Rob's House Posted July 22, 2012 Author Share Posted July 22, 2012 there's a big problem with your math at the end. medical care hasn't been based on the free enterprise system, supply and demand, since medicare was enacted. doc's who see a majority of medicare and medicaid patients have had their prices set for years - my entire career. yes, demand will increase but prices for the govt payers are determined by the govt and have been for decades. even in negotiations with private insurers, individual, independent doctors are prohibited by law from joining together to negotiate prices. the insurers have had the upper hand for years. so many of us are accustomed to it and have adapted. guess how...we work longer hours and see more patients or we accept lower pay. and that's what's likely to happen here. and by design, i believe, the bill will begin the boulder rolling downhill towards an alternative to the current model of private insurance. on that, we agree. I get what you're saying, but there's no getting around supply and demand. Just because you manipulate one or the other doesn't mean you negate the effects. That's a prime reason why the cost has risen so quickly. That being said, I tip my hat to you. Your conclusion is probably the most honest assessment I've seen from any supporters of the bill. Cheers, you old hippy Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 22, 2012 Share Posted July 22, 2012 there's a big problem with your math at the end. medical care hasn't been based on the free enterprise system, supply and demand, since medicare was enacted. doc's who see a majority of medicare and medicaid patients have had their prices set for years - my entire career. yes, demand will increase but prices for the govt payers are determined by the govt and have been for decades. even in negotiations with private insurers, individual, independent doctors are prohibited by law from joining together to negotiate prices. the insurers have had the upper hand for years. so many of us are accustomed to it and have adapted. guess how...we work longer hours and see more patients or we accept lower pay. and that's what's likely to happen here. and by design, i believe, the bill will begin the boulder rolling downhill towards an alternative to the current model of private insurance. on that, we agree. This is where I get incredibly frustrated. I'll never understand why otherwise very intelligent people can't see the ludicrous reality of solving problems created by complex, bad policy by introducing more complex, bad policy. Almost all of the problems we see today in the medical marketplace stem from the merger of government to Big Pharma and Big Insurance, and the monopolies and price controls they have created to benefit themselves in the form of permanent and growing market share and indirect subsidy. Why don't we have commodity medicine for run of the mill health care? Why don't we have clinics with a flat $25 a visit fee for colds, mundane ailments, tests, procedures, and preventative medicine? Why do we keep increasing the regulatory cost of health care at the expense of access, performance, and safety? If the problem is truely that hyper-marginal risks, such as certain cancers or highly improbable trauma histories or complex terminal or lifelong conditions, are too expensive and require insurance, then why don't we actually address that problem instead of the ass-backwards way we're handling it which creates real shortages and increases real costs. If catastrophic medical calamity is the real issue, we should perhaps nationalize that risk pool instead of one wherein the majority of people have some sort of needs or expense. Let the market solve problems wherein supply and demand are not an issue. Find an elegant way to minimize the cost and distribute the risk for the marginal problems instead. But we don't, and this really isn't about health care; that's just of an example of trying to fix bad policy with more bad policy. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 22, 2012 Share Posted July 22, 2012 (edited) Why don't we have clinics with a flat $25 a visit fee for colds, mundane ailments, tests, procedures, and preventative medicine? , we should perhaps nationalize that risk pool instead of one wherein the majority of people have some sort of needs or expense. Let the market solve problems wherein supply and demand are not an issue. Find an elegant way to minimize the cost and distribute the risk for the marginal problems instead. $25 visits aren't gonna do it. i realize that's an arbitrary number but the "simple" or mundane problems being seen are arbitrary too. they're not always simple. fairly often, they're a symptom of a much larger, much more expensive problem, neglected for years especially in the uninsured population. you can't put a $25 band aid on diabetes, which by most estimates will afflict 1/5 the population in the not too distant future. chronic disease is exceedingly common. plus, that number won't cover overhead in even a very efficient office. that larger risk pool including young, healthy patients is exactly what single payor provides. it is also simpler. hospitals and offices would only have to bill one payor. one standardized system to deal with for reimbursement, credentialing, appeals etc. for far too long, private insurance companies have cherry picked the healthiest pts leaving the sickest for the taxpayers to insure (or to fail miserably trying to fend for themselves). cut that out and the cost per "insured" life on the gov't program comes screaming down. taxpayers are subsidizing their already huge profits by picking up the very high bills for the sickest folks. and the private insurers add nothing of value to the health of the country. they're just an unnecessary expense. it's absurd...unless your in the insurance biz. Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
birdog1960 Posted July 22, 2012 Share Posted July 22, 2012 (edited) btw, as an aside here's a discussion on the use of "payor" vs "payer". articles supporting it seem use the former more often. don't know why. Edited July 22, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 23, 2012 Share Posted July 23, 2012 $25 visits aren't gonna do it. i realize that's an arbitrary number but the "simple" or mundane problems being seen are arbitrary too. they're not always simple. fairly often, they're a symptom of a much larger, much more expensive problem, neglected for years especially in the uninsured population. you can't put a $25 band aid on diabetes, which by most estimates will afflict 1/2 the population in the not too distant future. chronic disease is exceedingly common. plus, that number won't cover overhead in even a very efficient office. that larger risk pool including young, healthy patients is exactly what single payor provides. it is also simpler. hospitals and offices would only have to bill one payor. one standardized system to deal with for reimbursement, credentialing, appeals etc. for far too long, private insurance companies have cherry picked the healthiest pts leaving the sickest for the taxpayers to insure (or to fail miserably trying to fend for themselves). cut that out and the cost per "insured" life on the gov't program comes screaming down. taxpayers are subsidizing their already huge profits by picking up the very high bills for the sickest folks. and the private insurers add nothing of value to the health of the country. they're just an unnecessary expense. it's absurd...unless your in the insurance biz. Please reread what I wrote without any preconceived notions about my position. When you do, you'll note that I don't defend the public-funding/private-profit sector at all. Infact, if you read carefully you may even see it implied that medical insurance as we think of it today is incredibly unnessecary, and would be easily and more efficiently replaced with market based solutions revolving around commodity based medicine. You might also note that I've addressed your "diabetes concern". Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 (edited) Please reread what I wrote without any preconceived notions about my position. When you do, you'll note that I don't defend the public-funding/private-profit sector at all. Infact, if you read carefully you may even see it implied that medical insurance as we think of it today is incredibly unnessecary, and would be easily and more efficiently replaced with market based solutions revolving around commodity based medicine. You might also note that I've addressed your "diabetes concern". unless i'm misunderstanding you, you describe chronic disease as a marginal problem. i'm saying it's not marginal at all. millions of people have chronic diseases. in 2010, the cdc estimated 20.1 million americans have diabetes. (don't know where i saw the 50% estimate - in retrospect that seems impossibly high). i did appreciate your lack of appreciation for the current bastardized system. but i don't agree with your solution. the best way to get the best care for the most people at the lowest price is single payor. many other successful and wealthy countries have studied the problem and come to that conclusion. their outcomes speak for themselves. edit: 50% was a number estimated for diabetics + prediabetics by 2020. number is from united health so take it with several morton's salt boxes. Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
dayman Posted July 23, 2012 Share Posted July 23, 2012 Depending on the state you live in the law will vary but a whole different aspect of some of our inefficiencies are nursing laws. I only bring it up b/c it is tangentially related to the supply demand argument in some states. In a lot of states the nurses are allowed to do so little that PCPs cannot allocate very much of their time practicing at the "top of their license" which would help address some of these concerns. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 Depending on the state you live in the law will vary but a whole different aspect of some of our inefficiencies are nursing laws. I only bring it up b/c it is tangentially related to the supply demand argument in some states. In a lot of states the nurses are allowed to do so little that PCPs cannot allocate very much of their time practicing at the "top of their license" which would help address some of these concerns. this is an important point. in my case, the best nurse practitioner i ever employed was scooped up by a cardiology group that paid her nearly double what i was (or could, due to much lower reimbursement). even among mid levels, primary care is unpopular. mostly because of pay but also because it's broad and vast. in their shortened training it's easier to master one area than all of them. the aca addresses this to some degree as you noted in an earlier post. it encourages primary care at the expense of specialists. but again there's good data to support cost effectiveness with better overall outcomes in a systems with higher ratios of primary care to specialists. that's the opposite of what we now have in the u.s. Link to comment Share on other sites More sharing options...
Doc Posted July 23, 2012 Share Posted July 23, 2012 unless i'm misunderstanding you, you describe chronic disease as a marginal problem. i'm saying it's not marginal at all. millions of people have chronic diseases. in 2010, the cdc estimated 20.1 million americans have diabetes. (don't know where i saw the 50% estimate - in retrospect that seems impossibly high). i did appreciate your lack of appreciation for the current bastardized system. but i don't agree with your solution. the best way to get the best care for the most people at the lowest price is single payor. many other successful and wealthy countries have studied the problem and come to that conclusion. their outcomes speak for themselves. edit: 50% was a number estimated for diabetics + prediabetics by 2020. number is from united health so take it with several morton's salt boxes. You must be joking. As that article I linked suggested, rationing hurts patients. Cancer survival rates are dismal. And hundreds of thousands of elderly are euthanized annually. And if you think that infant mortality is better in socialized nations, that's because they use different criteria for "live birth" than the U.S. does, which if corrected and apples compared to apples, the U.S.'s IM rate would be the same. What you're doing with PPACA is not only creating the above problems, but adding more bureaucracy which ends up costing more money. Again it's the reason why CBO projections of costs fall well short of actual costs, by over a factor of 4. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 (edited) You must be joking. As that article I linked suggested, rationing hurts patients. Cancer survival rates are dismal. And hundreds of thousands of elderly are euthanized annually. And if you think that infant mortality is better in socialized nations, that's because they use different criteria for "live birth" than the U.S. does, which if corrected and apples compared to apples, the U.S.'s IM rate would be the same. What you're doing with PPACA is not only creating the above problems, but adding more bureaucracy which ends up costing more money. Again it's the reason why CBO projections of costs fall well short of actual costs, by over a factor of 4. you linked a single newspaper article from 1999. show me some real data. how bout this one. raw data can be found at the commonwealth fund report. Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 23, 2012 Share Posted July 23, 2012 Birdog1960: You've missed my point. Even if roughly 6.5% of Americans have diabetes as some point in their lives, the larger amount of the medical care they will receive over the large majority of their lives has nothing to do with diabetes, and is largely mundane. Those mundane procedures do not need to be insured at all, and the fact that they are only serves as a boondoggle for insurance companies. Supply and demand can sort that out rather nicely, and in the process, drive down costs. $25 is an arbitrary number, for sure, but for those who self-insure at the doctors office costs are significantly cheaper for annual checkups and routine care. If we want to have a discussion about the costs of catastrophic and chronic medical needs, and the lack of a market based solution to address this, than fine, I'm willing to have a discussion about the nationalization of that sort of care; but outside of those sorts of outliers, the market will always provide cheaper, more abundant solutions. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 (edited) Birdog1960: You've missed my point. Even if roughly 6.5% of Americans have diabetes as some point in their lives, the larger amount of the medical care they will receive over the large majority of their lives has nothing to do with diabetes, and is largely mundane. Those mundane procedures do not need to be insured at all, and the fact that they are only serves as a boondoggle for insurance companies. Supply and demand can sort that out rather nicely, and in the process, drive down costs. $25 is an arbitrary number, for sure, but for those who self-insure at the doctors office costs are significantly cheaper for annual checkups and routine care. If we want to have a discussion about the costs of catastrophic and chronic medical needs, and the lack of a market based solution to address this, than fine, I'm willing to have a discussion about the nationalization of that sort of care; but outside of those sorts of outliers, the market will always provide cheaper, more abundant solutions. it's standard of care to see diabetics every 3 months. a long term sugar test (hgba1c)is done at every visit. the cash cost for a private pay pt for the lab alone is about $40 even though the test cost less than $5 when done on a large scale. diabetics rarely have only one diagnosis, especially those who have had the disease for a long period. they suffer the myriad complications which develop often even with good control. the majority of pt on dialysis are diabetics. google the staggering cost of dialysis in the us. even early in the course, many patients have hypertension and high cholesterol as comorbidities. treating and following these cost even more. i've cited some examples of much less expensive single payor systems with better outcomes than ours. do you have any for your proposed system? why reinvent the wheel and experiment with unproven strategies? isn't that what liberals are so frequently accused of? Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
Doc Posted July 23, 2012 Share Posted July 23, 2012 you linked a single newspaper article from 1999. show me some real data. how bout this one. raw data can be found at the commonwealth fund report. There is a reason why those systems cost less: they ration, the US funds most of the research from which they benefit, they don't have the same population (illegals, gangbangers, welfare, obesity) as the US, they pay a large amount in taxes for it, and the American tort system. Out of that, what does Obamacare address? The answer is: very little. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 (edited) There is a reason why those systems cost less: they ration, the US funds most of the research from which they benefit, they don't have the same population (illegals, gangbangers, welfare, obesity) as the US, they pay a large amount in taxes for it, and the American tort system. Out of that, what does Obamacare address? The answer is: very little. show me the data. and why are our outcomes worse despite the cost? Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
ieatcrayonz Posted July 23, 2012 Share Posted July 23, 2012 show me the data. and why are our outcomes worse despite the cost? Just a guess but I'd say because our "outcomes" are meaningless statistics cheery picked by dorky commies with gray beards. Am I close? Link to comment Share on other sites More sharing options...
dayman Posted July 23, 2012 Share Posted July 23, 2012 Just a guess but I'd say because our "outcomes" are meaningless statistics cheery picked by dorky commies with gray beards. Am I close? What's funny is the grey beard was doing the interviewing...and the guy being interviewed was talking about the industry changing itself anyway...something that is happening regardless of the ACA the ACA provisions just get Medicare in the game. So if by dorky commies w/ grey beards you mean dorky capitalists w/ clean shaves I guess you are right. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 (edited) What's funny is the grey beard was doing the interviewing...and the guy being interviewed was talking about the industry changing itself anyway...something that is happening regardless of the ACA the ACA provisions just get Medicare in the game. So if by dorky commies w/ grey beards you mean dorky capitalists w/ clean shaves I guess you are right. i'm certain you are correct. but just for arguments sake, lets request some numbers from suave, upstanding single malt drinkers with receding hairlines and weaves refuting those from the "graybeards". Edited July 23, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
ieatcrayonz Posted July 23, 2012 Share Posted July 23, 2012 What's funny is the grey beard was doing the interviewing...and the guy being interviewed was talking about the industry changing itself anyway...something that is happening regardless of the ACA the ACA provisions just get Medicare in the game. So if by dorky commies w/ grey beards you mean dorky capitalists w/ clean shaves I guess you are right. Commies only ever agree to be interviewed by other commies henceforth captain graybeard is a commie. Anyway, if you think some commie trying to tell everyone what to do and then saying this is already happening and we can't stop it is somehow capitalist then you haven't been watching the global warming circus for the past 25 years. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 23, 2012 Share Posted July 23, 2012 Commies only ever agree to be interviewed by other commies henceforth captain graybeard is a commie. Anyway, if you think some commie trying to tell everyone what to do and then saying this is already happening and we can't stop it is somehow capitalist then you haven't been watching the global warming circus for the past 25 years. take you? you wanna point out the easiest logical fallacies to identify here or should i? Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 23, 2012 Share Posted July 23, 2012 it's standard of care to see diabetics every 3 months. a long term sugar test (hgba1c)is done at every visit. the cash cost for a private pay pt for the lab alone is about $40 even though the test cost less than $5 when done on a large scale. diabetics rarely have only one diagnosis, especially those who have had the disease for a long period. they suffer the myriad complications which develop often even with good control. the majority of pt on dialysis are diabetics. google the staggering cost of dialysis in the us. even early in the course, many patients have hypertension and high cholesterol as comorbidities. treating and following these cost even more. You'll note, that if you read carefully, I've addressed this already in the portion of my posts that repeatedly mention catastrophic and chronic medical expenses and a nationalized risk pool for these things. i've cited some examples of much less expensive single payor systems with better outcomes than ours. do you have any for your proposed system? why reinvent the wheel and experiment with unproven strategies? isn't that what liberals are so frequently accused of? Your examples have cherry-picked data and disregard many economic and social realities that separate the US from other nations, many of which have been mentioned by Doc, and despite some distaste you may have for those facts, you can't simply hand-wave them away. As for "my system" it's hardly mine, it's largely the system that was in place in the 60's before Big Insurance and Big Pharma lobbied their way into government and convinced the average American that it would be cheaper for them to pay massively inflated costs with scare tactics, and has existed in every other industry in the world for thousands of years driving technological advancement and lowering consumer costs. These strategies aren't just proven, but they are the only proven kid on the block, everything else being a varied take on the failed models of centralized planning. Link to comment Share on other sites More sharing options...
Recommended Posts