ask that question when someone else is paying and the answer is infinte dollars. If they are paying, you'll get a different answer.

Which prompts the question, why should the burden for paying for your surgery be shifted to someone who values it less? If it doesn't mean enough to you to sacrifice for it, why should others be forced to sacrifice for it? The expectation of medical care to be cheap is perverse.

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Of course it would. Many hospitals barely keep their doors open right now under the system we already have. The downward pressure of cash payments on revenue would make it untenable for them to continue.

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Depends. Overuse is a thing. Collection and admin costs are a thing. Cost shifting is a HUGE thing. Providers give away TONS of uncompensated care which gets passed along to those that pay.

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Anything that cuts revenue from where it is now would do this

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Not necessarily. For some reason with medical care people get prices and cost confused. But that's not the case. Prices (thus gross revenue) rarely align with costs--but rather with aggregate reimbursement recovery. That's why a tylenol costs $35 in a hospital.

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cash and/or government payer monopoly would cut revenue to hospitals, clinics, and doctors.

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Yes. And that's the only way prices will come down to affordable levels. We cannot operate a "system" where prices have no tie what people can afford, then wonder why they are so high.

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Why not policy of "earn your own money and pay for your own healthcare?" I ask, because that policy makes the most sense.

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Because when you have insurance through your employer, get diagnosed with an expensive ailment, you risk being fired to keep their rates lower.

Or if you’re working a job with no insurance planning to pay cash for your $40 Dr visit and find out you have a serious condition you’re out of luck.

With pre-existing conditions you can’t get insurance, and you’re jobless.

Then when you find out how much your chemo treatments, surgery, etc will cost you can’t afford to pay.

That all makes sense?

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I believe you're the one being emotional here. Or simply not reading and just jumping in with your personal talking points.

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Nah. My company has developed and maintained insurance pricing models for years.

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The point is not that anybody is owed any particular health care because it's necessary to save their life. The point is that there are a whole lot of people who simply couldn't come up with the money for it. 40% of Americans don't have sufficient savings for a $400 unexpected expense. That's an objective fact.

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Indeed. And why should they save for expenses, when they can just pass them along to someone else?

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So then we have a system in which the vast majority of the revenue that keep hospitals operating today would simply vanish.

That's also an objective fact.

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And I agreed. But you're confusing gross revenue with the ability to deliver care. Those aren't 1:1 unless you're going to argue that the current system is already running near 100% effeciency. Fair warning, if you do, I will laugh at you.

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The point is that the current system is built upon a foundation of revenue so vast that anything that would drastically reduce it would necessarily change the system drastically as well.

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Not necessarily. To make that assumption, you'd have to assume that all PTs are charged similar amounts. That's not the case. Patients that are currenlty being over charged (price!) would see cheaper prices. PTs currently paying nothing would see an increase. In aggregate it would provide downard pressure toward affordability. It does the provider no good to charge mroe than a customer can pay, because... they simply won't pay it. Remove the deep pockets and prices start to align better with cost.

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How people think you could pull massive amounts of revenue out of this system, yet nothing would change except it wold be a whole lot cheaper is as ridiculous as the people who think Trump can syphon as much money out of the economy via tariffs as he wants and it won't affect anything.

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Not simlilar to tariffs at all. Industrial prices align FAR FAR better with input costs. Prices and COGS have basically zero meaning in healthcare.

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Not really. Not unless you think the services would be under $400, and you can figure out some way that a hospital that used to get $30,000 for a hospital stay now gets less than $400 can stay open.

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Did you get a permit from your HOA before you constructed that strawman? Where did I say hospital stays should be $400? I've never said medical care should be cheap. I've said the opposiite.

But even addressing your strawman, saying "People cannot afford a $30,000 hospital stay" is silly when people are paying $80,000 for pickups. We need to get back to choosing what's more important and speding dollars in inline with it. Hard to believe that's controversial. But here we are.

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As long as you're talking about less than $400, we're golden.

"Hey honey, where's the $180 I had squirreled away in the cookie jar?"

"Oh, that, yeah, I had to have a double bypass last week. But there's still $20 left in there, did you see it?"

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Sorry man, but that's just silly.

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Because when you have insurance through your employer, get diagnosed with an expensive ailment, you risk being fired to keep their rates lower.

Or if you’re working a job with no insurance planning to pay cash for your $40 Dr visit and find out you have a serious condition you’re out of luck.

With pre-existing conditions you can’t get insurance, and you’re jobless.

Then when you find out how much your chemo treatments, surgery, etc will cost you can’t afford to pay.

That all makes sense?

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Not really, when you recognize that most people screaming about "can't afford coverage, I need YOU to pay for MINE" are standing behind their bass boat, or muscle car while screaming it.

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My company has developed and maintained insurance pricing models for years.

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Great. I owned medical clinics for 18 years. Some who billed insurance and some who only accepted cash. But hey. I'm sure your "model" has me beat for experience.

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And why should they save for expenses, when they can just pass them along to someone else?

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Again, I'm laughing at you. The average American makes below $40,000 a year. 47% of the adult population, in fact. And half of those make less than $20,000 a year.

Just how much do you think they can save a year?

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And I agreed. But you're confusing gross revenue with the ability to deliver care.

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No, I'm not. I'm just trying to avoid having to be tedious enough to start going through it line by line, because there's really no need to.

The starting premise is that health care is vastly expensive. It's also a fact that many hospitals and clinics are barely breaking even at their current revenue.

That's a fact.

So simple logic dictates that removing a large portion of revenue will more than offset anything you would save by removing costs associated with insurance billing. Administrative costs—according to Google—account for about 25% of average hospital budgets, and not all of those would go away just because there would be no more insurance billing. Let's say it's 12% without the insurance billing instead of 25%.

So cash just saved 13% of the cost of delivering care. Great.

But unless you're telling me that the market forces associated with a cash system will not drive prices down more than 13%, then you tell me how the hospitals I'm talking about that are teetering on the edge of the abyss right now will survive.

And if that is what you're telling me, then really? Health care prices will only see a 13% decline?

Again, I'm not arguing on behalf of people who can't afford cash. I'm arguing on behalf of myself. I can write a check for $50,000 for a medical procedure I need. Or $100,000. Or a million. Or 2 million. I can do that.

But that doesn't do me any good if I get hit by a bus and need emergency care to stabilize my condition if the vast majority of people in my community can't, so my local hospital closed and I have to make it to Atlanta before I bleed out internally.

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Not necessarily. To make that assumption, you'd have to assume that all PTs are charged similar amounts. That's not the case. Patients that are currenlty being over charged (price!) would see cheaper prices. PTs currently paying nothing would see an increase. In aggregate it would provide downard pressure toward affordability. It does the provider no good to charge mroe than a customer can pay, because... they simply won't pay it. Remove the deep pockets and prices start to align better with cost.

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Let's do it this way. Google says the average range for a heart surgery reimbursement runs between $55,000 and $83,000 to a hospital.

What do your models tell you that would go down to with a cash system?

Unless it's way, way, way, way, less than that, we have a problem.

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Where did I say hospital stays should be $400? I've never said medical care should be cheap. I've said the opposite.

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It's an entailment of your argument and the facts about Americans being able to afford cash hospital services (which is admittedly vague.)

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But even addressing your strawman, saying "People cannot afford a $30,000 hospital stay" is silly when people are paying $80,000 for pickups.

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People aren't paying $80,000 for pickups. They're BORROWING $80,000 to buy pickups. There's a gigantic difference.

Are you going to loan $30,000 to someone to have a surgery or get cancer treatment that they might not recover from? Nope. Neither is the bank. Any bank.

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Sorry man, but that's just silly.

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It sure is. It was intended to be. It's the practical reality of your argument.

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wouldn’t cover people for “pre-existing conditions,” which was a complete scam.

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How much would your car insurance cost, if all the companies were forced to cover "pre-existing wreck conditions"? The whole idea of insurance is that you are paying "in case" you have a problem, not that you start paying AFTER you already have a problem.

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Not really, when you recognize that most people screaming about "can't afford coverage, I need YOU to pay for MINE" are standing behind their bass boat, or muscle car while screaming it.

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Nonsense. I have insurance. It’s expensive, but I’m thankful I have it.
My wife started developing multiple medical issues over three years ago, one diagnosis after another, multiple surgeries. We’re waiting on biopsy results to come back to see if she has new cancer. She’d previously been healthy before her issues started.

She lost her job, she’s unable to work. Financially it’s been a kick in the arse, but I thank God every day I have her covered with health insurance.

I don’t have a bass boat (would love one), a muscle car, or an $80,000 truck.

I consider myself to be very lucky, and I’m perceptive enough to realize a lot of people aren’t.

Right on, they have had 15 years of ignoring the health care issue thinking that it would go away.

The GOP has no plan and dosent want one.
They have no ideas and can't fix anything.

The GOP congressmen and Senators are useless

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Which prompts the question, why should the burden for paying for your surgery be shifted to someone who values it less? If it doesn't mean enough to you to sacrifice for it, why should others be forced to sacrifice for it? The expectation of medical care to be cheap is perverse.

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Unfortunately nobody except the exceedingly wealthy could afford a heart procedure in five days in the hospital

That begs the question what happens do they do the procedure and end up with a patient declaring bankruptcy or not do the procedure and have the patient die

There is a reason that insurance exists

I am not a fan of the ACA and it ruined care for individuals and ultimately was a boon to insurance companies and their premiums

But to suggest that everybody has to unilaterally pay for their own healthcare destroys the concept of insurance and ultimately could lead to the destruction of society in general