Single payer healthcare system discussion

Toyman01 said:

CJ said:

Rep. James W. Wadsworth (R-NY) cautioned that passage would open the door to a government power “so vast, so powerful as to threaten the integrity of our institutions and to pull the pillars of the temple down upon the heads of our descendants.”

Probably not the place to discuss this but this sounds pretty truthful to me. We have a government so vast and so powerful that it intrudes into just about every aspect of our lives and so vast and powerful that we can't even afford to pay for it. 

The strange thing is that Rep Wadsworth seems to have compared his descendants to the Philistines, as pulling the temple down was Samson's last righteous act. So yay? Maybe he should have left the biblical allegories to (a) those that understand the original stories, and (b) out of politics at all.

dculberson said:

Toyman01 said:

CJ said:

Rep. James W. Wadsworth (R-NY) cautioned that passage would open the door to a government power “so vast, so powerful as to threaten the integrity of our institutions and to pull the pillars of the temple down upon the heads of our descendants.”

Probably not the place to discuss this but this sounds pretty truthful to me. We have a government so vast and so powerful that it intrudes into just about every aspect of our lives and so vast and powerful that we can't even afford to pay for it. 

The strange thing is that Rep Wadsworth seems to have compared his descendants to the Philistines, as pulling the temple down was Samson's last righteous act. So yay? Maybe he should have left the biblical allegories to (a) those that understand the original stories, and (b) out of politics at all.

That pesky first amendment...  The first words of the first amendment seemed pretty important:  "Congress shall make no law respecting an establishment of religion"

engiekev said:

There's going to need to be a massive cultural shift in order for the US to adopt better healthcare policy, just like Gun Control, and it won't happen overnight.

The big difference between the US and societies that care for their fellow citizens is that they aren't so fearful of losing $1 that they will kill someone.  Seriously, read this article.  A guy in a Mercedes shot someone at a McDonalds over french fries.  We have become so ridiculously fearful of losing our "inalienable right" to protect ourselves from the mortal danger of LOSING FRENCH FRIES?

The sad thing is, I started typing that example, THEN searched google for a story, and dozens of french fry shootings popped up.

Cultural shift?  We need a complete berkeleying reboot.  We live in a society that actively supports legislation that favors the rich and rips money from our pockets with the specific intent of skewing wealth, but we shoot people over one dollar's worth of fried potatoes.

frenchyd said:

Only the government has any incentive (...)  to lower costs or at least keep costs in check. 

BWAHAHAHAHAHAHAH *gasp* HAHAHAHAHHUCKHUCKHAHAHAHA *oh wait you were serious*

Are you kidding me?  Although I am an employee of a private company, much of my work is in the public sector.

If you had any idea how much money is wasted just in misguided attempts to save money, let alone on actual programs, there is no way you could say that with a straight face.

Duke said:

frenchyd said:

Only the government has any incentive (...)  to lower costs or at least keep costs in check. 

BWAHAHAHAHAHAHAH *gasp* HAHAHAHAHHUCKHUCKHAHAHAHA *oh wait you were serious*

Are you kidding me?  Although I am an employee of a private company, much of my work is in the public sector.

If you had any idea how much money is wasted just in misguided attempts to save money, let alone on actual programs, there is no way you could say that with a straight face.

 

I am glad someone else here understands that. I've been on the sidelines here waiting, because the last days have been all people who are in an echo chamber.

To keep upo with my personal story, I had to fight the insurance company on my wife's medicine. It has a $40K street price annually. They denied because her polyps are not grown enough to be below the second terbinate. This is the worst example of a bad insurance company (BCBS) because A) they ask for an adequete amount of pain and suffering before they will treat, and B) My wife has no second terbinate. It was removed during her second surgery.

I wrote the CEO a letter after dealing with the bran-dead people on the phone. It was overturned and they covered it.

The pharmaceutical company that made the drug covered the copay for us, up to $13K annually. Big bad business, eh?

So, an excellent example of insurance companies being stupid. I would not have had success appealing to the federal government, and also likely the drug would never have been researched. The folks with my wife's condition in other countries with socialized health care have zero access to this. They also have zero access to aspirin desenstization. They are literally two steps, roughly ten years, behind us.

baby/bathwater/blahblah

While I have nowhere near your challenges, my wife and I do have a big hurdle if we decide to have any more kids. With #2 we were in 3 times a week for blood tests and ultrasounds from about 4 months. She was induced 6 weeks early and spent her first 2.5 weeks in NICU. We are told that going forward the *risk will rise with each pregnancy and we will require in-utero blood transfusions at least every other week. We were lucky that the local facilities are very good and the staff were all amazing. We do not have insurance and spent months doing paperwork/applications/meetings, etc. We just got the final bill last week (after paying the average mortgage every month since she was born). 15 months later and about $15k out of pocket. That was about 10% of the total "bill" we were initially sent. The hospital (biggest health institution in the state) was very good to work with. I have no complaints. I don't believe they are greedy or turning anyone away. And they were much easier to deal with than the folks at government when they messed up #2's SS number.

-I DO NOT MEAN TO OFFEND ANYONE WHO WORKS IN THE INSURANCE INDUSTRY-

That said, I hate the runaround. And I hate insurance. The very concept boggles my mind. Through my employer I would have to pay $11k per year before I would ever see any benefit. Then the insurance folks do their thing and cover some costs and negotiate/push papers/whateve it is they do. Even if they were not making a red cent, they still need to pay the folks doing the work. Which means I am paying them. Trick is, they make money. Big money. The costs are so inflated as to seem comical. Sure plays well for Insurance though "Look how much money we saved you!" BS.

I am fortunate in that my wife is a saver and my lame job does pay fairly well. We can usually put away 40~70% or so of what insurance premiums would cost in a month. I believe in saving and being responsible for myself and my family. This insurance system is a scam in my eyes and I don't know the answer, but I know that most folks can't save at the rate my wife does and I cant imagine I would have been able to do all the footwork I did with my daughters birthing costs if I was working three jobs just to get by.

TL;DR: Barefootskater hates insurance, advocates saving for the future, and supports the free market (but does not believe we are truly experiencing a free market and throws more than a little blame at the insurance corporations).

*The only possible solution is currently being tested in TX I believe and is a private industry initiative.

In reply to barefootskater :

Without insurance you risk bankruptcy.  Bankruptcy you cannot get out of.  Their lawyers know how to tie up your assets in a way to ensure you're working for them rather than yourself.  
Maybe  you and your family will never get seriously sick.  Maybe you'll avoid accidents and incidents.  
You buy and pay for car insurance even though you're a good driver and never had an accident. 
 Without insurance you'll be paying those silly numbers like hundreds of dollars for an aspirin. 
Some fights you just can't win. 
The system as it's set up now is that sort of fight.  

Duke said:

frenchyd said:

Only the government has any incentive (...)  to lower costs or at least keep costs in check. 

BWAHAHAHAHAHAHAH *gasp* HAHAHAHAHHUCKHUCKHAHAHAHA *oh wait you were serious*

Are you kidding me?  Although I am an employee of a private company, much of my work is in the public sector.

If you had any idea how much money is wasted just in misguided attempts to save money, let alone on actual programs, there is no way you could say that with a straight face.

 

Duke,  I happen to agree with you about wasted money.  My late wife explained over and over again 10 cents out of every dollar spent on Welfare is spent seeking fraud and waste.  
Yet some insist that it's a major part of welfare and demand thst money is spent.  
Then you get the military and their spending.  Same deal. 

The root of this whole issue we are dancing around here is motivation.  Money / profit is a very big motivator (right up there with sex and power).  Paying someone to do something with very little correlation to performance provides very little motivation to perform above a minimum.  Some will, many won't.

The primary issue with Welfare for many is not the waste, it's the de-motivation it encourages.

You are fighting with very primal human behavior here, and it's hard to maneuver around.

How to discourage excessive profiteering?  Well, that's another hard one to deal with without killing motivation.  I am suspicious the primary reason why much of excessive profiteering exist is from simple (or complex) corruption.  That corruption is of course in the government.

What's my solution you ask? (or didn't)  I have no solution, but I will guess, as with most things, the best answer lies somewhere in between...

In reply to aircooled :

Right now we live in the worst of both worlds.  Government intervention and legislation has created the typical bloated and out-of-touch bureaucracy that government always does.  At the same time, those two things have also basically allowed private industry to write its own rules and profit from the requirement that everyone be covered or subsidized via Medicare, etc.

It's a self-reinforcing feedback loop, just like subsidized and guaranteed student loans, only worse.

In my opinion, the best course would be to strip out most of the fundamental disease - government intervention and legislation - and let the free market system actually function as a free market (it's amusing and irritating to see the US healthcare system demonized as "free market" or "capitalist" when it is anything BUT those two things at this point).

But that ship has probably sailed.

frenchyd said:

In reply to barefootskater :

Without insurance you risk bankruptcy.  Bankruptcy you cannot get out of.  Their lawyers know how to tie up your assets in a way to ensure you're working for them rather than yourself.  
Maybe  you and your family will never get seriously sick.  Maybe you'll avoid accidents and incidents.  
You buy and pay for car insurance even though you're a good driver and never had an accident. 
 Without insurance you'll be paying those silly numbers like hundreds of dollars for an aspirin. 
Some fights you just can't win. 
The system as it's set up now is that sort of fight.  

Hmmmm, if you have assets to dispose of, why are you declaring bankruptcy? This is personal bankruptcy, for normal people, not the bankruptcy of the LLC you were running so that when it goes under your personal assets are protected. Car insurance isn't relevant. You are required by law to carry it. And if you are wealthy enough, you can provide a bond to the state to self-insure.

Insurance begets higher prices which begets higher premiums, ad nauseum.  It's the exact same as the student loan problem. Would Universities keep raising rates at 3-5x inflation if the Feds and private banks didn't provide loans? Nope. 

"Do you have health insurance?"
"Yes."
"OK, you're visit today is $195 I'll charge to your insurance. End up with less while paying crazy amounts of overhead because of all the back and forth."

"Do you health insurance?"
"No, but I can pay cash."
"Oh, that will be $50. Because I don't have 18 staff members dealing with various different insurance companies and their rules and stipulations."

In reply to z31maniac :

My wife was shocked when I told her what happened when I paid off #1's hospital bill. At the time she was still covered on her dad's insurance (for which we paid his entire deductible that year) so I only had to pay the baby's portion of the bill. conversation was this:

Hi I'm here to pay off the bill for my son.

"Looks like your balance is $XXXX, who is your insurance provider?"

We do not have insurance.

"In that case your pay off amount is $XXXX-30%. Will that be Visa or Amex?"

Cash.

"Cash discount is good for another 15%."

When I got home and handed her the reciept she asked why I only paid half. If you remove two or three middle men the price will drop drastically. Only trouble is now I am the official negotiator in our house.

In reply to barefootskater :

I was blown away the other day at my girlfriend's previous job working for an eye doctor. We stopped by to visit 1-2 months ago when we were in Tulsa. There are probably 3-4 admin/assistant roles per doctor if not more. And we stopped by on a Friday afternoon when they aren't fully staffed since they close at 1.

So maybe there is answer in that: is there some of limiting what can be charged to insurance, forcing the general public to shop around? Could we have some sort of law in place that says "unless you're putting something into your body (other than shots/vaccines/medication) or being cut open, you can't use insurance." 

That would mean ER visits, urgent care, normal checkups would all be cash-only transactions. Doctors could run offices without staff. You'd pay for their time, not for insurance codes of various billing rates. We have car insurance for major damage, but we see service shops and pay out of pocket regularly. We don't use insurance for oil changes and spark plug swaps. Why do we need insurance for primary care?

The thing is, even having an HSA an essentially paying cash, I need to use insurance in order for it to be registered against my deductible. I don't get any discount because it has to pass through the insurance company, even if I pay the whole cost of the visit/procedure. 

I think what would happen if we limited what insurance could be used for is that insurance companies would partner with providers to figure out ways of getting more people into the operating room or having serious (ie costly) procedures. 

In reply to aircooled :

You imply that all welfare is a disincentive to work.  please explain to My sister who is totally bedridden.How she's just lazy?  She'd do anything she can to get more than the $868 a month she gets.  
(Severe arthritis). Countless operations to replace joints and fix bones. For the last several years she has been bedridden counting on her daughter to feed her. 
Spina bifida is what keeps my cousin on welfare  and a Vietnam Vet buddy of mine self medicated himself to total disability dealing with the demons he brought home with him. 
According to my late wife these are all exceptions. 
The average welfare recipients is single white women less than 27 with 1.5 children  who remains on welfare for 13 months.  That's right some guy knocked her up and left her. 
 
Doubt me?  Call your welfare office and ask what it takes to get welfare and how much they get. 
 

pheller said:

That would mean ER visits, urgent care, normal checkups would all be cash-only transactions. Doctors could run offices without staff. You'd pay for their time, not for insurance codes of various billing rates. We have car insurance for major damage, but we see service shops and pay out of pocket regularly. We don't use insurance for oil changes and spark plug swaps.

A doctor is still going to need a staff to run an office. Go back to the example of the eye doctor. 

Is it more efficient to have some staff to things like measure for glasses and contact fitment at a much lower rate while the doctor is seeing the next patient? I guess you can no longer call and make an appointment?  Does the doctor also take time to call you with your test results, after he drew the blood, packaged it, sent it to the lab, etc, or pay someone a lower rate? How do I get ahold of the doctor's office since he/she forgot to send my prescription in? 

Heck, even something as simple as being able to sign for a package from UPS or FedEx or something. Doc can't do that if he is in the middle of an evaluation.

So there has to be some admin staff, just not multiple people that do nothing but process paperwork for the insurance and drug companies. That doesn't help patient care, it only adds crazy expense. 

In reply to frenchyd :

When we first got the bill for that experience it was more than 4 years of my income. Maybe some folks would see those numbers and assume bankruptcy is the best course forward. I saw the start of a transaction the same as any other. Even without the "discounts" I'm sure we would have found a way to settle. The system surely is set up to help itself perpetuate though, at the cost of all of us. The system needs totally dismantled. I don't have the answers, I don't think we're likely to figure them out here and even if we did who would listen to a bunch of gearheads from the internet? But there must be a better way and as Aircooled said, it is probably to be found somewhere in the middle.

Having grown up very poor, with a single parent for most of my childhood I am personally very aware of the welfare system and how it works. Without floundering, we'll just have to agree that we see things very differently.

*edit to inject a bit of lightheartedness. RE- applying for welfare

In reply to tuna55 :

Weird because the public sector has had more influence in getting new drugs on the market, and provides far more funds for successful impactful drug research projects, than the private sector.

https://www.latimes.com/health/la-xpm-2011-feb-10-la-heb-drug-development-taxpayers-20110210-story.html

https://www.ncbi.nlm.nih.gov/books/NBK50972/

https://www.pnas.org/content/115/10/2329

There's no reason that can't continue under a single payer system.

Requiring all medical facilities to post their prices on a menu board like McDonalds would go a long way toward helping control costs. The hospital knows the average cost of just about any surgery to within a few dollars. Try to get them to give you that price. All they want to quote is your out of pocket. I have taken the price of a procedure, a nuclear stress test, from $1700 out of pocket to $350 total cash price with 5 phone calls. 

Until the costs are known, they can't be controlled. Right now it's a shell game and the general public is the patsy. 

I do agree exposing costs is important.  People can't vote with their wallet if they don't know the costs.

I asked my doctors office for an itemized bill for my last visit.

Them:  We gave you an itemized bill.

Me:  It just says visit - $320

Them: yeah

Me:  Why the berkeley did 10 minutes of time cost $320

Them:  That's what it costs

Me:  OK, so my next follow up visit is in a few weeks, what will that cost?

Them:  We don't know.

I was in the hospital a couple weeks ago for four days. Brought in by ambulance after the nice rescue folks scooped me up off the floor of my home & dumped in the ER. Heart rate was 35 BPM and body temp 95 F = Bradycardia. Unfortunately they couldn't figure out what caused the Bradycardia episode. I figured it out a couple hours after being released and jumping on the internet. I accidentally poisoned myself cleaning palm seeds with arecoline in them causing cholinergic poisoning which caused the Bradycardia. Anyway this is the itemized breakdown I received from the hospital only. The doctors, labs, and other bills are still arriving..

Laboratory services                         $12,084.40

EKG services                                          $789.60

Diagnostic/therapeutic imaging   $12,449.57

Pharmacy                                             $9,803.21

Emergency room                                $6,307.06

Supplies                                               $ 1,989.28

Special care unit                                 $4,008.00

  TOTAL                                                   $47,431.12

aircooled said:

How to discourage excessive profiteering?  Well, that's another hard one to deal with without killing motivation.  I am suspicious the primary reason why much of excessive profiteering exist is from simple (or complex) corruption.  That corruption is of course in the government.

 

I don't see why that "of course" follows. There's plenty of corruption in the private sector.

You I am not even sure what corruption in the private sector even means.  Unless you are talking about them taking advantage of corruption in the government.  They are certainly taking part, but it’s the corruption in the government that allows it.

I see corruption as misuse of something meant for the common good (maybe I am wrong).  If a company overcharges you, that’s not corruption, that’s just expensive. Unless it’s somehow required by the government  or a monopoly, in which case that goes back to government failure (corruption).

frenchyd said:

In reply to aircooled :

You imply that all welfare is a disincentive to work.  please explain to My sister who is totally bedridden.How she's just lazy?  She'd do anything she can to get more than the $868 a month she gets....
 

Oh come on now! Do you honestly think I am in any way referring to a bed ridden disabled person when I say welfare can be de-motivating!?  How exactly can you de-motivate someone from doing something they can’t do?

That’s like saying putting fish in water de-motivates them from walking on land.

In reply to aircooled :

Welfare isn't some choice lazy people take when they don't want to work.  It's desperation time.  It's the cupboard is empty and the children are Hungry. 
 
Disincentive? What hogwash, it's living as cheaply as can be done, barely.  
 

You are aware that welfare money comes from property taxes aren't you ?  It's not some big federal program that erects giant apartment buildings that are eyesores for generations before they're torn down and replaced.  ( That's housing and urban development). 
Anyway since it's local they are constantly looking for people to serve on the boards.  You clearly have ideas about welfare, why not get on those boards and share your ideas?  You'll find several like minded people and maybe you guys can figure out how to come up with the extra money it would cost to end welfare.  Or just welfare for lazy good for nothings. 
 Hint; it costs a lot more to not have welfare than to have welfare.  
Let me repeat that.  It costs more not to have welfare than to have welfare.    More! A lot more!