Healthcare Content (Protest Instructions) >>>>>

[twatts]

Yep, she was really upset for about a half hour, wouldn't even nurse really which is very uncharacteristic of her. 

Shit man, jack dem tax rates back up to Eisenhower levels that should make a bigger dent.

Glad to hear she's doing well!!!  As for not nursing, the swallowing action probably hurt her ears... 

Terry

[runawayjimbo]

Yep, she was really upset for about a half hour, wouldn't even nurse really which is very uncharacteristic of her. 

Yeah, mine was screaming and head butting us for like 30 mins or so too. Then she just snapped out of it and by the time we got home she was like nothing ever happened. Fucking kids are resilient.

Shit man, jack dem tax rates back up to Eisenhower levels that should make a bigger dent.

YOU REALLY ARE A FUNNY GUY!!!!!

Anyway, this has been fun afternoon of shirking nearly all my responsibilities for tooling around on here. I haven't done that in a while.

[Hicks]

Yep, she was really upset for about a half hour, wouldn't even nurse really which is very uncharacteristic of her. 

Shit man, jack dem tax rates back up to Eisenhower levels that should make a bigger dent.

Glad to hear she's doing well!!!  As for not nursing, the swallowing action probably hurt her ears... 

Terry

Heh, they gave her a bottle of sugar water, she took that just fine.   :hereitisyousentimentalbastard

[mbw]

and by then maybe your kids brain would have been cooked like an egg on the hood of an overheated Jeep Sahara in the Sahara.

Or maybe the fever would have broken in a couple of hours, like it did...

But if it came down to that, we would have been in the ER - that's what its for.

To make my wife feel better when she's in a panic, that is not what its for... 

Terry

hillariously scary that you would defend a system in which:

1.  they obviously wildly inflate costs
2.  the same treatment costs you a tenth one day later
3.  has you blaming your wife for wanting the best for your kid.

glad it all is well however.

[twatts]

and by then maybe your kids brain would have been cooked like an egg on the hood of an overheated Jeep Sahara in the Sahara.

Or maybe the fever would have broken in a couple of hours, like it did...

But if it came down to that, we would have been in the ER - that's what its for.

To make my wife feel better when she's in a panic, that is not what its for... 

Terry

hillariously scary that you would defend a system in which:

1.  they obviously wildly inflate costs
2.  the same treatment costs you a tenth one day later
3.  has you blaming your wife for wanting the best for your kid.

glad it all is well however.

I'm not trying to defend the system, I have my own issues with it.  I'm just pointing out that paying for medical procedures is expensive and we should expect them to be, and that what you might think is an outrageous cost in a relative terms is insignificant to the non-treatment of certain things.  In the case of ear-tubes, paying $6000 is worth having a life-time of good hearing, etc, but that's IMO...

1.  we could discuss the costs, though I'm not prepared...  but it ties in with #2.  If you want, I can get a whole speal on the subject since my father works in the insurance field.  I'm sure he has first-hand opinion concerning the costs of insurance...
2.  It was NOT the same treatment per se.  One involved Emergency Services, the other did not.  I paid for the "convenience" of being able to walk into an ER instead of waiting.  You would treat the Lamborghini in my analogy the same as the Yugo.  It's obviously not, although they both provide the same service (a ride to the mall).
3.  again, "best" is relative.  Paying our entire HSA out for one ER call was not "best", when the same service is available the next day for 1/10 the cost, and especially now that our HSA is flat broke and we are pregnant again... 

And yeah, I'm glad it worked out too...

[VDB]

So, the question is, how to pay for single-payer (if that's the objective).

Here are the assumptions to be met in order for such a hypothetical discussion to be relevant:
1. There is suitably widespread popular support for implementing such a system -- important because people will also need to be accepting of how to pay for it
2. Such a system would be more efficient than the current system -- i.e. it will lead to lowering the cost of care
3. Such a system would replace the current system

Well, if you implement a tax to pay for a new system that costs less than the old, and you no longer have to pay for the old one, then in theory you save money in the tradeoff. Raise taxes (yes, everyone hates that) but relieve people of paying for expensive private insurance (yay). Net win, if in fact assumption #2 is correct (otherwise, why bother, correct?).

Now, we have to take into account that "Medicare for all" would also be designed to cover the uninsured. I heard on the radio the other day that caring for the uninsured (which, unfortunately for Tea Partiers, healthcare providers are legally and ethically bound to do) costs the average insurance-carrying family an extra $1,000 a year. Don't know if that's true, but it was on NPR so Rick Santorum would probably call it bullshit. Assuming that when we spread around the cost to care for the poor under a single-payer gov't system, if it comes in at less than $1,000 in "freeloader underwriting" per household, that's still a win.

Whether or not the above is actually my preference, I haven't decided, but the question was posed, how do we pay for it, and I say that's how you pay for it.

Oh and by the way, the tax would have to be structured in such a way so that the poor people who can't afford insurance today wouldn't instead be hit with an extra tax that they also couldn't afford. In other words, good luck meeting assumption #1, because this will come across as expanding welfare for freeloaders at the expense of the job-creators. Despite the fact that we end up paying for it anyway.

[runawayjimbo]

In the case of ear-tubes, paying $6000 is worth having a life-time of good hearing, etc, but that's IMO...

To clarify (since I'm tired of watching you guys butcher this :wink:), the tubes are (generally) not about hearing. Infants/toddlers have a difficult time draining fluid behind their ear drums because their stupid inner ears slope the wrong way (they gradually move up and point to your throat as we grow). That's why they often get ear infections after common colds. The tubes are drilled in the ear drum to help them clear the fluid.

Where the hearing concerns come in is that this fluid can dampen a kid's hearing which, at this age (mine is almost 2, I think Hicks' is a little younger) is a very important for language development. The tubes (in theory) allow them to process speech and develop their own language skills. To Hicks' other point about the necessity, I also wasn't sure how the fuck you can accurately test a 1-2 yr old's hearing, but that's why we (a) rely on competent doctors and (b) make the decision as parents about the best course of action for our kids.

Parenting is some scary shit.

[Hicks]

In the case of ear-tubes, paying $6000 is worth having a life-time of good hearing, etc, but that's IMO...

To clarify (since I'm tired of watching you guys butcher this :wink:), the tubes are (generally) not about hearing. Infants/toddlers have a difficult time draining fluid behind their ear drums because their stupid inner ears slope the wrong way (they gradually move up and point to your throat as we grow). That's why they often get ear infections after common colds. The tubes are drilled in the ear drum to help them clear the fluid.

Where the hearing concerns come in is that this fluid can dampen a kid's hearing which, at this age (mine is almost 2, I think Hicks' is a little younger) is a very important for language development. The tubes (in theory) allow them to process speech and develop their own language skills. To Hicks' other point about the necessity, I also wasn't sure how the fuck you can accurately test a 1-2 yr old's hearing, but that's why we (a) rely on competent doctors and (b) make the decision as parents about the best course of action for our kids.

Parenting is some scary shit.

Exactly, I was never convinced that the hearing test was very accurate for a pre-verbal child like her (she's turning one in a couple of weeks), so I was completely at the mercy of the doc's judgement. 

[sunrisevt]

Just jumping in again to validate VB's post above, and agree: the biggest challenge of a single-payer system in the US would be getting the necessary political support from the general electorate. Too many people vote against their own interests for it to be realistic, I'm afraid.

[gah]

Just jumping in again to validate VB's post above, and agree: the biggest challenge of a single-payer system in the US would be getting the necessary political support from the general electorate. Too many people vote against their own interests for it to be realistic, I'm afraid.

That and the insurance companies would never allow it to happen. It would eliminate an entire industry.

[sls.stormyrider]

just jumping in after spending too much time here this AM

-the medical billing system is a totally fucked up game. The payment for anything delivered in the hospital is a fraction of what the bill is - the average is between 40 and 50 % for someone with insurance, less then 33% for Medicaid, depending on the state. But - if yo have no insurance or medicaid, you are expected to pay the entire amount.

-the cost of the procedure goes to everyone involved - docs, nurses, hospital, etc. Given that, if you look at what something actually costs to deliver and what the reimbursement is, they don't always correlate. medicare and the private insurance cos go after high profile, high volume procedures and knock the prices down (imaging for one). the reimbursment for quick procedures like Hicks daughter had, cataract surgery, is imo inflated above what it should be. meanwhile, if I spend 1/2 hour talking to a pt on the phone, or an hour looking up a tough problem in the literature, I get paid nothing. I don't care (well, maybe a little  :wink:), it's my job, and I don't let it deter me, but the system is fucked. It's a problem that is slowly being adressed, but it will take years before it's corrected.

-emergency rooms are the most expensive place to deliver care. One thing universal coverage will do to lower costs is provide more access to get people into the docs office and out of the ER.

[DoW]

just jumping in after spending too much time here this AM

-the medical billing system is a totally fucked up game. The payment for anything delivered in the hospital is a fraction of what the bill is - the average is between 40 and 50 % for someone with insurance, less then 33% for Medicaid, depending on the state. But - if yo have no insurance or medicaid, you are expected to pay the entire amount.

-the cost of the procedure goes to everyone involved - docs, nurses, hospital, etc. Given that, if you look at what something actually costs to deliver and what the reimbursement is, they don't always correlate. medicare and the private insurance cos go after high profile, high volume procedures and knock the prices down (imaging for one). the reimbursment for quick procedures like Hicks daughter had, cataract surgery, is imo inflated above what it should be. meanwhile, if I spend 1/2 hour talking to a pt on the phone, or an hour looking up a tough problem in the literature, I get paid nothing. I don't care (well, maybe a little  :wink:), it's my job, and I don't let it deter me, but the system is fucked. It's a problem that is slowly being adressed, but it will take years before it's corrected.

-emergency rooms are the most expensive place to deliver care. One thing universal coverage will do to lower costs is provide more access to get people into the docs office and out of the ER.

I wanted to avoid the specific details on payment because people on here would flip if they ever knew it.
it's a bit anti-liberal and definitely structured as republican big corporation rules.
that aspect definitely needs reform.  I just hope (for my own beliefs) there is an acceptable median between what we have now and single payer.

[runawayjimbo]

Some good stuff here, VDB. Of course, it's somewhat irrelevant since that's not what we ended up with but I am at least glad to see that we've seem to have come to grips with the fact that the current law blows and we should start dicussing ways to actually reform the fucked up system. Now, to your points:

Well, if you implement a tax to pay for a new system that costs less than the old, and you no longer have to pay for the old one, then in theory you save money in the tradeoff. Raise taxes (yes, everyone hates that) but relieve people of paying for expensive private insurance (yay). Net win, if in fact assumption #2 is correct (otherwise, why bother, correct?).

Obviously this hinges on #2 (insert scat joke here) i.e., that a gov't run system would reduce total medical spending and leave the incentives for innovation unchanged. I am highly suspect of this assumption. But more importantly, there's a very strong possibility (I'd even say certainty) that politicians would soft sell the tax and just finance the shortage with more debt as they are wont to do. So the bigger question to me is not will the net effect be less money out of people's pockets in the short term but the impact on the debt and deficit over the long run. Paying less in gov't premiums now for widespread financial ruin doesn't see like a fair tradeoff to me. Plus, you have the same issues we have with Social Security: growing elderly population who consumes more medical care, less workers to pay for them, and politicians too scared to tell people we can't afford it. Just seems pretty unsustainable to me (especially in light of the $15T in current debt, 60% of which is due in the next 5 yrs).

Now, we have to take into account that "Medicare for all" would also be designed to cover the uninsured. I heard on the radio the other day that caring for the uninsured (which, unfortunately for Tea Partiers, healthcare providers are legally and ethically bound to do) costs the average insurance-carrying family an extra $1,000 a year. Don't know if that's true, but it was on NPR so Rick Santorum would probably call it bullshit. Assuming that when we spread around the cost to care for the poor under a single-payer gov't system, if it comes in at less than $1,000 in "freeloader underwriting" per household, that's still a win.

This is a good point and one that I forgot to account for in my dirty calculation (I was double counting current Medicare/aid spending). But here's an alternative to consider: uncompensated care in 2011 was $41B (I can't find the link now but I'll dig it up later if interested), which is about 3% of total spending (historically it's between 3-6%). Similarly, lawyers generally provide 3-6% annually in pro bono services. It seems to me if the dirty scumbag lawyers (:wink:) can provide this level of "free" services, why couldn't medical providers? Have some kind of risk pool for uncompensated care that insurers, hospitals, providers all kick in to. In an $2T industry, I gotta believe they have enough capital to come up with $40B a year. It just seems to me there are more effective ways to achieve universal coverage (if that's the ballgame) without forcing people to hand over their personal healthcare decisions to a central planner.

Whether or not the above is actually my preference, I haven't decided, but the question was posed, how do we pay for it, and I say that's how you pay for it.

It's a start, but I think you're still a long way from covering the cost of an entire gov't run program. Plus, what's missing from the analysis is the effect of higher tax rates on the economy (cue Hicks with the "we did just fine with Clinton" argument), the distortions in market pricing that could be caused by a monopoly healthcare provider, the potential loss of new technologies that enhance health outcomes, and the likelihood that a gov't who already spends 12% more than they've collected (average since 1950; 22% in the past decade) would have any success in trimming the fat.

Just jumping in again to validate VB's post above, and agree: the biggest challenge of a single-payer system in the US would be getting the necessary political support from the general electorate. Too many people vote against their own interests for it to be realistic, I'm afraid.

Can you at least acknowledge that there is no basis to decree as you did that a single payer system would be in the best interest of everyone? You can say that you would prefer single payer and that you believe it would bring down costs and increase quality and not bust the budget, but I don't think it's fair to  say anyone who doesn't agree with your conclusions is too stupid to know what's good for them.

Here's an interesting question for you, sunrise: during oral arguments, the SG had a difficult time articulating if there was any limit to Congress' power under the Commerce Clause; my question is, can you think of anything that Congress should not be authorized to do? Or do liberals really believe that the Congress should have the ultimate power to make any decision they deem too complicated for the rest of us commonfolk to understand?

[sls.stormyrider]

just jumping in after spending too much time here this AM

-the medical billing system is a totally fucked up game. The payment for anything delivered in the hospital is a fraction of what the bill is - the average is between 40 and 50 % for someone with insurance, less then 33% for Medicaid, depending on the state. But - if yo have no insurance or medicaid, you are expected to pay the entire amount.

-the cost of the procedure goes to everyone involved - docs, nurses, hospital, etc. Given that, if you look at what something actually costs to deliver and what the reimbursement is, they don't always correlate. medicare and the private insurance cos go after high profile, high volume procedures and knock the prices down (imaging for one). the reimbursment for quick procedures like Hicks daughter had, cataract surgery, is imo inflated above what it should be. meanwhile, if I spend 1/2 hour talking to a pt on the phone, or an hour looking up a tough problem in the literature, I get paid nothing. I don't care (well, maybe a little  :wink:), it's my job, and I don't let it deter me, but the system is fucked. It's a problem that is slowly being adressed, but it will take years before it's corrected.

-emergency rooms are the most expensive place to deliver care. One thing universal coverage will do to lower costs is provide more access to get people into the docs office and out of the ER.

I wanted to avoid the specific details on payment because people on here would flip if they ever knew it.
it's a bit anti-liberal and definitely structured as republican big corporation rules.
that aspect definitely needs reform.  I just hope (for my own beliefs) there is an acceptable median between what we have now and single payer.

yea, but as the people here see more medical bills and more EOBs they'll figure it out.
and I agree, I'm hoping for a median between single payer and current system. Switzerland seems to have done it.

Similarly, lawyers generally provide 3-6% annually in pro bono services. It seems to me if the dirty scumbag lawyers () can provide this level of "free" services, why couldn't medical providers? Have some kind of risk pool for uncompensated care that insurers, hospitals, providers all kick in to. In an $2T industry, I gotta believe they have enough capital to come up with $40B a year. It just seems to me there are more effective ways to achieve universal coverage

we write off about 3% in "bad debt", ie free care, not counting the fact that the health care system has a "free care" system for people who don't quite qualify for public funding. What's different about this biz (compared to law or other professions) is that health care reimbursement is regulated. Even though Medicare is a minority player compared to privates (about 35 - 40% give or take), private insurance companies use Medicare reimbursement as a guide.
Regardless, my guess is that lawyers "make up" the charity cases from the profit they make on the paying customers, they just don't know it. Likewise, the health care system gets a bit more back from the private payers to make up for the losses from Medicaid and bad debt.

[DoW]

we write off about 3% in "bad debt", ie free care, not counting the fact that the health care system has a "free care" system for people who don't quite qualify for public funding. What's different about this biz (compared to law or other professions) is that health care reimbursement is regulated. Even though Medicare is a minority player compared to privates (about 35 - 40% give or take), private insurance companies use Medicare reimbursement as a guide.
Regardless, my guess is that lawyers "make up" the charity cases from the profit they make on the paying customers, they just don't know it. Likewise, the health care system gets a bit more back from the private payers to make up for the losses from Medicaid and bad debt.

I LOL'd at make up cases.
I can't agree or disagree.  it was just funny.
the two professions can;t be compared.
lawyers are smart and then we have doctors  :wink: