Goodbye to US HealthCare?

[ThePythonicCow]

Re: Goodbye to US HealthCare?

I feel exactly the same way. It is amazing how much healthier you are when you eat the right foods and get a decent amount of exercise.

Yup, for sure. Rogermexico and I both claim that exercise is less important to health than nutrition, but that is a quite secondary quibble to your main point.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

Don't ever get shot, stabbed, clubbed, don't ever get into a serious car wreck, don't misstep off a curb, don't ever fall off a ladder, don't get old with diseqilibrium and break your hip or your neck, etc. etc. etc. Oh, and there might just be some cancers that are not the effect of lifestyle, except prostate ones which are ever more likely if you stay alive long enough.

I make no claim to immunity from accidents or such; I'm not that clue deprived. I only ask that I be allowed to deal with them the same way as my ancestors. I'll pay for what care I can, take charity as available and as needed in some cases, and do without otherwise.

This might mean I die sooner than I would given the finest possible medical care. So be it.

I might choose to pay for this care by purchasing some sort of insurance or prepaid health plan, or pay for it out of savings or pay for it out of future income (debt.) What I can't pay for and what isn't given to me by some kind charity or doctor, I don't get. Tough.

Jim -- why is it so difficult for people to recognize that the absence of federal government funded health care does not dictate no health care? Why do so many disagreements over some federal program degenerate into disagreements over the desirability of the service being considered by any means, as if there were no other means than the federal government to accomplish anything?

By the way, prostrate cancer too is a matter of life style, in my view. It is also one of the many ailments the test for which is used to generate excess profits for the medical industry.

[c1ue]

Re: Goodbye to US HealthCare?

The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care.

This is interesting in another way: according to Atlantic Monthly health care opinion article there is 1 health care insurance employee per 2 doctors.

If the actual spending breakdown is 31 vs. 69, this also implies nearly equal pay between health care insurance employees (and health care corporate shareholders) and doctors.

I make no claim to immunity from accidents or such; I'm not that clue deprived. I only ask that I be allowed to deal with them the same way as my ancestors. I'll pay for what care I can, take charity as available and as needed in some cases, and do without otherwise.

This might mean I die sooner than I would given the finest possible medical care. So be it.

I might choose to pay for this care by purchasing some sort of insurance or prepaid health plan, or pay for it out of savings or pay for it out of future income (debt.) What I can't pay for and what isn't given to me by some kind charity or doctor, I don't get. Tough.

Jim -- why is it so difficult for people to recognize that the absence of federal government funded health care does not dictate no health care? Why do so many disagreements over some federal program degenerate into disagreements over the desirability of the service being considered by any means, as if there were no other means than the federal government to accomplish anything?

Mooster,

I understand your viewpoint.

I would point out, however, that you don't have the choice to opt out of using roads. Of using water and sewage systems. Of national defense. Of the US dollar. Etc etc.

The second point is that while you certainly may be strong enough willed to be willing to die due to care not provided but provideable, the reality is that most people are not. If this were not so, the ERs around the nation wouldn't be crowded with the uninsured (as well as overinsured).

The last point is that the cost of care you are willing to pay for itself is mushrooming due to the inadequacies of the system.

From my ever evolving view - the problem as I see it is that health insurance only addresses the actuarial side of health care. It does not address the delivery side.

This is exactly like a trophy wife or a kid with a too large allowance: the coupling of access to money without consequences of either paying bills or earning income leads to wasteful behavior.

The reform that needs to happen - Obama apologists to the contrary - is both a reform of the payment/actuarial side AS WELL AS a reform on the delivery side.

The reality which these YWCers refuse to acknowledge is that Obama by allowing the debate to be framed by the health insurance industry, is in fact perpetuating the broken system by grafting taxes onto it.

And I don't mean graft as in tree or skin graft.

I mean graft as in bribes and extortion.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

I would point out, however, that you don't have the choice to opt out of using roads. Of using water and sewage systems. Of national defense. Of the US dollar. Etc etc.

The roads, water and sewage are not (for the most part) federal programs. Nor should they be.

National defense is properly a federal program; though it has overgrown with its own problems, as Eisenhower noted in his farewell address.

Currency is properly a federal program, though it too has overgrown with problems, as many including us here at iTulip have noticed.

The presence of a few programs that are properly federal does not mean that all desirable collective activities should be government, much less federal government.

The reality which these YWCers refuse to acknowledge is that Obama by allowing the debate to be framed by the health insurance industry, is in fact perpetuating the broken system by grafting taxes onto it.

It's broke alright!

[c1ue]

Re: Goodbye to US HealthCare?

The roads, water and sewage are not (for the most part) federal programs. Nor should they be.

That these are not federal programs is irrelevant. They don't need to be because those partaking of them are the ones living in the states providing the services.

Health care on the other hand is not either so immediate nor short term unavoidable. A simple example: people retiring to Florida after working in Oklahoma for 30 years.

Lastly it is unclear that a state administered program is necessarily any more efficient or less bureaucratic than a federal one. That the pond is bigger doesn't itself necessarily mean anything.

The presence of a few programs that are properly federal does not mean that all desirable collective activities should be government, much less federal government.

Certainly true, but again I fail to see an alternative solution - especially given that the collective health care in every peer of the US as well as most less-than-peers is working far better than the 'capitalist' system right now.

And again, I am totally against the present health care 'reform' proposal.

But it does not mean I cannot see how a better system would be.

Yet another reason why collectivized health care is necessary: portability.

The present system doesn't allow past actuarial contributions to make any damned difference to future actuarial costs.

This is another area where insurance companies likely squeeze the system: every time a person changes a job, the insurance company can use the person's new (older) profile to charge insurance fees.

The past contributions which by and large were not (yet) paid out in the form of health care gets pocketed. This is 'float' pure and simple which the health insurance companies just pocket.

Your own experience may reflect this. As I recall you used to work in California then moved to Texas. Unless you are still with the same company - highly unlikely given the software work you perform - then if you paid any health insurance in the past, those contributions were all tossed out.

This is stupid plain and simple.

Unlike car insurance which is a fixed cost at any given time modified only by inflation, health care costs rise in greater proportions as you age. The entire point of an actuarial pool is that those younger with less costs can contribute with their contributions scaling over time as well as those who need more services than average getting subsidized by those who do not (but neither knowing ahead of time which category they fall into).

[Dirk Diggler]

Re: Goodbye to US HealthCare?

So what you are saying is, that because I don't desire health insurance, I am some sort of fool. Because I must have the same situation as you (described) and live in a dangerous neighborhood, have lousy car insurance, am clumsy and reckless doing household chores, etc. etc.

Thanks for the concern, but none of those apply. If they did I would definitely reconsider MY decision to pass on the over-priced, shitty insurance I could be paying for each month.

[metalman]

Re: Goodbye to US HealthCare?

So what you are saying is, that because I don't desire health insurance, I am some sort of fool. Because I must have the same situation as you (described) and live in a dangerous neighborhood, have lousy car insurance, am clumsy and reckless doing household chores, etc. etc.

Thanks for the concern, but none of those apply. If they did I would definitely reconsider MY decision to pass on the over-priced, shitty insurance I could be paying for each month.

my man! pay as you go is the way to go, if you can afford it...

The Real Dirk Diggler: John Holmes Story

[reallife]

Re: Goodbye to US HealthCare?

To those of you who do not carry any health insurance...remember, insurance is carried, not to pay for your health care, but to protect your assets (and credit worthiness) in the event that your health care expenses exceed your ability to pay. I have read that the top reason for personal bancruptcy is unexpected medical bills. Patients who are without health insurance plans to negotiate discounts on their behalf are charged the full, non-discounted fee. Patients who do not pay within a reasonable period are referred to collections. This will have adverse effects on their credit worthiness, ability to obtain mortages, car loans, credit card rates, etc.

Most of us doctors are learning quickly that our only recourse to an unpaid bill is to ruin a non-payer's credit rating. I personally have a very low threshold for non-payment. Ninety days without full payment and the bill goes to the nastiest collection company I can find. Sure, I get only pennies on the dollar, but I am done with the expense of attempting to collect from a deadbeat. Sorry, but that is the way it has to be. The gov't wants us to run our medical practices in a business-like manner. We must make payroll, malpractice and other expenses, etc. The only way we can stay in business is to act like a business. Just like the plumber who comes to your house to fix a broken pipe in the middle of the night, we must be paid. To go without medical insurance puts your whole financial future at risk. I would have thought that the the average iTulip forum member would be bright enough to have that figured out. :eek:

[ThePythonicCow]

Re: Goodbye to US HealthCare?

Originally Posted by c1ue
Health care on the other hand is not either so immediate nor short term unavoidable. A simple example: people retiring to Florida after working in Oklahoma for 30 years.

This basically makes no sense to me. Either the young offset the cost of the higher medical costs of the older, or not. If they do, then the young in Florida in a given year can offset the higher costs of the medical care for the older in Florida, or not. This is not an offset across time. This is an offset across different subpopulations who co-exist at the same time.

Originally Posted by c1ue
Lastly it is unclear that a state administered program is necessarily any more efficient or less bureaucratic than a federal one. That the pond is bigger doesn't itself necessarily mean anything.

Per-state regimes, rather than a federal regime, do not preclude failed institutions. But they do ensure 50 smaller regimes rather than one big one. As with other state and local regimes, some will be better, some worse. But the massive international oligarchy resists local control for a reason. Local control is easier for locals to shape in their own best interests, and more difficult for multinationals to co-opt.

Originally Posted by TPC
The presence of a few programs that are properly federal does not mean that all desirable collective activities should be government, much less federal government.

Originally Posted by c1ue
Certainly true, but again I fail to see an alternative solution - especially given that the collective health care in every peer of the US as well as most less-than-peers is working far better than the 'capitalist' system right now.

Chosing the lesser of two evils because you don't see an alternative, and because "it's obviously busted, so something must be done" will not fix things. If we don't expose and reduce the influence of the multinational oligarchy that currently profits from and controls our sickness, we will have little chance of fixing things. See my key point below.

Originally Posted by c1ue
The present system doesn't allow past actuarial contributions to make any damned difference to future actuarial costs.

This is another area where insurance companies likely squeeze the system: every time a person changes a job, the insurance company can use the person's new (older) profile to charge insurance fees.

Why don't we have this problem with auto insurance? Auto insurance rates change over time. My young son pays more than I do for the same insurance. Could not medical insurance do the same, with the older paying more than the younger if indeed the older spend more on covered medical costs?

Originally Posted by c1ue
Your own experience may reflect this. As I recall you used to work in California then moved to Texas. Unless you are still with the same company - highly unlikely given the software work you perform - then if you paid any health insurance in the past, those contributions were all tossed out.

This is stupid plain and simple.

I worked for the same company. But if I hadn't, so what? As I got older, my medical insurance costs will on average increase. Someone will pay this increase. Who? If you expect the insurance company to take from me when I am younger, save that money and then use those savings to spend for my care when I am older, then you are asking the insurance company to take on the role of a long term saver. This is not a role they will fulfill well.

Originally Posted by c1ue
Unlike car insurance which is a fixed cost at any given time modified only by inflation, health care costs rise in greater proportions as you age. The entire point of an actuarial pool is that those younger with less costs can contribute with their contributions scaling over time as well as those who need more services than average getting subsidized by those who do not (but neither knowing ahead of time which category they fall into).

Car insurance varies with age, just as does medical, only inverted. Young men are greater car insurance risks, but less medical insurance risks. Old men the reverse. Women I suppose as well, though I have less personal experience in that matter .

The key is this. We are quite unlike to have any chance of fixing the medical problems in America until we properly understand what they are. In my view, the primary problem is that an oligarchy of large drug, medical and agriculture firms is making immense profits off sick people. People eat junk, and when they get sick, are then prescribed more junk, and when they get even sicker, afflicted with junk procedures, until they are near death, then endure very expensive life sustaining treatment until they die. A few large multinational firms have co-opted the national and international goverment, NGO, media, advertising, education, research, production, and distribution organizations of the world to further their profitable dominance in these related businesses.

The claims that this is capitalist, socalist or some other "ism" are a distraction, much as the Super Bowl and the Presidential elections are distractions.

[MulaMan]

Re: Goodbye to US HealthCare?

America's current health care system is already controled by federal and state governments. It is not a free market.

The problem is the regulations all favor corporations over the individual.

The first step is for Obama to re-regulate to benefit the individual over the corporation.

Providing a public option will free the US labor force from getting locked in as slave labor with huge corporations - pyramid schemes. Small business will be able to compete again and large employers will need to offer employees a reason to work for them such as benefits - go figure.

[ThePythonicCow]

Re: Goodbye to US HealthCare?

Patients who do not pay within a reasonable period are referred to collections. This will have adverse effects on their credit worthiness, ability to obtain mortages, car loans, credit card rates, etc.

I've ceased borrowing money. I no longer care what my credit rating is.

I will not voluntarilly contract with you or any other doctor for medical services for which I cannot pay. I purchase only what I can pay for, or drop dead.

Is that a fair deal in your view?

[Dirk Diggler]

Re: Goodbye to US HealthCare?

my man! pay as you go is the way to go, if you can afford it...

The Real Dirk Diggler: John Holmes Story

Thanks metalman, I think you just found me an avatar.

[Jim Nickerson]

Re: Goodbye to US HealthCare?

To those of you who do not carry any health insurance...remember, insurance is carried, not to pay for your health care, but to protect your assets (and credit worthiness) in the event that your health care expenses exceed your ability to pay. I have read that the top reason for personal bancruptcy is unexpected medical bills. Patients who are without health insurance plans to negotiate discounts on their behalf are charged the full, non-discounted fee. Patients who do not pay within a reasonable period are referred to collections. This will have adverse effects on their credit worthiness, ability to obtain mortages, car loans, credit card rates, etc.

Most of us doctors are learning quickly that our only recourse to an unpaid bill is to ruin a non-payer's credit rating. I personally have a very low threshold for non-payment. Ninety days without full payment and the bill goes to the nastiest collection company I can find. Sure, I get only pennies on the dollar, but I am done with the expense of attempting to collect from a deadbeat. Sorry, but that is the way it has to be. The gov't wants us to run our medical practices in a business-like manner. We must make payroll, malpractice and other expenses, etc. The only way we can stay in business is to act like a business. Just like the plumber who comes to your house to fix a broken pipe in the middle of the night, we must be paid. To go without medical insurance puts your whole financial future at risk. I would have thought that the the average iTulip forum member would be bright enough to have that figured out. :eek:

Reallife, forgive my unwillingness to search all your posts to verify what you practice, but as I recall you are the private, non-group, military-trained anesthesiologist. Is that correct?

[grapejelly]

Re: Goodbye to US HealthCare?

we may not have a free health care market, but we do have choices. I have a private plan I pay for. I am happy with it. Leave me the $#$#@ alone. Don't screw with it, don't make me participate in *your* plan.

This is all Road to Fascism stuff, accelerating at a faster rate. I hate it.

[c1ue]

Re: Goodbye to US HealthCare?

This basically makes no sense to me. Either the young offset the cost of the higher medical costs of the older, or not. If they do, then the young in Florida in a given year can offset the higher costs of the medical care for the older in Florida, or not. This is not an offset across time. This is an offset across different subpopulations who co-exist at the same time.

I'm unsure what is unclear. The population of Florida is disproportionately represented by those who have never worked there but moved there to retire. The ratio of young in Florida to old is clearly much lower than in other states.

A state based system wouldn't work for Florida; similarly state based systems don't allow portability.

Per-state regimes, rather than a federal regime, do not preclude failed institutions. But they do ensure 50 smaller regimes rather than one big one. As with other state and local regimes, some will be better, some worse. But the massive international oligarchy resists local control for a reason. Local control is easier for locals to shape in their own best interests, and more difficult for multinationals to co-opt.

Agreed, a gaggle of health regimes from the states is safer in some respects than a conglomerate federal regime.

But the question is if the result is better overall.

50 individual state health regimes - besides having the portability issue noted above as well as the potential demographic challenges - also disaggregate the bargaining power vs. pharmaceutical companies, for example. The lobbying resistance of any individual state is also lower than that of the federal government and also less visible.

Secondly the likelihood of 50 states all passing health regimes is nil. If the goal is to provide a health care safety net, then one or more states lacking coverage fails this criteria. Also from a funding perspective, it is unclear how states could manage such a program. There are already federal infrastructure from Medicare and Social Security for this type of bureaucracy.

Chosing the lesser of two evils because you don't see an alternative, and because "it's obviously busted, so something must be done" will not fix things. If we don't expose and reduce the influence of the multinational oligarchy that currently profits from and controls our sickness, we will have little chance of fixing things. See my key point below.

I don't see having a comprehensive health care provision system in the US as the lesser of two evils. I see one evil: the health care system in the US is not working now. A state based system doesn't break the multinational oligarchy any more than no national health care system; the way to break the oligarchy is to fight it - fighting it can be in any system.

But fighting the oligarchy doesn't address the health care issue any more than Communism/Lenin fixed the Russian economy when it took out Kerensky. But the change in regime allowed a change in government behavior (for better or worse).

Why don't we have this problem with auto insurance? Auto insurance rates change over time. My young son pays more than I do for the same insurance. Could not medical insurance do the same, with the older paying more than the younger if indeed the older spend more on covered medical costs?

Auto insurance rates don't change at the same rates as health insurance needs over time. Auto insurance is predicated primarily on damage to autos; that damage is identical no matter what the age though the probability of damage is different.

As I said previously - for health care it is entirely different. Not only do the rates of needing health care increase, the average spend per instance goes up.

As for 'pay as you go', I repeat again: having 'all you can eat' insurance is also part of the problem.

Insurance companies have extremely little incentive to encourage preventative practices. A government on the hook no matter what does.

I worked for the same company. But if I hadn't, so what? As I got older, my medical insurance costs will on average increase. Someone will pay this increase. Who? If you expect the insurance company to take from me when I am younger, save that money and then use those savings to spend for my care when I am older, then you are asking the insurance company to take on the role of a long term saver. This is not a role they will fulfill well.

Excuse me, but insurance companies are EXACTLY supposed to be long term savers. Otherwise life insurance is completely pointless. The fundamental principle of insurance is that you pay your actuarial share each year with the long term expectation that the insurance company will be around to pay when you make a claim. Whether this claim occurs in 2 years or 40, the exact same principle applies: the insurance company is intended to aggregate AND safeguard the unspent premiums in expectation of a future payout.

To say that insurance companies cannot save long term means the fundamental principle is broken to begin with.

Car insurance varies with age, just as does medical, only inverted. Young men are greater car insurance risks, but less medical insurance risks. Old men the reverse. Women I suppose as well, though I have less personal experience in that matter .

See above

The key is this.

We are quite unlike to have any chance of fixing the medical problems in America until we properly understand what they are. In my view, the primary problem is that an oligarchy of large drug, medical and agriculture firms is making immense profits off sick people. People eat junk, and when they get sick, are then prescribed more junk, and when they get even sicker, afflicted with junk procedures, until they are near death, then endure very expensive life sustaining treatment until they die. A few large multinational firms have co-opted the national and international goverment, NGO, media, advertising, education, research, production, and distribution organizations of the world to further their profitable dominance in these related businesses.

It seems that you feel opting out of the system will somehow break the oligarchy you speak of.

In history, this has never occurred.

Broken systems change only when a force changes it; having a federal program with the right mandate could be that force.

Individuals choosing to die unnecessarily is not going to do it; the vast majority of the population is not going to make the same choice.

Furthermore I still fail to see a cogent response as to why the US could not implement a system which is working in dozens of other nations.

The money is there. The skill set is there. The need is there.