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General Health Care/Health Cost thread

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3 hours ago, American Swindle said:

Here's a free market approach to surgeries.  I know Oklahoma sucks, but this surgery center does not

 

 

 

Also an interesting podcast episode:

https://tomwoods.com/ep-481-how-capitalism-can-fix-health-care/

Dr. Josh Umbehr operates a concierge family practice in Wichita, Kansas, and counsels doctors about making the transition to direct care, bypassing insurance and government, through Atlas.MD. He ran for lieutenant governor of Kansas in 2014 on a ticket with his father, Keen, at the top.

A point made in the episode is that Doctor's, having spent 12years plus learning a specific skill, have little business acumen when it comes to the operational side of their practices so they usually just roll with entrenched system as it is.  

Anastasis, what are your thoughts on the Surgery Center in OK?  You heard of them?

My wife was looking at a hip replacement and they do them for 15K cash. I guess what I'm trying to say is that maybe we should embrace free market capitalism for a change.  Please don't confuse it with crony capitalism or "crapitalism."  

 

 

Fucking this.  Push the system towards markets for MOST care.  

Anyone who thinks Single Payer leads to anything other than degradation of care, reasearch and innovation is kidding themselves.

yeah, yeah...i know, the government went to the moon. 

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4 minutes ago, Incredulity said:

Fucking this.  Push the system towards markets for MOST care.  

 

Pretty much what those who rely on the largest sample sizes of peer groups for evidence and have concluded a more socialized approach relative to the most free market approach that we practice in this country would be preferable. 

 

But Oklahoma is even less persuasive than But Chicago.

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5 minutes ago, Al Bundy's Napoleon Hand said:

Pretty much what those who rely on the largest sample sizes of peer groups for evidence and have concluded a more socialized approach relative to the most free market approach that we practice in this country would be preferable. 

 

But Oklahoma is even less persuasive than But Chicago.

But Sweden, FTW.

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3 minutes ago, Incredulity said:

But Sweden, FTW.

The virtual entirety of the western, industrialized, democratic world of which we are the richest, of which we have the most free market approach in delivery of health care, and in which we get the least bang for our buck.

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57 minutes ago, Al Bundy's Napoleon Hand said:

The virtual entirety of the western, industrialized, democratic world of which we are the richest, of which we have the most free market approach in delivery of health care, and in which we get the least bang for our buck.

We have nothing approaching a free and open market in healthcare. 

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52 minutes ago, Anastasis said:

We have nothing approaching a free and open market in healthcare. 

False binary, another conservative crutch. Of our peer group nations, we are at the far end of a free market, healthcare-as-a-commodity, for-profit healthcare delivery system than any other. The irony of the GOP's take no prisoners-no compromise-no fucking alternative-shit, we just got what we've been advocating for now we have to invent some Narnia of Freer Markets approach even after going through TWO administrations in which they've controlled both chambers of Congress and the presidency while proclaiming that they REALLY REALLY SUPER REALLY THIS TIME wanna provide relief for its citizens while providing excellent care for Saudi royalty who can afford it and delivering

 

JACK.

 

SHIT.

 

is that there is scant room in the free market corner they have painted themselves into. There's little partial of a  freedom tile to explore.

 

You don't want nationalized health care?

Dems: You got it.

You don't want even a public option, champions of choice and competition?

Dems: You got it.

You want reform that incorporates the existing for-profit insurance industry?

Dems: You got it

You want those who choose to decline purchasing insurance to pay a penalty?

Dems: You got it.

 

Well, looks like this Obamacare thing passed after 25 years of completely earnest, principled conservative objections aaaaand....... 0 votes from the party that added 161 amendments to the bill, lied to your face that it was railroaded through, and subsequently sabotaged a law that

1. Insured millions of Americans than insured previously

2. Decreased the rate overall health care costs

3. Cut medical bankruptcies in fucking half.

 

I can not stand it when someone or some organization or ideology bitches and bitches and bitches and bitches about a problem, and then when they're given multiple free reigns to do something about it, sticks their goddamn dick in a blender or bitches about the ice cream cone the adults finally fucking gave them.

 

Go fuck yourselves and anyone who believes conservatives or *eyeroll* Gary Johnson voters want to do anything with America's healthcare delivery system other than make it worse.

 

 

 

 

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Just now, Al Bundy's Napoleon Hand said:

False binary, another conservative crutch.

Go ahead and list the characteristics of a free market dynamic and then lets go through that list and evaluate the American healthcare system against that standard. 

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3 minutes ago, Anastasis said:

Go ahead and list the characteristics of a free market dynamic and then lets go through that list and evaluate the American healthcare system against that standard. 

The ball's in your court. Come up with a system that doesn't involuntarily require everyone else to pay for healthcare in the most ineffective and expensive way possible. We've been waiting since Eisenhower.

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4 minutes ago, Al Bundy's Napoleon Hand said:

The ball's in your court. Come up with a system that doesn't involuntarily require everyone else to pay for healthcare in the most ineffective and expensive way possible. We've been waiting since Eisenhower.

I've previously shared a lot of different ideas. Approaches that could balance the need for catastrophic backstopping with some semblance of free market forces, most notably consumer empowerment and pricing transparency. 

On 7/31/2018 at 10:05 AM, Anastasis said:

I agree that we need to scrap the current system.  I have outlined this in greater detail previously, but I think that we can get there "quite simply" by converting Medicare into a universal catastrophic coverage program, decoupling (what would now be) supplemental private insurance coverage from employment to create a functional market that all Americans can access, extending access to HSA accounts to all Americans, providing a robust safety net for individuals living in poverty, require price transparency, reform aspects of the FDA and patent law, make smart public health investments in comparative effectiveness and cost effectiveness research, etc.  There are functional solutions that can merge a universal coverage backstop with a private free market dynamic.  Problem is, too many entrenched interests with deep lobby pockets and a totally dysfunctional political system.     

 

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Another form of the same outline:

On 3/12/2019 at 12:31 PM, Anastasis said:

 

My ideal wave the wand world system would involve:

1. Catastrophic backstop coverage for all Americans.  This could be implemented via a single payer framework. 

2. Decouple insurance from employment. Insurance plans compete on open market to sell "supplemental plans" that cover the pre-catastrophic phase. Public safety net options also operate in this phase. The backstop of the catastrophic coverage above should create downward pressure on base case premiums making coverage more affordable.  

3. Significant expansion of HSA's to cover expenses associated with supplemental plans and out of pocket expenses. 

4. Requirements for pricing transparency at provider, facility, and pharmacy.

5. Various reforms to drug approval process, patent law, and NIH research funding to drive cost-effectiveness.

 

IMO, something along the lines of above optimizes the contributions from public and private sectors, maximizes individual engagement in their healthcare decision making, and allows market forces to operate with appropriate inputs.  It's also a total pipe dream. 

 

 

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Catastrophic coverage is available now as is coverage decoupled from employment. Pricing transparency is one of Obamacare's elements. All of these were included in the tepid salve of Obamacare. Unfortunately, the law of supply and demand are severely blunted when it comes to people's health and almost non-existent in cases of emergency. 

 

Just to be clear, I'm not the one making the argument "We have nothing approaching a free and open market in healthcare."

You're making that argument.

And even your solutions require an element of government intervention.

That's the disconnect in the conservatives argument. This ideological implication that capitalism is the solution and socialism is the problem for every social and economic ill, while I have no problem stating an effective, data-driven Goldilocks balance, adjusted for which particular aspect of society you're addressing, is reasonable. I'm not getting on a soapbox and declaring there's NOTHING approaching the purity of socialism or there's NOTHING approaching untainted free and open market in American healthcare. What I am saying is no one in our peer group is as far to the free market end of the spectrum as we are and we know what the results are.

 

Citizens in the richest country where Whole Foods pays no taxes on 11 billion profit go bankrupt in the current status quo for having the audacity to get sick or injured. Rearranging deck chairs, making micro-changes, adjustments, cosmetic calibrations, throw in a decade or two to see if this new and improved wheel design is better in a fantasy world where the GOP actually implements it (lol) is just fucking air. 

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23 minutes ago, Al Bundy's Napoleon Hand said:

Just to be clear, I'm not the one making the argument "We have nothing approaching a free and open market in healthcare."

You're making that argument.

Yes, that is correct.

23 minutes ago, Al Bundy's Napoleon Hand said:

And even your solutions require an element of government intervention.

Yes. I believe that a good approach can blend the best of both worlds, a broad based backstop that spreads risk for catastrophic situations witha solution that allows market dynamics to shape cost and utilization for the vast majority of non-catastrophic cases.

 

Edited by Anastasis

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Converting my firm to self insured for health coverage has really opened my eyes to the cost of care. A few numbers from this past year, $250k+ for a cancer drug that will not cure the individual but just extends life expectancy and quality of life, $140k for bypass surgery, $90k for rehab for alcohol/depression issues, $80k for MS drug, etc. Our drug cost is the burden on our plan with probably 60%+ of the cost being drug related. The level of detail we get on our plan is a positive and a negative, because we see the detail but still can’t control the cost other than trying to educate the employees. However, for them it’s still a care issue and they only view cost of care on a deductible basis. They are paying $5k, $6k, etc no matter what the total cost is, so why worry with it.

The flip side of that is that doctor groups I work with are making less now than they ever have outside of some specialties. Family practice is a lose/lose unless you go to a concierge practice setup or take the urgent care route and just review charts for FNP’s. Even specialties like OB’s are falling off unless they focus on high end surgeries. Anything involving cancer, dermatology, specialized functions, etc are still blowing and going though.

Local community hospitals are shutting down all over because they are hemorrhaging money because the cost of care to insured isn’t covering the cost of care for uninsured. Doctors can’t make money in the smaller hospitals, so providers are leaving causing care coverage issues.

The whole system is broken.

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10 hours ago, Anastasis said:

Yes, that is correct.

Yes. I believe that a good approach can blend the best of both worlds, a broad based backstop that spreads risk for catastrophic situations witha solution that allows market dynamics to shape cost and utilization for the vast majority of non-catastrophic cases.

 

And in those hollowed out rural and deindustrialized parts of Murica?

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I don’t understand why insurance should pick up the tab for a $250K cancer drug that isn’t a cure. I’m not being unsympathetic to that individual but ultimately any rationed system has to make cost/benefit decisions. And yes, EVERY healthcare system in the world is rationed. There isn’t an unlimited one in any country.  Ultimately it’s rationed due to lack of unlimited provider time or facility space. It all comes down to money.

there is also a false narrative in that healthcare shouldn’t bankrupt an individual. I would argue that healthcare is the only reasonable source of bankruptcy. Extending life is the most important expense you could ever have. Buying a too-expensive house or car, or even starting a failed business are worse examples of bankruptcies.  you’re a fool if you’re in bankruptcy because of a house.  Cure your spouse of cancer and bankrupt, you should be admired.

But back to the $250k drug treatment. Many people in the US have no ability to ever save that much or own an asset worth 250k even if they work for 50 years. Should they accept that their life will be slightly shorter because they are “poorer” than some, or do as a society say that it’s not that person’s fault they are not as wealthy and the drug is free.

as treatment becomes more expensive and we have more poor people, I don’t see how the treatment can be “free” to the person.

 

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We’re going into year 4 of paying for this drug. It is 20-25% of my total spend on medical coverage each year. We talk all the time about what our opinion would be if it was one of our spouses. At some point we have to realize the cost of extending for some period isn’t worth the cost to the whole especially when quality of life in that period is not good. I know at this point I want to go out on my own terms and in my own spirits, not bed ridden and in pain with an extra 6 months because of some drug.

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We had to make that decision several years ago when the melanoma was staged. 35K per year on a 60% chance that I would be alive in five years. You're staring at the doctor and thinking about your children at home that are still in elementary and middle school and wondering about that money that you'd set aside for college. Wondering if the spouse sitting beside you knows that you are willing to die to not bankrupt their future. Their lives are just beginning and you're wondering if yours is coming to a close. We had always and will always be frugal, that is just the way we are. Went with the small home to pay it off early, didn't need new cars, and here we were, looking at a financial abyss that had little to do with lifestyle and every thing to do with stupid genetics. Everyone's looking at you in the cramped examination room and you are sitting there trying to digest it all. It sucked.

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1 hour ago, David Dennison said:

And in those hollowed out rural and deindustrialized parts of Murica?

This is a problem no matter the method of healthcare financing.  That being said, I would suggest that we reduce barriers to implementation of telemedicine and other provider extension technologies and personnel. Especially when access to specialties such as psychiatry is required, under serviced regions are extremely problematic. The financing mechanism is not the core problem.     

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1 hour ago, Brew said:

We’re going into year 4 of paying for this drug. It is 20-25% of my total spend on medical coverage each year. We talk all the time about what our opinion would be if it was one of our spouses. At some point we have to realize the cost of extending for some period isn’t worth the cost to the whole especially when quality of life in that period is not good. I know at this point I want to go out on my own terms and in my own spirits, not bed ridden and in pain with an extra 6 months because of some drug.

Unfortunately healthcare resources are not infinite. At the end of the day, you can't force/expect the doctor to work 20 hour days for 40 years,  big pharma to produce new drugs at cost, and the hospital to purchase an overabundance of the latest MRI machines each year.  but I agree that some abuse the system for obscene profits.

At the individual level, healthcare choices are the most personal thing possible but healthcare as a system has to be impersonal. Everyone hates the term death panels or rationing but at some point those have to exist.  Centers won't give heart transplants to patients after a certain age. Is the 90 year old less deserving than the 60 year old?  No since they're still a person but we decide that it's better to give the heart to the 60 year who should get more benefit out of it.

 

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8 hours ago, Nice Guy Eddie said:

 Everyone hates the term death panels or rationing but at some point those have to exist. 

If I understand it right, the term "death panel" was first used by Sarah Palin around 2009 when health care legislation was being discussed. It was argued that Democrats missed the mark when opponents took up the death panel cry because they (Democrats) just said, 'no, that isn't true,' instead of pointing out that it already exists in the form of health insurance decisions regarding claims. Everything went so partisan that trying to work on reform fizzled.

 

 

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On 12/4/2019 at 7:01 PM, Anastasis said:

We have nothing approaching a free and open market in healthcare. 

We also don’t get the least for our buck. I get a fuckload of coverage for me and my family for a few grand a year. 

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