hemster
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Post by hemster on Dec 20, 2021 9:17:06 GMT -5
[Disclaimer] This is not political. Please refrain from political comments.
For an advanced nation, we are at the bottom of the list of countries that provide healthcare for their citizens. But we have capitalistic principles (which I like) and runaway costs. Consequently, the number of people who cannot afford health insure has been increasing, to the detriment of their health. So what's a person to do if they need care? They go to the ER! They cannot pay the exorbitant charges, so the rest of us get premium increases, and the spiral continues.
So we all are already paying more than what it would cost the nation to provide subsidized healthcare. There are lots of models out there and we could develop our own. But is there will to do so?
[/Disclaimer] This is not meant to be political. Please refrain from political comments.
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KeithL
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Post by KeithL on Dec 20, 2021 10:58:20 GMT -5
Sadly, many of the models are incorrect, and the claim that "we would ALL be paying less with national health care" is largely unsubstantiated.
The bottom line is that, as someone already said, there is no such thing as free or low cost medical care. Good medical care is expensive - and, in the end, someone has to pay the bill. (Sweden, who has very high taxes, but who has long since been lauded as "a model of socialized health care", is now facing cutbacks - because they simply cannot make ends meet.) And, in the UK, where "socialized medicine" has been the norm for years, many of their citizens are NOT satisfied with the quality of health care they receive.)
There are certainly some anticompetitive practices that we practice here in the USA that contribute to the problem. For example, the fact that we here in the US are required to pay for FDA approved drugs, and not allowed to purchase lower cost non-FDA approved equivalents from foreign sources. In essence this helps ensure that pharmaceutical companies are able to make enough profit to cover development costs.
However the bottom line, at the human level, is very simple... Insurance companies are in it to make a profit... The reason they remain in business is that they are able to collect more from their customers in premiums than they pay out for health care. Therefore the bottom line is that, if those who cannot afford good health care are to be provided with good health care, then SOMEONE has to pay for it... And that cost is going to fall on the price of premiums for those who can afford to pay more. Therefore common sense dictates that: - those who cannot afford good health care are going to be in favor of a system that subsidizes their health care - those who CAN afford good health care are NOT going to be in favor of a system that charges them more to support subsidies for those who cannot afford to pay
HOWEVER, in a system where the government provides health care, the government has in essence simply become your insurance company. (And, in that context, the "premiums" are paid out of your taxes.) Or, in a more extreme case, they have become the health care provider itself.
(And, in that context, the government must pay the doctors, pay for the drugs, and pay to keep the hospitals and other facilities open and operating.)
And, since not even the government can simply "operate at a loss forever by simply printing more money", someone still has to pay in the end. (So, if we are to provide services for those who cannot pay for them, then those who can pay will still end up paying - whether in the form of higher insurance premiums or higher taxes.)
Also, to be blunt, while some MAJOR changes could help the situation, they would indeed be major, and would disrupt the entire industry. While the details have become politicized the basic problem is still simply one of cost and ability to pay. (And good medical care is simply more expensive than what many people can afford to pay.)
The short answer is that "the will exists" - but perhaps not in sufficient quantity to get us to that goal.
[Disclaimer] This is not political. Please refrain from political comments. For an advanced nation, we are at the bottom of the list of countries that provide healthcare for their citizens. But we have capitalistic principles (which I like) and runaway costs. Consequently, the number of people who cannot afford health insure has been increasing, to the detriment of their health. So what's a person to do if they need care? They go to the ER! They cannot pay the exorbitant charges, so the rest of us get premium increases, and the spiral continues. So we all are already paying more than what it would cost the nation to provide subsidized healthcare. There are lots of models out there and we could develop our own. But is there will to do so? [/Disclaimer] This is not meant to be political. Please refrain from political comments.
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Post by housetech on Dec 20, 2021 13:25:49 GMT -5
Free market principles work, YES (unfortunately) health care is now a political issue and it should never be. Follow the money, it's cronyism today. Single payer is communism- we all get equally crappy care. Whenever gov't get involved in anything, the price always increase, ALWAYS. (I once sold health insurance) Medicare & Medicaid increased the cost and price of medical care- that's a FACT. Estimates are 40% of medical cost are due to waste, fraud, abuse & gov't regulations. I could write a white paper on the subject.
There are doctors who have started "co-op" (for lack of the exact name) clinics that are cheap and effective. They do everything except major surgeries. Patients join the program for a monthly fee ($75/mo), then pay a low cost doctors' visit ($10-25), all drugs and medical supplies are purchased in bulk by the co-op to be used. Patient's drugs are purchased from the co-op at a very reduced price. There are THOUSANDS OF DOCTORS WHO ARE PUSHING FOR MEDICAL CO-OPS because what we're doing doesn't work... but we keep doing it. Every county has a county hospital that our property taxes already pay for and they are being over run with patients (& illegals). Thank goodness there are minor emergency medical services becoming popular in most communities. There are better and cheaper ways for medical care, but we have a political class that refuses to make the changes that are needed- gov't never gives up power & control once they get it. It's all politics, all the time on every issue, it seems.
To pay for major surgeries and accidents, there are "major accident" insurance policies that are cheap.
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Post by monkumonku on Dec 20, 2021 13:34:13 GMT -5
Free market principles work, YES (unfortunately) health care is now a political issue and it should never be. Follow the money, it's cronyism today. Single payer is communism- we all get equally crappy care. Whenever gov't get involved in anything, the price always increase, ALWAYS. (I once sold health insurance) Medicare & Medicaid increased the cost and price of medical care- that's a FACT. Estimates are 40% of medical cost are due to waste, fraud, abuse & gov't regulations. I could write a white paper on the subject. There are doctors who have started "co-op" (for lack of the exact name) clinics that are cheap and effective. They do everything except major surgeries. Patients join the program for a monthly fee ($75/mo), then pay a low cost doctors' visit ($10-25), all drugs and medical supplies are purchased in bulk by the co-op to be used. Patient's drugs are purchased from the co-op at a very reduced price. There are THOUSANDS OF DOCTORS WHO ARE PUSHING FOR MEDICAL CO-OPS because what we're doing doesn't work... but we keep doing it. Every county has a county hospital that our property taxes already pay for and they are being over run with patients (& illegals). There are better and cheaper ways for medical care, but we have a political class that refuses to make the changes that are needed- gov't never gives up power & control once they get it. It's all politics, all the time on every issue, it seems. To pay for major surgeries and accidents, there are "major accident" insurance policies that are cheap. You said it right there, follow the money. As long as humans are in charge of administrating health care, it is never going to improve because of that. Even under communism/socialism - that is all run by humans as well and is the same thing, follow the money. The greater the amount of administration, i.e., the more people involved in overseeing things, the more corrupt it gets because that means more hands pilfering and easier ways to hide it. The best hope is to allow true freedom of competition.
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Post by housetech on Dec 20, 2021 14:04:04 GMT -5
monkumonku, a nearly $5 TRILLION gov't budget pays for a lot of corruption. As long as we keep feeding the beast, it will never stop. It seems nearly all politicians enter "public service" from the working class then leave gov't "service", wealthy. That's not how our gov't was supposed to work. The Federal gov't has ZERO Constitutional authority to be involved in our medical care. (non-debatable)
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KeithL
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Post by KeithL on Dec 20, 2021 14:22:05 GMT -5
There is one thing that I think would provide a partial solution...
At the moment we have a divergence between insurance-based "pricing" and reality. For example, as an uninsured individual, "paying cash", you may be quoted $10k for a particular surgery. Yet, when that same surgery is paid for by your insurance, they pay a "negotiated price" of only $3k. Obviously the insurance company is negotiating "wholesale prices" with the hospital... Which they can do because they represent tens of millions of paying customers. But, also obviously, the hospital can afford to provide the service for only $3k.
My suggestion is simply that someone, which could be the government or a private company, offer "0%" coverage insurance. This insurance could cost virtually nothing - because it would cover 0% of your actual bill. However you would still count as "a customer of a big insurance company", who could still negotiate on behalf of their millions of customers... And so would be paying 100% of that LOWER NEGOTIATED RATE. So, in the example, your "insurance" would pay the $3k negotiated rate, which you would then pay all of yourself. This would still be far less than what you would have had to pay as "someone paying cash".
With something like this available an individual could choose to not have insurance that would actually pay the bill... But still benefit from the far lower "negotiated insurance company rates". And, at least in principle, this would allow more people to survive as uninsured, or to purchase other cheaper less comprehensive insurance.
Those numbers in the example are real... A friend of mine had a $11,000 surgery on his knee... (Which was claimed to be "the real price he would have had to pay if he didn't have insurance".) For which his insurance company paid a $3200 "negotiated rate"... (Which paid the entire bill...)
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Post by housetech on Dec 20, 2021 17:44:11 GMT -5
Those multi-tier scales are directly a result of Medicare/Medicaid. Medicare will only pay $X for a procedure regardless how complicated it is. Medical professionals needed to make up the differences from losing money on some Medicare patients and over charge (sorry, fully charge) insured patients. Medical professionals found if Medicare only pays $150,000 for open heart surgery, but it really cost $250,000, then bill the patient, they (patient) would just ignore the extra $100k bill because medical bills were not reported to the credit bureaus. The purpose of insurance is to keep people from going bankrupt. Insurance is NOT to keep people from paying any of their medical cost; that is why our premiums are so high now. Taking little Johnny to the doctor for a cold is not what health insurance is for. The "pays for everything insurance" came from companies trying to get the best employees, so they offered expensive policies to attract them.
Insurance premiums is not to pay our medical bills. Our premiums are invested into the markets to fund infrastructure projects and that makes the insurer money, and that return on investment is what pays our medical bills. People want the "gov't insurance" to pay for our medical cost, but that is impossible because the gov't doesn't invest our taxes to make a profit. If we expect the gov't to pay our medical cost, taxes would become so high, we couldn't afford to have medical coverage, it would bankrupt the gov't. The biggest cost of the Federal gov't today is Medicare/Medicaid and Social Security. When Obamacare was introduced, financial experts said it will never work and that is why gov't "insurance" is an impossibility. We need to find a better way for the medical professions and the patients.
There was a time when most hospitals were privately owned, mostly by churches (non-profits). Sometimes patients weren't getting the best care, mistakes were made. Then lawyers decided they could sue the hospitals for malpractice and it was the lawsuits that cause them to sell out to for-profit medical corporations that now control the vast majority of medical care. So, things are much more complicated than some want to admit.
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hemster
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Post by hemster on Dec 22, 2021 14:36:18 GMT -5
There is one thing that I think would provide a partial solution... At the moment we have a divergence between insurance-based "pricing" and reality. For example, as an uninsured individual, "paying cash", you may be quoted $10k for a particular surgery. Yet, when that same surgery is paid for by your insurance, they pay a "negotiated price" of only $3k. Obviously the insurance company is negotiating "wholesale prices" with the hospital... Which they can do because they represent tens of millions of paying customers. But, also obviously, the hospital can afford to provide the service for only $3k. My suggestion is simply that someone, which could be the government or a private company, offer "0%" coverage insurance. This insurance could cost virtually nothing - because it would cover 0% of your actual bill. However you would still count as "a customer of a big insurance company", who could still negotiate on behalf of their millions of customers... And so would be paying 100% of that LOWER NEGOTIATED RATE. So, in the example, your "insurance" would pay the $3k negotiated rate, which you would then pay all of yourself. This would still be far less than what you would have had to pay as "someone paying cash". With something like this available an individual could choose to not have insurance that would actually pay the bill... But still benefit from the far lower "negotiated insurance company rates". And, at least in principle, this would allow more people to survive as uninsured, or to purchase other cheaper less comprehensive insurance. Those numbers in the example are real... A friend of mine had a $11,000 surgery on his knee... (Which was claimed to be "the real price he would have had to pay if he didn't have insurance".) For which his insurance company paid a $3200 "negotiated rate"... (Which paid the entire bill...) If I was that friend and did not have private insurance to pay $11,000 cash for the surgery, I might be temped to go the route of medical tourism (if we weren't in a pandemic). There are many nice hospitals with US/European trained doctors in Thailand, India, etc. where I could get the surgery. Even after bundling it with a vacation, it would cost me less than $11k.
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Post by Boomzilla on Dec 22, 2021 16:59:43 GMT -5
Our current system isn’t fair. We could debate which injustices are most egregious, and what needs to be changed endlessly, but we’re just counting angels on the head of a pin. Simple things that seem obvious:
A good doctor is worth paying for. Nurses are almost universally underpaid. Drugs are too expensive. Even poor Americans need health care. There’s no free lunch.
Finis
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Post by Soup on Dec 22, 2021 19:06:34 GMT -5
And all those "free" covid tests are NOT free.....
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cawgijoe
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Post by cawgijoe on Dec 23, 2021 6:19:38 GMT -5
And all those "free" covid tests are NOT free..... Very true...taxpayer funded as well as the vaccine's. I remember when I bought my first townhouse along time ago and was finishing the basement....needed carpet....went to the local mom-and-pop carpet store. I negotiated a price and then asked the old store owner who had emigrated from Iran, "is the padding free?"....he looked at me and said, "Let me tell you young man, of course it's free....but don't forget, nothing is free in America." In other words, you are paying for it in the price of the carpet itself. That has stuck with me my whole life.
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