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Old     (Laker1234)      Join Date: Mar 2010       02-13-2016, 7:27 AM Reply   
I just thought Trump was scary http://finance.yahoo.com/news/how-be...170549663.html
Old     (DocPhil)      Join Date: Aug 2015       02-13-2016, 5:22 PM Reply   
Yet every other advanced nation in the world has universal healthcare and they destroy us in the rankings year after year....hmmmm....coincidence?
Old     (Coolaintcheap)      Join Date: Jan 2016       02-13-2016, 8:36 PM Reply   
Better get your wallet out if he gets elected!!!! Socialist or communist???
Old     (DocPhil)      Join Date: Aug 2015       02-13-2016, 8:44 PM Reply   
Me? I'm just a scientist that likes data

http://www.commonwealthfund.org/~/me...irror_2014.pdf
Old     (Coolaintcheap)      Join Date: Jan 2016       02-13-2016, 9:11 PM Reply   
Quote:
Originally Posted by DocPhil View Post
Me? I'm just a scientist that likes data



http://www.commonwealthfund.org/~/me...irror_2014.pdf

I was referring to sanders! I spend quite a bit of time sledding in Canada in the winter and I can't quite figure out why if their health care system is so great... Why do soooo many come to the U.S. For procedures???

Last edited by Coolaintcheap; 02-13-2016 at 9:14 PM.
Old     (cwb4me)      Join Date: Apr 2010       02-14-2016, 4:19 AM Reply   
Better doctors. You get better doctors when they get paid better.
Old    mojo1127            02-14-2016, 5:48 AM Reply   
Using Canada as an example; their population is about 1/10th of ours. Their model is not sustainable here. Second, they do not have universal healthcare. It's different in each province. 3rd, many have to supplement with private coverage for any type of real coverage. Fourth, most who can do come here for procedures. Lastly, they are looking at a 90 billion $$ shortfall in the budget. For a country that size that is bad. Health care isn't the only reason for their lack of funds. Kicking military members out of their homes for Syrian terrorists is also part of that.
Old     (Coolaintcheap)      Join Date: Jan 2016       02-14-2016, 6:06 AM Reply   
Edit!
Old     (Coolaintcheap)      Join Date: Jan 2016       02-14-2016, 6:20 AM Reply   
I was being a lil' sarcastic with my post about why so many Canadians come here for procedures. It's my understanding from the small percentage of folks I've talked to and what I've read it is the wait times. Not wait times to see a general practitioner but rather wait times for referral to a specialist. When you start talking months not weeks for MRI or CT scans I can understand the frustration from some folks up north!!! I'm by no means saying what we have or have had in the past is the way to go but I'm not sure the Canadian model is a good example of a quality system!
Old    mojo1127            02-14-2016, 6:24 AM Reply   
I could be wrong, but I believe it was Vladimir Lenin who said,"socialism is the stepping stone to communism. "
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 8:35 AM Reply   
Canada is a terrible example of how successful universal healthcare can be. In fact, in worldwide rankings they are slightly above us in terms of quality and outcomes. That being said, many countries do it right. Many people think that either you have universal healthcare or you don't. That couldn't be further from the truth.

There are many examples of highly successul universal healthcare systems aroud the world. Germany, UK, Australia all have universal systems that are vastly superior to what we have. They have lower cost, higher quality and way better outcomes. And they have solved the issues of wait times while keeping this physicians highly paid and successful.

And to insinuate that somehow universal healthcare means you are socialist is a fallacy. Healthcare is a right of all people. It is NOT a privilege. Taking care of your own people doesn't mean you are socialist. It means you are compassionate.
Old    mojo1127            02-14-2016, 9:00 AM Reply   
the biggest problem people seem to have in understanding is that not many people become doctors, and even fewer become good ones. the amount of money it costs to become a doctor is very very high. next we have sue happy pieces of crap(both lawyers and patients). This causes doctors to have to spend astronomical amounts of money on malpractice insurance. I agree taking care of your own people like veterans, however; it becomes tough to be compassionate when any and everyone is allowed to walk into our country and take advantage of us. often they get faster and better treatment that actual citizens. hell, they even got 750,000,000 $$ worth of Obamacare. rather than have lots of people here illegally who use emergency rooms amongst other services who's fund they help to drain. one more thing, can you point me to the part of the constitution that says health care is a right? If you like all these other systems then you can move to one of the aforementioned countries, good lluck getting a work visa. I've said it before and i'll say it again. the united states is what it is. you wouldn't complain that a ford dealership doesn't sell chevy, and you wouldn't get butt hurt if a Chinese restaurant didn't serve queso dip. so don't get butt hurt when America does things the American way. if you like socialism move to Venezuela or cuba
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 9:10 AM Reply   
It doesn't say that in the consitution. It also doesn't say you have a right to clean water. I bet you would be pretty upset if you lived in Flint Michigan or your water supply was tainted.

We can do things the "American way" and still make our country better. Just because we learn from successes that other countries have doesn't mean that we are somehow becoming them or becoming socialist. Isn't this what corporations and businesses do? Piggyback on successes of other businesses and learn from their mistakes?

I would argue that because we are such a great nation, we can do it better than everyone else. We can insure all of our people cheaper, better and faster. Now, THAT is truly the American way.
Old    mojo1127            02-14-2016, 9:12 AM Reply   
well the entire reason there is a water problem in flint is because of the local officials, as well as the EPA who planned on not saying until after 2016. I would be pissed if I had the same water issues as flint. you seem to miss the point that the whole ordeal was created by government. it could have happened under conservative leadership, but it didn't. you are relying on government to do things better. social security is a great example of something they did to help people, but the coffers are dry.if it's so great make it optional, and let's see how many people use it. docphil, I am guessing you're not a physician, when you speak to your accountant do you tell him, "make sure I pay as much taxes as I possibly can."?

Last edited by mojo1127; 02-14-2016 at 9:15 AM.
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 9:15 AM Reply   
Quote:
Originally Posted by mojo1127 View Post
well you are relying on government to do things better. social security is a great example of something they did to help people, but the coffers are dry.if it's so great make it optional, and let's see how many people use it. docphil, I am guessing you're not a physician, when you speak to your accountant do you tell him, "make sure I pay as much taxes as I possibly can."?
Actually I am a practicing internist and I am currently getting my masters degree in Health Administration Leadership. So, I have a bit of credibility on this topic.

That being said, I completely understand your frustration and relate to your concern about government involvement. However, one simply has to look to other nations.

Go read that commonwealth report that I posted. Explain to me how every other major nation has a universal healthcare system and they all destroy in the rankings year after year.

How can that be?

Go study Germany's system. They have an opt out clause. If you want to go private, you can. Yet, their national system is awesome, very high in the rankings they beat us every year. Why not model it after Germany? Or the UK. The UK is the best system in the world. The NHS is terrific. And you can opt out and go private if you want. It can be done my friend. And WE can do it better

Last edited by DocPhil; 02-14-2016 at 9:17 AM.
Old    mojo1127            02-14-2016, 9:18 AM Reply   
So you are throwing money in the toilet for a degree that does nothing but turn you into a pencil pushing bureaucrat? Why not focus on honing your skills as a physician rather than wasting time focusing on something else? I'm still waiting on an answer as to whether you take deductions on your taxes or try to pay as much as you can. Or do you simply write a check to the treasury which is 100% allowed. Then why do millions of people come to America if we are so oppressive when it comes to free stuff? why wouldn't they go to Germany en masse(and non Christian Syrians don't count)
edit: Do you have a private practice or just work at the hospital?

Last edited by mojo1127; 02-14-2016 at 9:26 AM.
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 9:29 AM Reply   
Quote:
Originally Posted by mojo1127 View Post
So you are throwing money in the toilet for a degree that does nothing but turn you into a pencil pushing bureaucrat? Why not focus on honing your skills as a physician rather than wasting time focusing on something else? I'm still waiting on an answer as to whether you take deductions on your taxes or try to pay as much as you can. Or do you simply write a check to the treasury which is 100% allowed.
Wow....personal attacks for someone who is trying to better themselves. Nice.

Anyways, health systems that have physicians in leadership positions have better quality, lower costs and improved outcomes. As a physician, I can affect healthcare one patient at a time. In a leadership role at my organization, I can affect it on the macro level and advocate for policy changes that help a population of patients. I still practice full time so right now I am doing both. Do you want more physicians in leadership roles or pencil pushing bureaucrats?

You might consider it a "waste of time" and that is fine. you are entitled to your opinion.
Old    mojo1127            02-14-2016, 9:35 AM Reply   
I was just about to apologize for the personal attack. I am sorry. If you're spending your own money then do whatever makes you happy.Typically, doctors who take "leadership" roles end up being pencil pushing bureaucrats. Some examples would be hospital boards, board of medical examiners, etc. I will still push for an answer to whether or not you pay as much as possible in taxes and/or write checks to the treasury to fund services you advocate, or If you are waiting to do so until required by law.
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 9:45 AM Reply   
Quote:
Originally Posted by mojo1127 View Post
I was just about to apologize for the personal attack. I am sorry. If you're spending your own money then do whatever makes you happy. I will still push for an answer to whether or not you pay as much as possible in taxes and/or write checks to the treasury to fund services you advocate, or If you are waiting to do so until required by law.
No problem man. It's all good. I think you and I want the same thing. In fact, who doesn't want better health for the CITIZENS of our great country? I also agree that providing healthcare to illegal immigrants is a big issue as well. I bet we are not the only country around the world that struggles with this. I think we should look to our allies for ideas on how to cope. Maybe we can improve on what they have done.

As for your question about taxes, it is clearly a trap. If I say that I don't then I am a hypocrite right? If I say that I do then I'm a liar. Let me answer it this way: I think healthcare is exempt from typical rules of government, free enterprise and capitalism. I agree that more government intervention is usually a bad thing. I personally believe, as I stated before, that healthcare is a right of all people in our nation. I would be all for a privatized system if it worked. It has been tried by many nations and it simply doesn't work. Right now, the safest, best and cheapest systems around the world are government run.

Nice dodge eh? maybe I should be running for office
Old    mojo1127            02-14-2016, 9:56 AM Reply   
My point about the tax thing is this. Let's use Warren Buffett for example. He whines about his secretary paying more taxes than he does. Well, he should give her preferred stock options then to lower her tax rate.. he could simply write a check for a few billion to the treasury, or cash everything in instead of just paying for carried interest, but he won't. rules for thee not for me situation. His best buddy President Obama rails against things like corporate inversions. Well, high corporate tax rates cause inversions. I think Buffett cleared somewhere in the 3 billion $ profit financing this bk deal. Point is, people often champion causes that require tax revenue, but expect only others to foot the bill.
Old     (DocPhil)      Join Date: Aug 2015       02-14-2016, 10:06 AM Reply   
Quote:
Originally Posted by mojo1127 View Post
My point about the tax thing is this. Let's use Warren Buffett for example. He whines about his secretary paying more taxes than he does. Well, he should give her preferred stock options then to lower her tax rate.. he could simply write a check for a few billion to the treasury, or cash everything in instead of just paying for carried interest, but he won't. rules for thee not for me situation. His best buddy President Obama rails against things like corporate inversions. Well, high corporate tax rates cause inversions. I think Buffett cleared somewhere in the 3 billion $ profit financing this bk deal. Point is, people often champion causes that require tax revenue, but expect only others to foot the bill.
Great point and I totally agree. However, the logic doesn't apply in this scenario. Here's why.... So you are essentially saying, well if you support more government spending on healthcare then pay more taxes? Right? Well, I don't necessarily support broad brush increases in spending. I support a universal healthcare system specifically and more government involvement in that realm and not a huge expansion of the government overall. Will that come if someone like Sanders is elected? Maybe. In reality a universal healthcare system is not likely in the foreseeable future. Just read about the Green Mountain Act and you will understand why.

So what do I do to affect change? Well, I am a physician so I treat patients. I also am learning how to be a healthcare leader so I can affect policy change. And I also support candidates that believe in the what I think is the best healthcare plan for our country. So, no. I don't support broad brush increases in taxes or paying more taxes unless I know that at least part of it will go towards what I think is best.

You have to be careful not to label someone so quickly. Just because I believe in universal healthcare doesn't mean I am a socialist, communist or even a democrat. It means I am someone who has studied the data extensively and believe that is the right move.
Old     (ralph)      Join Date: Apr 2002       02-14-2016, 5:41 PM Reply   
What's clear is the current system is broken. What's alarming is that people don't want change.

Consumption is killing the planet, future generations will look back at us as selfish arseholes. The dichotomy is we have more than ever but are less happy as a result. I'm trying to change my life, old habits are hard to break, it would be nice to have a sustainable vision to follow. The entire system perpetuates gratuitous consumption, as a society we have gone astray from what really makes a satisfying life.

Jeepers, I am turning into a hippie.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 7:11 AM Reply   
Healthcare has always been pretty messed up. It was socialized in the workplace a long time ago. A fit guy pays the same amount for HI as the fat diabetic sitting next to him at work. Yet outside the workplace that same fat diabetic wouldn't have been able to get HI at nearly any price before ACA. Outside the workplace you pay for HI after taxes, assuming you could get it. Inside the workplace it might be before any taxes including FICA, so the govt is subsidizing up to around 40% of your payments. Now, all that preferred treatment and govt subsidies has driven up prices and excluded a lot of people fron getting HC. The ACA is pretty much payback by all those people who need the govt to help make HC accessible to them. The whole idea of what is fair has long been dismissed as not relevant because if nobody cared before what's fair, why should that be the issue now?

What's so great about a HC system that you pay into for decades, then when you get too sick to work the system is designed to kick you to the curb and leave you uninsured? You want an alternative fix? How about eliminating any IRS rules regarding payments to HI, such that every single person is deciding for themselves if they want to buy or not. Eliminate employer sponsored plans and make it an individual decision. Create a law that requires HC providers to charge exactly the same price to every customer for the same service. They can set their price, but they can't negotiate discounts to selected groups that don't apply to every customer. HC has one of the most ridiculous "billed price" vs "actual price" schemes I've ever seen in the marketplace.

If you put the buying decision back into the hands of the individual, then the individual customer has the power to control prices. With employer sponsored HI, it's a use it or lose it proposition. If you don't purchase you lose the 40% contribution by the govt and you lose the contribution by the employer. Make HI an after tax purchase solely from the consumers pocket and you will see HI tumble like a house of cards.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 8:44 AM Reply   
Quote:
Originally Posted by fly135 View Post
Healthcare has always been pretty messed up. It was socialized in the workplace a long time ago. A fit guy pays the same amount for HI as the fat diabetic sitting next to him at work. Yet outside the workplace that same fat diabetic wouldn't have been able to get HI at nearly any price before ACA. Outside the workplace you pay for HI after taxes, assuming you could get it. Inside the workplace it might be before any taxes including FICA, so the govt is subsidizing up to around 40% of your payments. Now, all that preferred treatment and govt subsidies has driven up prices and excluded a lot of people fron getting HC. The ACA is pretty much payback by all those people who need the govt to help make HC accessible to them. The whole idea of what is fair has long been dismissed as not relevant because if nobody cared before what's fair, why should that be the issue now?

What's so great about a HC system that you pay into for decades, then when you get too sick to work the system is designed to kick you to the curb and leave you uninsured? You want an alternative fix? How about eliminating any IRS rules regarding payments to HI, such that every single person is deciding for themselves if they want to buy or not. Eliminate employer sponsored plans and make it an individual decision. Create a law that requires HC providers to charge exactly the same price to every customer for the same service. They can set their price, but they can't negotiate discounts to selected groups that don't apply to every customer. HC has one of the most ridiculous "billed price" vs "actual price" schemes I've ever seen in the marketplace.

If you put the buying decision back into the hands of the individual, then the individual customer has the power to control prices. With employer sponsored HI, it's a use it or lose it proposition. If you don't purchase you lose the 40% contribution by the govt and you lose the contribution by the employer. Make HI an after tax purchase solely from the consumers pocket and you will see HI tumble like a house of cards.
So can you buy insurance when you are sick? Can you buy anytime? So what's to stop people from waiting until they are sick to buy insurance. In this model, there is no incentive for preventative care.

So you are going to force HC providers to charge the same prices but allow people to purchase insurance whenever they want? Hospitals and HC providers would go bankrupt.

Like I said, the normal rules of free market enterprise don't apply to healthcare. It is a different animal.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 9:42 AM Reply   
Hey, I'm all for universal healthcare. Just pointing out to those free market advocates that the system has never been free market. It's been propped up with regulations and subsidies that created a socialized HC system in the workplace. So yeah a free market system allows HI providers to charge individuals based on their heath or excluding them from coverage all together. That's the way is was before the ACA if you weren't in the socialized workplace environment. Now it just applies to everyone. So yeah, sick people don't get HI pretty much.

Not sure why you have a problem with HC providers charging the same price to all their customers. They pick the price and that's what they charge everyone. Totally eliminates HI companies from bullying HC providers on their prices. It's pretty ridiculous when you see Billed: $450, after HI discount: $35.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 10:03 AM Reply   
Quote:
Originally Posted by fly135 View Post
Hey, I'm all for universal healthcare. Just pointing out to those free market advocates that the system has never been free market. It's been propped up with regulations and subsidies that created a socialized HC system in the workplace. So yeah a free market system allows HI providers to charge individuals based on their heath or excluding them from coverage all together. That's the way is was before the ACA if you weren't in the socialized workplace environment. Now it just applies to everyone. So yeah, sick people don't get HI pretty much.

Not sure why you have a problem with HC providers charging the same price to all their customers. They pick the price and that's what they charge everyone. Totally eliminates HI companies from bullying HC providers on their prices. It's pretty ridiculous when you see Billed: $450, after HI discount: $35.
I have a problem with fixed prices in a scenario where persons can buy insurance any time they want. So you don't pay anything into the coffers when you are okay but when you are sick you buy insurance and get everything covered. I'm afraid it will never work. Insurance companies will just deny coverage due to pre existing conditions which is what they did before the ACA! Come on now.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 11:31 AM Reply   
You must be confused about my fixed price thing. I'm not suggesting that anyone "fix" the price except the HC provider. Once they fix the price then everyone pays the same. This has absolutely zero to do with people buying HI only when they get sick. Nothing in the "fixed" price thing has anything to do with HI companies being forced to cover anyone. Not sure why you are going there. In fact, it allows people who don't have ins to be able to pay themselves knowing that they are not being charged 10x what someone with HI is being charged.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 11:34 AM Reply   
Quote:
Originally Posted by fly135 View Post
You must be confused about my fixed price thing. I'm not suggesting that anyone "fix" the price except the HC provider. Once they fix the price then everyone pays the same. This has absolutely zero to do with people buying HI only when they get sick. Nothing in the "fixed" price thing has anything to do with HI companies being forced to cover anyone. Not sure why you are going there. In fact, it allows people who don't have ins to be able to pay themselves knowing that they are not being charged 10x what someone with HI is being charged.

So me and my fellow doctors get to charge whatever we want? Come on now...
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 11:40 AM Reply   
Wow, you really can dance around an issue. What's so hard about charging everyone the same price for the same service. Every day you go to a store and expect that the price you pay is the same for all the other customers in the store. You don't pay $10 for a bottle of catsup and the next guys pays $1.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 11:43 AM Reply   
Quote:
Originally Posted by fly135 View Post
Wow, you really can dance around an issue. What's so hard about charging everyone the same price for the same service. Every day you go to a store and expect that the price you pay is the same for all the other customers in the store. You don't pay $10 for a bottle of catsup and the next guys pays $1.
Actually prices for goods and services are different all over. An oil change at one quick lube is different from another quick lube. A pineapple at Meijer is different from a pineapple publix

The issue is that who is gonna set those prices? Physicians? You want someone you has a vested interest into the cost of something to set the price? That is one of the problems with fee for service now. Docs are incentivized to do more procedures with no attention to quality. Do you think setting prices and charging whatever you want improves quality? I don't
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 11:48 AM Reply   
Thta's right. I'm not telling HC-a to set the prices for HC-b. You set your prices just like every other business out there. According to your own business model and cost/revenue predictions. I'm just saying that you shouldn't be able to charge different customers different prices for the same service.

Somebody sets the f**king price, right? Why do you keep going on about how nobody can set the price? This isn't rocket science. You set the price for your business and that's what you charge everyone who comes for your services.
Old     (cwb4me)      Join Date: Apr 2010       02-15-2016, 11:49 AM Reply   
When you fix prices you don't account for complications. A doctors fees should be adjustable to cover for complications. Since a doctors fees are labor and two of the same operations can take two different amounts of time. He or she should be able to adjust the price to account for the amount of labor involved. Just like any job involving labor the customer can be overcharged. The customer should do their research to see if they are dealing with a reputable doctor.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 11:53 AM Reply   
Have you guys ever looked at a HI statement? I'm talking about the vast difference between billed and actual price. This has nothing to do with a doctor spending more time. You guys are going off on tangents that aren't even relavant. I've seen billed vs actual cost for lab tests that vary by a factor of 10. A co-workers bill for an operation was $30K and the insurance discounts it to 10K. That has nothing to do with a doctors time or difficulty.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 12:33 PM Reply   
Quote:
Originally Posted by fly135 View Post
Have you guys ever looked at a HI statement? I'm talking about the vast difference between billed and actual price. This has nothing to do with a doctor spending more time. You guys are going off on tangents that aren't even relavant. I've seen billed vs actual cost for lab tests that vary by a factor of 10. A co-workers bill for an operation was $30K and the insurance discounts it to 10K. That has nothing to do with a doctors time or difficulty.
The point is that you can't just say "let's fix prices" in a vacuum. There are so many other factors that come into play. And who is going to decide those prices? Physicians? Hospitals?

I can tell you if you are suggesting that physicians do it, then it is a bad idea. Why do you think physicians shouldn't own imaging equipment. There is a giant incentive to order unnecessary testing.

Fee for service is a bad system in general and fixing prices has nothing to do with that. You need to pay physicians based on quality and outcomes. I think we can all agree on that.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 12:56 PM Reply   
The prices are already "fixed". "Fixed" as in decided. You tell me who has decided them. Somebody has, or you wouldn't get a bill. I'm surprised that this is so difficult for you to understand. Do you think it's freak'n magic? Or are you telling me that when it's time to send a bill that they ask God what to charge? What is so hard about understanding what I am saying. I thought it was pretty dang clear. HI companies negotiate prices with HC providers. I'm saying that those negotiated prices can't be lower than what they charge anyone else. I.E. if they negotiate that they can provide a service for a partiicular fee, then that fee can't be lower than what anyone else is charged. I.E. if a HC provider decides to give a great deal to a particular HI company, then they have automatically provided the same great deal to everyone of thir customers.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 1:03 PM Reply   
Quote:
Originally Posted by fly135 View Post
The prices are already "fixed". "Fixed" as in decided. You tell me who has decided them. Somebody has, or you wouldn't get a bill. I'm surprised that this is so difficult for you to understand. Do you think it's freak'n magic? Or are you telling me that when it's time to send a bill that they ask God what to charge? What is so hard about understanding what I am saying. I thought it was pretty dang clear. HI companies negotiate prices with HC providers. I'm saying that those negotiated prices can't be lower than what they charge anyone else. I.E. if they negotiate that they can provide a service for a partiicular fee, then that fee can't be lower than what anyone else is charged. I.E. if a HC provider decides to give a great deal to a particular HI company, then they have automatically provided the same great deal to everyone of thir customers.
I think you are a little confused here.

How is that going to help anything?
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 1:18 PM Reply   
Confused about what? You are the one who keeps suggesting that nobody can decide what a HC service costs. Which is clearly untrue. First you have to be able to understand what I'm saying before you question "how will that help"? What's the point of me explaining how it can help if you don't know what I'm talking about?
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 1:24 PM Reply   
Quote:
Originally Posted by fly135 View Post
Confused about what? You are the one who keeps suggesting that nobody can decide what a HC service costs. Which is clearly untrue. First you have to be able to understand what I'm saying before you question "how will that help"? What's the point of me explaining how it can help if you don't know what I'm talking about?
I'm not saying that no one can decide what a HC service costs. I am asking who you think should decide that? You suggested passing a law that dictates that costs are fixed. So, who decides those costs? The government? Providers? I'm telling you that if you think the system will be fair if providers decide then you are wrong.

You also mention putting the "buying power" back in the hands of the patients. How? if costs are fixed then there is no competition.

This is like some capitalistic/socialistic lovechild.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 1:33 PM Reply   
I'm not suggesting that a law be passed that "fixes" the price. I'm suggesting a law be passed that says that a HC provider does not discriminate between it's customers with preferred pricing. They can charge whatever they want as long as all customers are billed the same for the same service. I thought that I was making that clear when I talked about HI companies negotiating discounts. The pricing is not "fixed" as in set in stone by some governing entitiy.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 1:40 PM Reply   
And what is the role of the insurance company?

I understand what you are suggesting now. What does this do you address quality, value based payments, price transparency, uncompensated care, and the other major problems in the system.

Variation in pricing is an issue but a minor one. Fee for service is a much bigger issue
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 2:08 PM Reply   
That has no effect on the role of the HI company. They still provide the same service as they did before. The only difference it that when an individual self pays, they know they are not getting some ridiculously inflated price that others don't have to pay. You can call it a minor issue. So if it's minor then why not be for equitable pricing? I'm not thinking it's as minor as you say. And it definitely speaks directly to transparency in pricing.

The other issues are separate issues that have no bearing on equitable pricing. You are preaching to the choir when it comes to universal HC. I'm for it. But for those who argue that we need to repeal the ACA and go back to what we've had before, I'm suggesting that we put everyone on equal footing. If you could only get HC for your family because it's been socialized in the workplace, then you should do without. I don't want to subsidize your unhealthy family. Get rid of the govt subsidizing your HI through diverted tax revenue. Pay for it yourself out of your own pocket. If your employer wants to pay for it then you pay income and fica on the amount. No more HI companies igoring preexisting conditions just because you buy in the workplace, but denying outside the workplace. Just get rid of employer spounsered HI altogether. Buy it yourself just like every other product. It's all these policies that divde the public. If we were all in the same boat then we could agree to fix the problems instead of marginalizing a segment of the public until it gets so large that they out vote you.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 2:14 PM Reply   
Quote:
Originally Posted by fly135 View Post
That has no effect on the role of the HI company. They still provide the same service as they did before. The only difference it that when an individual self pays, they know they are not getting some ridiculously inflated price that others don't have to pay. You can call it a minor issue. So if it's minor then why not be for equitable pricing? I'm not thinking it's as minor as you say. And it definitely speaks directly to transparency in pricing.

The other issues are separate issues that have no bearing on equitable pricing. You are preaching to the choir when it comes to universal HC. I'm for it. But for those who argue that we need to repeal the ACA and go back to what we've had before, I'm suggesting that we put everyone on equal footing. If you could only get HC for your family because it's been socialized in the workplace, then you should do without. I don't want to subsidize your unhealthy family. Get rid of the govt subsidizing your HI through diverted tax revenue. Pay for it yourself out of your own pocket. If your employer wants to pay for it then you pay income and fica on the amount. No more HI companies igoring preexisting conditions just because you buy in the workplace, but denying outside the workplace. Just get rid of employer spounsered HI altogether. Buy it yourself just like every other product. It's all these policies that divde the public. If we were all in the same boat then we could agree to fix the problems instead of marginalizing a segment of the public until it gets so large that they out vote you.
I think you are confused as to how the process of a provider giving a service works.

What is your impression of how you get a bill and how a provider is paid as it is today?

You seem to be under the impression that doctors routinely charge way more for an office visit than another person. It doesn't work that way. A person might get a different bill but it has nothing to do with what I charge. It is all based on contracts and negotiations with insurance carriers.

You seem to be more in favor of banning negotiation of reimbursements from insurance companies. Is that what you mean? If that is what you mean, then I absolutely agree. It is ridiculous and big problem. It is also highly variable from state to state.

You have about as much a chance of that happening as universal HC passing though

Last edited by DocPhil; 02-15-2016 at 2:22 PM.
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 2:26 PM Reply   
I'm not saying that you ban HI companies from negotiating reimbursements. But whatever they negotiate applies to all customers. This will have the effect of liminting the power of their negotiations as HC providers won't be able to negotiate prices lower than they can afford as a trade off for getting the large block of customers. My impression of the bill comes from looking at the bill and seeing discounts that the HI companies have negotiated.

If a HI company pays $35 for a lab test billed at $450, then I should be able to walk in off the street with no HI and get the same lab test for $35.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 3:02 PM Reply   
Ok so the perceived inequity you are trying to correct is that if you have HI then you shouldn't get a discount?

So if payers can't negotiate a discount who do you think that cost is shifted to? The patient. So with even high deductible plans now patients will have more out of pocket costs.

I'm guessing this has personally affected you so you are fired up about it but I can assure you this is not high on the list of major issues in our current HC system. Its not in the top 10
Old     (fly135)      Join Date: Jun 2004       02-15-2016, 4:03 PM Reply   
You just got through saying that you absolutely agree that negotiated discounts are a big problem. Now you are defending the exact same thing you previously stated is a big probelm. So now I'm supposed to take your word that it's not a major issue? As in what defines a major issue? If I was affected by it, you are also telling me that I should just not worry about it. I'm having a problem trusting that you even know what you are talking about.

"Ok so the perceived inequity you are trying to correct is that if you have HI then you shouldn't get a discount? "

That's one way of saying it. The other way is that everyone should be charged the same for the same service. Or everyone gets the same discount.

And no, it hasn't affected me personally. It has been brought to my awareness by examining my HI statements. Along with the other types of discrimination in the HC/HI industry, and the pushing of money into the industry I've come to realize that we are pricing many Americans out of being able to get HI/HC. You can't have a lot of people living in poverty and only have a HC system that serves the middle to upper classes.
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 4:10 PM Reply   
Yes I agree that insurance companies negotiating rates is a problem. But the solution is not some ridiculous pseudo free market system where somehow it benefits you in reverse to have insurance. So you pay for insurance then Joe blow on the street has the same cost? Ummm....ok

You are right about the problem but wrong about the solution

The solution is universal healthcare. Plain and simple. Every other major country has solved this problem with universal healthcare.

If you are for it, you are for it. Don't offer a solution that shifts more cost to an already over burdened patient
Old     (DocPhil)      Join Date: Aug 2015       02-15-2016, 4:18 PM Reply   
And negotiated discounts are not a problem because they are somehow unfair as you state.

They are problem because insurance companies are putting more and more pressure on hospitals and doctors and the margins are becoming more and more thin. Almost to the point where it is difficult to survive and operate.

The perceived inequality is not a major issue.
Old     (fly135)      Join Date: Jun 2004       02-16-2016, 6:08 AM Reply   
"So you pay for insurance then Joe blow on the street has the same cost? Ummm....ok"

Wow, could you possibly be distorting the facts any worse? You have insurance to pay for costs that could be higher than you can afford. That an uninsured person pays the same price for a service as an insured person is not negating the value of having insurance. You just are billed the same amount as the insured person. The difference is that the insured person has the insurance company pay for a portion of the bill. How could you possibly know what is and isn't a legitimate issue when it's so difficult for you to understand such a simple concept as "everyone being billed the same for the same service".

I'm for universal HC. As I said I'm addressing the people who aren't and think we should be back to what we had before the ACA. If that's the case then make it a free market where everyone can be rejected by HI companies. Having a job that offers HI should not protect you from that. And the govt shouldn't be chipping on for your HI when the HI companies are free to reject people.
Old     (DocPhil)      Join Date: Aug 2015       02-16-2016, 6:40 AM Reply   
Quote:
Originally Posted by fly135 View Post
"So you pay for insurance then Joe blow on the street has the same cost? Ummm....ok"

Wow, could you possibly be distorting the facts any worse? You have insurance to pay for costs that could be higher than you can afford. That an uninsured person pays the same price for a service as an insured person is not negating the value of having insurance. You just are billed the same amount as the insured person. The difference is that the insured person has the insurance company pay for a portion of the bill. How could you possibly know what is and isn't a legitimate issue when it's so difficult for you to understand such a simple concept as "everyone being billed the same for the same service".

I'm for universal HC. As I said I'm addressing the people who aren't and think we should be back to what we had before the ACA. If that's the case then make it a free market where everyone can be rejected by HI companies. Having a job that offers HI should not protect you from that. And the govt shouldn't be chipping on for your HI when the HI companies are free to reject people.
Oh no. I fully understand what you mean. I just think it is more of you trying to prove a point to people that want a free market insurance system. It doesn't offer any realistic solutions to the vast of majority of problems we face in healthcare. I guess I am just more inclined to offer a solution than a talking point.

No one is arguing with you about going back to how things were before the ACA. Who are you arguing with? Surely not me.

Last edited by DocPhil; 02-16-2016 at 6:44 AM.
Old     (fly135)      Join Date: Jun 2004       02-16-2016, 7:15 AM Reply   
You mean ... now you fully understand what I mean. Because one post above you didn't.

Like I said, I'm not advocating going to a free market HC system. It wasn't one before the ACA and I'm simply saying that people who want to go back need to not just regress to a system that gave them advantages while disadvantaging others. Instead, they should go to a system that really reflects what they believe and then they can see how bad it can be. And yes there are people arguing that we need to go back to before the ACA. Lots of people. And yes I understand that you aren't one of them.

I disagree that what I'm saying is nothing more than a talking point. The path to good solutions is to make sure that the bad solutions are fully understood as that. And that involves talking points, if that's how you want to characterize it.
Old     (DocPhil)      Join Date: Aug 2015       02-16-2016, 7:21 AM Reply   
Quote:
Originally Posted by fly135 View Post
You mean ... now you fully understand what I mean. Because one post above you didn't.

Like I said, I'm not advocating going to a free market HC system. It wasn't one before the ACA and I'm simply saying that people who want to go back need to not just regress to a system that gave them advantages while disadvantaging others. Instead, they should go to a system that really reflects what they believe and then they can see how bad it can be. And yes there are people arguing that we need to go back to before the ACA. Lots of people. And yes I understand that you aren't one of them.

I disagree that what I'm saying is nothing more than a talking point. The path to good solutions is to make sure that the bad solutions are fully understood as that. And that involves talking points, if that's how you want to characterize it.
I was finding your train of thought hard to follow. You are arguing with yourself.

Just kidding. Its all good man. I see what you are saying.

But trust me when I say that there are bigger fish to fry. Like transparency for example. The thought is to put higher costs on consumers right? And let them shop around. So how in the world are they supposed to do that if no one (including docs) knows what anything costs.
Old    deltahoosier            02-17-2016, 3:57 PM Reply   
I feel you two are talking by each other.

John has noticed that he can not get the same billing for service and someone with Healthcare insurance. I think he is correct. I think you acknowledged that point.

John's other contention is he as a private party can not compete with a corporation in setting value for services because he believes that people who are in a corporation get a tax free benefit (free/ socialized corporate healthcare). He wants businesses out of paying for healthcare. We wants all people to get the money and buy on their own. He hopes that would reduce costs because you don't have infinite deep pockets to pay for HI plans.

I take contention that "Healthcare is a Right". A right means that you can exercise that right at any time regardless. What you are advocating with that statement is I can make you as a doctor, perform (name the procedure) for free or at a non market cost regardless of your consequences.

Basic market principle. If more money is in the system, the costs will rise or the volume will rise to capture it. Costs started going up as soon as people started having healthcare insurance. You are starting to see the same issue with Vet Med as well now that they are offering animal insurance.

Germany pays around 17% of their annual pay for healthcare. 14% to regular and 3% to end of life. They have wait times and the well to do can still buy insurance outside of the socialized plan (and they do because it is better). The people also pay for the education of the doctors so the state can fix pricing since they own the doctors. Married dual income $100,000 a year total with 2 kids, you will pay around 54% of their income in taxes. The rates go higher as the income portion jumps up to 47.5% alone for the highest earners.

We pay 4.5% lifetime for medical but people don't realize it. They can not use it until retirement age. It has 25% of the people and 50% of the costs of all healthcare according to one study I saw.

I guess at the end of the day, I am not sure how socializing medicine helps the cost as you have doctors who still need to pay for their education. Pay for nurses and equipment. They have to pay for the current regulation as well. I saw one article that Malpractice insurance costs around 1% of the healthcare costs but up to 10% testing charges (additional make sure it is for sure this tests) to make sure the doctor stays out of court.

People don't want insurance, they want a service plan. Insurance is made to not be used. Currently when usage goes up, they go back to the businesses and up the costs to the business. Business writes the check, raises their cost of goods and services and everyone keeps going. Only way you can control costs is reduce usage. Less money to capture means more competition. Unfortunately what that means if the consumer gets hit with more bill, we will not go in unless we need too.
Old     (DocPhil)      Join Date: Aug 2015       02-17-2016, 4:08 PM Reply   
Healthcare is a right means that we are the only advanced nation that doesn't guarantee healthcare to all of its citizens. It is not some magic wand that you wave and a doctor appears to fix you. You are taking the meaning too literally.

How's that "more competition" thing working out right now? Increase in CDHPs and high deductibles means more consumer cost burden. This means the buyer has more skin in the game. This increases competition. Right? Wrong. Instead, with more out of pocket costs, people just wait until they are super sick and go to ER (as you alluded to). Then it ends up costing the whole system more. Less money doesn't mean more competition. It means less focus on prevention and higher costs later.

In a universal healthcare system, there is actually less bureaucracy. single payer. simple. This is actually one instance where government control helps. A single payer reduces administration costs by at least 40%.

The solution is a single payer system where quality is rewarded and unnecessary usage is deterred. This includes decreasing high cost items like specialist referrals, imaging, etc. This is what they do in the UK. They have found a great balance and have the best system in the world.

Last edited by DocPhil; 02-17-2016 at 4:11 PM.
Old     (wakemetoday)      Join Date: Mar 2006       02-17-2016, 6:17 PM Reply   
To me, the setup is similar to ours http://www.numbeo.com/cost-of-living...=United+States (Notice private at the bottom). IMHO, you also have to consider the climate. Most of the US population would be healthier if we lived in a place where it never got cold. Also, because of the system, it is expensive to live there--notice housing at the bottom http://www.numbeo.com/cost-of-living...=United+States
Old    deltahoosier            02-18-2016, 10:14 AM Reply   
Quote:
Healthcare is a right means that we are the only advanced nation that doesn't guarantee healthcare to all of its citizens. It is not some magic wand that you wave and a doctor appears to fix you. You are taking the meaning too literally.
I agree it is a literal translation, however the masses believe you can ask and receive as they are accustom to the Bill of Rights and all. I know it is word play ,however it biases the argument to say it is a right.

Quote:
How's that "more competition" thing working out right now? Increase in CDHPs and high deductibles means more consumer cost burden. This means the buyer has more skin in the game. This increases competition. Right? Wrong. Instead, with more out of pocket costs, people just wait until they are super sick and go to ER (as you alluded to). Then it ends up costing the whole system more. Less money doesn't mean more competition. It means less focus on prevention and higher costs later.
You don't think paying an addition 14% to 17% of your income (no deduction for the poor either) is not having skin in the game? Or the additional taxes they pay for paying the doctors to go to college. I openly welcome all these ballers who decided to be independent contractors to collect high income and because they don't want to work for the man, pay 17% percent of their income for Healthcare. I went to a company for the benefits at a young age because I could see the need. I live in an area where many can work outside contracting and not pay for insurance and collect way high salaries than I can. Maybe they should pay the 17% and it could cut down on the price inflation of housing and other goods.

If all the people openly committed to that right now, we would not be talking about Healthcare crisis. I wonder what kind of plan a private party can get for $17,000 year?

We do have free/ subsidized healthcare to a certain degree. It is called county hospital. People don't like county because it is crowded.

The laws governing ER's should change and what they charge is a ridiculous lie. My wife got taken in for a fainting spell at work. They took blood and did an EKG. The bill was over $8000. They would and could not bill that if it were not for deep pockets. Either that or it is a game they use. Bill a truck load of money. Don't get paid that amount. Actually get closer to what it really cost, then write the rest off in taxes. I am pretty sure it is a scam, but what do I know.

I agree, when people have to pay more they will delay going to the doc. However, I have insurance and I still delay going to the doc because I have to take time off from work because we all have to drive an hour each way to get to work. It is not easy to casually see the doctor.
Quote:
In a universal healthcare system, there is actually less bureaucracy. single payer. simple. This is actually one instance where government control helps. A single payer reduces administration costs by at least 40%.
I don't believe there is less bureaucracy in a single payer system. I don't believe it for a second. I have yet to see a government run anything be efficient. Historically, The Federal government will create a position instead of consolidation when it comes to business needs. You will never convince me that government can do it cheaper.

We have administration costs because of law and regulation. How many experts have to be brought in to watch a particular law or to dot the I's and cross the T's? I know this for a fact.

How is this?

I think what has to happen is people who did not take a job with benefits need to pay their fare share in healthcare. They chose high income vs benefits ( I know it is a not fit all statement). Let the people that do that, write it off on their taxes.

Second, they need to make an incentive for hospital to offer walk in services that have less malpractice implications.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 10:24 AM Reply   
Quote:
Originally Posted by deltahoosier View Post


I don't believe there is less bureaucracy in a single payer system. I don't believe it for a second. I have yet to see a government run anything be efficient. Historically, The Federal government will create a position instead of consolidation when it comes to business needs. You will never convince me that government can do it cheaper.

.
This statement here negates everything you have to say on the matter. I don't NEED to convince you. Simply look at the statistics. Every other country that has universal healthcare spends less than us. New Zealand spends about 1/3 of what we spend.

Did you read that mirror mirror report? No, I bet you didn't.

Read it again and if you are not convinced then you simple won't open your eyes.

http://www.commonwealthfund.org/~/me...irror_2014.pdf
Old    deltahoosier            02-18-2016, 12:12 PM Reply   
I will read it, however not all government models are the same.

Most of those governments:

A) Don't have certain rights granted to individuals like privacy rights which changes paperwork requirements.

B) Different regulations for procedures vs how much value is on a human quality of life/ life in general.

C) They absolutely don't have the same diversity of people, climates, cultures, economic status, products, youth sports, and so on. Since they have socialized the medical training, they also have cost control over the doctors. Point is, the government has much more control over price controls.

D) They also don't have unfettered inputs to the system through illegal immigration. We can't have a truly closed system. We will have almost more people who don't pay into the system by being here illegally than most of those countries have population.

With uncapped inputs to the system and doctors who have to recoup their education costs plus incentive to become a doctor in the first place (Porsche 911, big house, hot wife, nurse on the side, vacations, and so on), I don't know how you go to a absolute price structured socialized system?

How is it that profit margins are so low for doctors (reported 10% to pay staff and self) and insurance companies (reported 3 to 4% which is low for a business), yet each year the costs go up over 20% or more. More and more users of the system that has not hit it's absolute volume cap I would guess.

With the doctors and hospitals still as a for profit business, I don't see how you get away with cost caps? The more people use a service plan, the more it will cost. period. There is no other discussion because money does not work any other way.

A) You either write a contract where you as a doctor has to see everyone for a set fee for daily slots
B) You make a fixed amount for everyone you see per visit.

With A, you see more people for less time. Quality has to suffer at some point. Insurance cost is capped. Can regulate money coming in and going out.
With B, You can choose to see as many as your quality will allow or greed will allow and the insurance (government) has moving costs. Can not regulate costs because you don't know how many people will use it in a given year and you don't know how many illegals will use it.

I believe you in administration costs, however why would a private business not have an incentive to make it efficient? I am sure that it is for the most part considering the massive amounts of record keeping and regulations. I don't believe the government can do it cheaper. Never in the history of this country the government has done it better, done it cheaper, or done it without politicizing it.

How do we not believe the government will not use the data to start telling people how to live? Your private info is great if your party is in, what about the other party who wants to social engineer and can use the government hammer to do so? They do that in Europe.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 1:01 PM Reply   
Quote:
Originally Posted by deltahoosier View Post
I will read it, however not all government models are the same.

Most of those governments:

A) Don't have certain rights granted to individuals like privacy rights which changes paperwork requirements.

B) Different regulations for procedures vs how much value is on a human quality of life/ life in general.

C) They absolutely don't have the same diversity of people, climates, cultures, economic status, products, youth sports, and so on. Since they have socialized the medical training, they also have cost control over the doctors. Point is, the government has much more control over price controls.

D) They also don't have unfettered inputs to the system through illegal immigration. We can't have a truly closed system. We will have almost more people who don't pay into the system by being here illegally than most of those countries have population.
.

What are you talking about? You know this for a fact? All of these countries in the report that smoke us on quality and outcomes AND spend less money. You are simply throwing a some poop on the wall and hoping something sticks.

You know for a fact that they don't have privacy rights or problems with illegal immigration? Half of the countries are in Europe that probably have a bigger immigration problem per capita than we do.

The UK or Australia doesn't protect people's privacy?!!??! Gimme a break!!!!

You are guessing. You're incorrect

Last edited by DocPhil; 02-18-2016 at 1:03 PM.
Old    deltahoosier            02-18-2016, 2:06 PM Reply   
Those two countries are islands. They can control their boarders much easier. I did not say immigration. I said Illegal immigration. Which changes the cost dynamic of a closed system of payers and the provider. You can choose to allow immigration and what type of immigrants into your closed system. Illegals not so much. Before you say that illegals can't get it, they do already under Obamacare.

Not throwing poop on the wall. Now you are simply trying to marginalize a rational concern because you are choosing to ignore my inputs about costs. At best, I think you are turd tossing.

http://www.theguardian.com/society/2...health-records

Police and government officials can get patient records without a warrant and possibly get the records if the individual opts out. This includes mental health, smoking, drinking and so on.

My intent is not to argue about specifics such as government social structures, but to point out that their are many inputs that make us different to a couple of island nations.

From your article.

Quote:
There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
What a load of garbage. Low out of pocket costs? Let's see. I pay a 15 dollar co pay. They pay 17% of their income. Also, do they take into count that the individuals also pay for a lifetime of doctors and nurses to go to school? How does that fit into the equation for overall healthcare expenditure?

Look. I am not saying this is an easy answer. Not all the data translates directly. Some of the intial chart don't take into consideration the whole system for costs, it is cherry picking. Then it looks like the other parts of the chart are opinion pol based. Many poll results are biased by cultural factors. For instance, my buddy in Germany has to rid his bike 10 miles to get on a train. I find that unacceptable. He is ok with it. Matters of perceived quality and timeliness are relative numbers.

I will continue reading. I would love to have the answers and I don't. I just know that the more you use something the more it costs. End of story on that. Many are concerned about the government having information to use against the people. History tells us that typically goes bad. People have to acknowledge that concern of the people whether you find it without merit. I also know we need to get better records to help the doctors as well. Another tough issue.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 2:38 PM Reply   
Your response shows that you didn't read my post. You simply glossed over it and couldn't wait to type what you wanted to type

1)I said nothing about UK and Australia and immigration. I said they guarantee privacy. The countires in the report have issues with immigration as I stated. So your contention that they don't deal with immigration? WRONG

2)you stated they don't respect privacy: WRONG

3)your contention that government control can't reduce costs. READ the report. Their per capita expense is way less than ours. PER CAPITA. Very simple metric to what the country spends on healthcare. Your assertion: WRONG

Read the full report and get educated on the subject

The fact that you state that I will never convince you that government control can reduce costs mean you are too biased. That means that despite overwhelming data in the report you won't listen. So when you say you want the answers, well....no you really don't.

Last edited by DocPhil; 02-18-2016 at 2:41 PM.
Old     (cwb4me)      Join Date: Apr 2010       02-18-2016, 2:51 PM Reply   
Show us one government agency that is more efficient than the private sector. Anything the government has control of wastes money and isn't nearly as productive as a private sector business or agency.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 2:53 PM Reply   
Quote:
Originally Posted by cwb4me View Post
Show us one government agency that is more efficient than the private sector. Anything the government has control of wastes money and isn't nearly as productive as a private sector business or agency.
There are none.

Healthcare is the exception. Read the report. EVERY other country has primarily government run universal healthcare and they spend way less than us with less adminstrative hassle.

You can ignore the data all you want

Last edited by DocPhil; 02-18-2016 at 2:56 PM.
Old     (shawndoggy)      Join Date: Nov 2009       02-18-2016, 3:44 PM Reply   
Quote:
Originally Posted by cwb4me View Post
Show us one government agency that is more efficient than the private sector. Anything the government has control of wastes money and isn't nearly as productive as a private sector business or agency.
The thing that you are forgetting is that some things aren't profitable and really shouldn't be and we're all OK with that. Those are called basic government services.

fire department
police department
military
education*
streets and highways**
zoning***
environmental protection****
courts
prisons
indigent mental health

* remember that while private schools may arguably in some instances have better outcomes, they are not required to take all comers. Please cite a privately run education system that serves all comers, regardless of capacity to pay, that has better outcomes than public education. Basically you end up with the Taliban model.

** sure there is waste (like Palin's bridge to nowhere) but cite me an example of a successful privately run municipal street system.

*** is there even an example of a privately run zoning department that keeps an industrial hog farm from opening next door to your house?

**** yes, Nixon's EPA is the agency that the uninformed love to hate, but when was the last time a river quite literally caught fire in the USA. The reason bald eagles are off of the endangered species list and that LA has about 90% fewer unhealthful days now than it did in the 70s is not because of voluntary industry self regulation.
Old    deltahoosier            02-18-2016, 4:03 PM Reply   
You protest a little too much I think.

You absolutely glossed over every word I typed. I tried to address your contentions.

You said this:

Quote:
1)I said nothing about UK and Australia and immigration. I said they guarantee privacy. The countires in the report have issues with immigration as I stated. So your contention that they don't deal with immigration? WRONG
after you said this:

Quote:
You know for a fact that they don't have privacy rights or problems with illegal immigration? Half of the countries are in Europe that probably have a bigger immigration problem per capita than we do.

I hate quoting myself:

Quote:
I did not say immigration. I said Illegal immigration.
You seem to be centering your argument around UK and Australia with a mix of other countries. Earlier you said that England and Australia had better systems than Germany so I figured you were speaking more in line of your standard for the discussion. I addressed those two countries. They do not deal with ILLEGAL immigration the way we do.

We have a huge ILLEGAL immigration issues. I can start going over the costs in California alone. As of 2003 it was over 15 billion for services, 1/3 of the prison population for violent crime, and over $25 billion a year sent to Mexico directly in cash payment from the local economies. Hard telling what it is today.


Quote:
2)you stated they don't respect privacy: WRONG
Again: Read as you are telling me to do. http://www.theguardian.com/society/2...health-records

Yes, they have privacy laws but not necessarily concerning the government taking a look and using that information.


Quote:
3)your contention that government control can't reduce costs. READ the report. Their per capita expense is way less than ours. PER CAPITA. Very simple metric to what the country spends on healthcare. Your assertion: WRONG
Apparently you wanted to type so fast that you did not read. I read your article and you disregarded the entire discussion. I will address it again.

Quote:
There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
Again, that is a horrible statement. Of course they will have low out of pocket expenses because %14 to %17 of their income never reaches their pocket. Then additional income does not reach their pocket because they have to pay for the doctors and nurses education.

How much is the real cost to the person? If we can say that out of pocket expenses don't count until Americans put out say 25% of their income, where we be?

Many of the results look like they were in a couple of categories:

A) purely process and procedure errors by non process thinking people. These are procedure cleanups that could happen by restructuring hospitals away from contracting to actually being employees. Having consistent staff and a good process improvement feedback system like Six Sigma. Not by centralizing by a government.

B) I don't know how they get the information from patients. Usually people who respond to polls are people who are angry. So if I send out a 100 polls and 15 answer back with 13 being angry then you have a high percentage of negativity.

C) They compare the US to different countries in all the categories, yet never seem to keep the countries consistent for comparison.

Quote:
On indicators of efficiency, the U.S. scores last overall with poor performance on the two measures of national health expenditures, as well as on measures of administrative hassles, timely access to records and test results, duplicative tests, and rehospitalization. Among sicker respondents, those in Canada and the U.S. were most likely to visit the emergency department for a condition that could have been treated by a regular doctor had one been available, with rates twice as high as that of the United Kingdom and France. In the summary ranking, the U.K. and Sweden score first and second, respectively.
I would say culturally we were always taught to go to ER. Many inner cities are still taught that. I know for a fact illegals (and we have 10 to 15 million at least) will do that. Again, those types of things can be fixed by incentives to open walk up clinics instead of ER or changing the cost structure for the ER because I know a doctor is not going to charge $8000 for blood work and a EKG.

I am not finding anything here that says centralizing is good. Most of this study is about accuracy and efficiency which clearly is not in the governments wheel house.

The main argument is cost. I don't think this study takes into count the total system cost.

How much of the healthcare expenditures counted was hospitals with those fake high bills that they right off?

I hear the argument if we has less sick people paying in, then cost would go down. yes and no. I believe statistically the economic impact of not having only sick people having insurance would be impacted thus insurance companies charging people less because they would have cash reserves to hedge the bet. That is making statistical bets not an actual cost of healthcare. We just forced everyone to buy insurance. I'm fine with that. Means less competition with my money from all those people who did not find a job with healthcare.
Old    deltahoosier            02-18-2016, 4:10 PM Reply   
Quote:
Originally Posted by shawndoggy View Post
The thing that you are forgetting is that some things aren't profitable and really shouldn't be and we're all OK with that. Those are called basic government services.
......
That is not the argument. The argument is being made that government run healthcare would be cheaper to administer.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 4:10 PM Reply   
[QUOTE=deltahoosier;1930241]

The main argument is cost. I don't think this study takes into count the total system cost.


/QUOTE]

Dude you need to tighten up your posts. You're all over the map here.

I said that half of the countries in the report are in Europe and deal with illegal immigration. I was not referring to UK and Australia. I was referring to those two countries in regards to privacy.

THE STUDY DOESN'T take into account costs?!?!?!?! Seriously? Did you read it????? Per capita expenditures on healthcare. That is a basic stastic that I have pointed to many times. That is pretty simple to compare and is not subjective.

Last edited by DocPhil; 02-18-2016 at 4:19 PM.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 4:12 PM Reply   
Quote:
Originally Posted by deltahoosier View Post
That is not the argument. The argument is being made that government run healthcare would be cheaper to administer.
cheaper than what we have. Absolutely

I don't see how you can just gloss over the data. It is not subjective.

Do you think it is a coincidence that EVERY other country spends less than we do!?!?!?

Next you will probably argue that per capita expenditure has some kind of flaw

I've seen you in other threads. I think you just like to argue bro. Get over it on this one. You're wrong

Last edited by DocPhil; 02-18-2016 at 4:21 PM.
Old    deltahoosier            02-18-2016, 6:08 PM Reply   
Quote:
I said that half of the countries in the report are in Europe and deal with illegal immigration.
The US has about 3.8 percent of the population are illegals. England peaked at 1 percent, Germany .4 percent., France .17 percent.

England has roughly 64 million people. The US has 319 million people. We have 12 million illegals, they have 0.6 million

Technically they do deal with illegals, however ours is a pretty large group.

You seem to have made two contentions:

1) That government run would be more efficient. You admitted that we have not seen a government program that is efficient. What makes us think that we can flip a switch and make that kind of change? Future behavior is most often reflective of past behavior.

2) You say it is cheaper. You have a chart that says it is cheaper in other countries. They may be however I will not buy the fact that OUR government has the ability to be cheaper.

We already have government ran healthcare in medicare. It has 25% of the population and 50% of all the expenditures. We pay 4.5% for life for a end of life care where Germany pays 3 percent into it. German's pay 15.5% into regular healthcare and If I had to use that as a simplistic linear extrapolation and pretended both systems were manageable, we would pay 23.25% of our income toward healthcare pre end of life coverage under a government system (assuming current efficiency with the American government system vs the Germans). I know it is simplified but so are the charts that don't account for cultural differences.

According to CNN Money, the average family makes $53,657 a year. Time magazine says the average family plan costs $413 a month for $4,950 a year. Average Spending per Capita which is private and public dollars combined is roughly $9,146 according to the world bank. That means end of life care, business covered expenditures and so on.

That means that an American family is paying 13.7 percent of their income on average for their insurance right now as is (healthcare premium plus Medicare). It is cheaper for an individual. That is $7351 per year. Under your government model, I have to assume looking at the supposedly working German system, our government ran version would look more like 23.25% of our income (pre end of life) and 27.75% total. That is $12,475 per year pre end life and $14,890 total. Almost double if you simply compared the 3 supposedly working models and extrapolating the last.

How is that going to be cheaper? If you use the $9,146 number from the world Bank, we are paying roughly 17% total (end life plus pre). It looks to be double of what we do now and about $5,743 per capita over what we pay all together with corporate contributions.

Breakdown:

Current Health per capita (includes business contributions and Medicare): 17% of income
Current Health Insurance premium (not including business contribution) plus Medicare: 13.7% of income
Germany total healthcare tax contribution (end life plus pre): 18.5% of income
German end life: 3% of income
American end life (government ran): 4.5% of income
American scaled pre endlife (government ran): 23.25% of income
American Total (government ran): 27.75%

I don't think we even pass the sniff test my man. If you assume Medicare and the German systems work, then you by default have to say that accounts for cultural differences. I would say that our private system is right on par.

I don't know how the German numbers are ran. Their average salary is 42,324 EUR or $47,094. They pay 18.5% total that equals $8715 a year per capita. We pay $9146. Not sure how they added in your charts. Actually I will tell you where your charts math is off. They are only counting the employee cost of 8% in their calculations. The government businesses pay 7.5%. If you do the math, your chart puts Germany at $3,767 per capita (if you fradualently don't included all contributions to the per capita). I am pretty sure your person did some funny math.

Last edited by deltahoosier; 02-18-2016 at 6:15 PM.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 6:13 PM Reply   
I called it! The numbers are wrong!

The dude on wakeworld crunched the numbers and it won't work!

The Commonwealth fund has no clue what they are doing. They need to get their statistical analysis from wakeworld!

Thanks I needed that. Lol
Old    deltahoosier            02-18-2016, 6:18 PM Reply   
Straight math homie.

I used CNN, Time Magazine, World Bank as sources. Your per capita is 17% of the American average income. Germans pay 18.5% of their average income in insurance taxes.

Last edited by deltahoosier; 02-18-2016 at 6:22 PM.
Old     (DocPhil)      Join Date: Aug 2015       02-18-2016, 6:21 PM Reply   
You're absolutely right. One of most respected reports for worldwide healthcare (published many times over the years) is wrong and the dude on wakeworld is right

I concede

Let me know when the data for 2015 is ready. I can't wait

This guy must be a lawyer

Last edited by DocPhil; 02-18-2016 at 6:25 PM.
Old    deltahoosier            02-18-2016, 6:28 PM Reply   
http://data.worldbank.org/indicator/SH.XPD.PCAP

Quote:
Health expenditure per capita (current US$)
Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation.
Sounds like the definition of healthcare includes more than just healthcare too. It includes emergency aid as well. We as a country give out considerable aid so I wonder how much that changes the data.
Old    deltahoosier            02-18-2016, 6:54 PM Reply   
Oh btw. My American numbers for per capita match your charts. Go to the German websites. They tell you exactly what they charge an average person. One mistake I made is the Germans cap the employee contribution at 8% of the 15.5% that is chipped in. The 8% plus 3% for 11% is the German worker contribution.

I don't know where your people got their data when the German government says straight up that this is the tax to the workers and business for healthcare and there are direct published numbers for average salaries. Total expenditures/ average salary go into the per capita calculation per the world banks definition. The methodology works perfectly for the American numbers on the chart. Why not the German numbers?

CNN Money $53,657 divided by the World Bank $9146 per capita (which inclues business, private and other expenditures) = 17% which is pretty much exactly with your chart. Reverse the method. I know the German average salary $47,094 and I know the German Government published individual and business contribution of 18.5% so the math works both ways at $8715 per capita using the world bank definition (and that is not including potential emergency funding that America includes).

Not sure what your contention is. Not interested in honest debate?
Old     (fly135)      Join Date: Jun 2004       02-19-2016, 5:54 AM Reply   
Your example portrays "per capita" as "per worker". Per capita means per person, not per worker. So spouses and children who don't work would divide that number down.
Old    deltahoosier            02-19-2016, 5:08 PM Reply   
Good call John.

I am looking at the numbers again. For instance, the $53,657 is the family income however the price per month was for a family was $413 a month for $4,950 a year. I found a source that says household income is calculated as anyone over the age of 15 is counted. That is still 9.2% per working family in the US. I am not sure if the cost of insurance per family is including medicare (end life) deduction of 4.5%. That would be 13.7% if that is the case. I would think it would but who knows. Germany is mandated at 8% employee insurance and 3% end life for a total of 11%

I looked at my scaling. Turns out it is 2.9% rate (not 4.5%) for medicare with additional scaling at a high wage of .9% If it takes 15.5% regular medical and 3% end of life in Germany and 2.9% percent for end life worker contribution in the US right now (maybe more as Medicare is in constant trouble) for a total of 14.9% I think will have to increase medicare as it is in constant trouble. These are obviously napkin type things, but it can give me a first order scale to start a discussion.

The stat said $ 9146 per capita US. You correctly said that is all people. It turns out that average household income is anyone over the age of 15 is counted. Family size has nothing to do with it so it looks just straight money earned total divide by people over the age of 15. I looked up one source that say the US has population under the age of 15 as 19%. We have 318.9 million people or 258.3 million over age 15. That would make the per capita move to per worker as $10883 per year (spending total). That is a 20.3% of worker income (we know it looks like a average worker pays at least 9.2% of this the rest is most likely business) I still believe the German number to be $8715 per worker of which the worker pays 11 percent)

So we are at:

11% for a German worker contribution (state mandated)
9.2 to 10.65% for an American worker contribution (depends on if Medicare is included in the calculation at 1.45% worker contribution)

20.3% average total per worker US ( It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation.)
18.5% average total per worker Germany (This includes individual and employer contribution)

Looks like a scaled American could be around 15% assuming medicare works plus the additional 2.9% for end life for 17.9%. Medicare benefits sound scaled down and many doctors will not take them.

Last edited by deltahoosier; 02-19-2016 at 5:10 PM.

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