Healthcare going forward

[Benvolio]

It has been said, that the progressive person looks to the future and imagines how things might be better, whereas the regressive person looks to the past convinced that things were always better... while ignoring the inconvenience of fact....that sick people should also receive a helping hand from those of us able to.

That really does not work when welfare and crime are a permanent way of life for a large segment of the people with more coming in.

 

[Stardreamer]

The healthcare issue in society boils down to three basic issues: Access, Quality, and Cost. Everything else is just factors in determining how you want to juggle these three. The ideal state that everyone wants is a High, High, Low situation. Easy access, High quality and low cost. But the reality of the situation and the nature of the beast here is you can only really achieve two of those because achieving one or more will negatively effect one of the others. So you wind up having to make compromises or sacrifices. The ACA focused on improving on all three but more on access and quality so even though improvements were made in cost, cost still suffered in the mix. The question is what do we as society want most, High access and low cost at the sacrifice of quality for example.

Ben's solution seems to be low, high, low. High quality care at a low cost at the sacrifice of access for those who are disadvantaged and very sick. <Sarcasm>But then it is better for society that those folks just get on with dying and reducing the surplus population, their mostly brown people and white trash anyway so they are least productive members of society. </sarcasm>

My own preference is the ideal of high, high, low with the understanding that the best we might achieve is high, high, medium. This is acceptable if the cost is spread and balanced across society. I think the best approach if you aren't going to use ACA is a hybrid approach that has worked in other Western democracies, say a Medicare system that everyone can use, base premiums drawn through taxes with the option for those who want it to buy private plans in addition.

 

[Benvolio]

The healthcare issue in society boils down to three basic issues: Access, Quality, and Cost. Everything else is just factors in determining how you want to juggle these three. The ideal state that everyone wants is a High, High, Low situation. Easy access, High quality and low cost. But the reality of the situation and the nature of the beast here is you can only really achieve two of those because achieving one or more will negatively effect one of the others. So you wind up having to make compromises or sacrifices. The ACA focused on improving on all three but more on access and quality so even though improvements were made in cost, cost still suffered in the mix. The question is what do we as society want most, High access and low cost at the sacrifice of quality for example.

Ben's solution seems to be low, high, low. High quality care at a low cost at the sacrifice of access for those who are disadvantaged and very sick. <Sarcasm>But then it is better for society that those folks just get on with dying and reducing the surplus population, their mostly brown people and white trash anyway so they are least productive members of society. </sarcasm>

My own preference is the ideal of high, high, low with the understanding that the best we might achieve is high, high, medium. This is acceptable if the cost is spread and balanced across society. I think the best approach if you aren't going to use ACA is a hybrid approach that has worked in other Western democracies, say a Medicare system that everyone can use, base premiums drawn through taxes with the option for those who want it to buy private plans in addition.

Nice analysis. But in this country democrats will always work for a free ride for half the counrty--democrats, minorities--at the expense of the other half. And the socialist impulse will if, if allowed, impede the development of new drugs and devices. Government involvement in this counrty will inevitably mean excess red tape, bureaucracy, record keeping--someone light make a profit if not strictly controlled.

 

[opinterph]

--someone [might] make a profit if not strictly controlled.

Twenty (20) people earned nearly $410 million dollars managing large US healthcare companies in 2015. [Link]

 

[Benvolio]

Twenty (20) people earned nearly $410 million dollars managing large US healthcare companies in 2015. [Link]

Those incomes are high, but the market value of a successful chief executive is high. Think how much the parties spend to get their leader in the presidency, because it can make a huge difference. That is also true of a large company which needs a profit to survive. The CEO is often the difference between large profit or large loss. A successful CEO can be hired away if he is offered more by another company. The company would not pay so much if it did not need to..

 

[Stardreamer]

Nice analysis. But in this country democrats will always work for a free ride for half the counrty--democrats, minorities--at the expense of the other half. And the socialist impulse will if, if allowed, impede the development of new drugs and devices. Government involvement in this counrty will inevitably mean excess red tape, bureaucracy, record keeping--someone light make a profit if not strictly controlled.

And Republicans believe that the only function of society is to allow the richest to get richer at the expense of half the country. See how simple life is when you reduce the complex problems to two dimensional cartoons.

 

[MakeDigitalLove]

Those incomes are high, but the market value of a successful chief executive is high. Think how much the parties spend to get their leader in the presidency, because it can make a huge difference. That is also true of a large company which needs a profit to survive. The CEO is often the difference between large profit or large loss. A successful CEO can be hired away if he is offered more by another company. The company would not pay so much if it did not need to..

Do you actually believe that?

 

[Kabluey]

Do you actually believe that?

Probably.
His multilevel marketing check is due any day now.

 

[Benvolio]

And Republicans believe that the only function of society is to allow the richest to get richer at the expense of half the country. See how simple life is when you reduce the complex problems to two dimensional cartoons.

No. We disagree with your knee jerk reaction that if someone is rich it was at the expense of someone else. Oprah is worth 2 billion plus. Who did she steal it from? Leonardo di Caprio is worth 200 million or so. Who did he impoverish. Bill Gates owned much of Microsoft. Who did he steal from?

 

[gsdx]

No. We disagree with your knee jerk reaction that if someone is rich it was at the expense of someone else. Oprah is worth 2 billion plus. Who did she steal it from? Leonardo di Caprio is worth 200 million or so. Who did he impoverish. Bill Gates owned much of Microsoft. Who did he steal from?

It's amazing how your mind works. Do you seriously think that we believe Oprah and Leo and Bill earned their wealth by stealing it? Trump stole his wealth from workers and companies that he didn't pay. That is a proven fact. Drug companies steal their wealth by charging exorbitant prices for prescription drugs which millions of people NEED.

Of course you think that, just like you think the few million bucks spent on R&D and the more than a few million bucks spent on advertising makes up for the billions and billions of bucks in profits that the drug companies steal from Americans.

 

[Benvolio]

It's amazing how your mind works. Do you seriously think that we believe Oprah and Leo and Bill earned their wealth by stealing it? Trump stole his wealth from workers and companies that he didn't pay. That is a proven fact. Drug companies steal their wealth by charging exorbitant prices for prescription drugs which millions of people NEED.

Of course you think that, just like you think the few million bucks spent on R&D and the more than a few million bucks spent on advertising makes up for the billions and billions of bucks in profits that the drug companies steal from Americans.

Liberals love the golden eggs, but they hate that goose.

 

[Stardreamer]

No. We disagree with your knee jerk reaction that if someone is rich it was at the expense of someone else. Oprah is worth 2 billion plus. Who did she steal it from? Leonardo di Caprio is worth 200 million or so. Who did he impoverish. Bill Gates owned much of Microsoft. Who did he steal from?

Itjust went right over your head didn’t it?

 

[KaraBulut]

Liberals....

Nice try at baiting and taking the thread off-topic.

Nice, but not effective.

 

[Stardreamer]

Nice try at baiting and taking the thread off-topic.

Nice, but not effective.

It is amazing how my sarcastic attempt to point out the silliness of addressing complex social issues with two dimensional cartoon arguments produced three or more posts without it being realizing it was sarcasm. I suppose I should just use the <sarcasm> tag whenever I'm dealing with Ben. TANSTAAFL arguments aside it is in society's interest, even a free democratic capitalistic society, to provide for healthcare solutions to keep the population healthy. I'm a libertarian but even I can appreciate the advantage in that.

 

[Stardreamer]

From Vox:

In remarks at a press preview of his budget priorities on Monday, President Donald Trump teased the idea that, after working with his team and in consultation with Republican governors, he is nearly ready to unveil his plan to repeal and replace the Affordable Care Act.

“We have come up with a solution that’s really, really, I think very good,” he said, before proceeding to say nothing about what that solution looks like. One issue, according to Trump, is that health insurance policy is difficult. “It’s an unbelievably complex subject, nobody knew that health care could be so complicated.”

HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HAHA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!HA!

Mr. President, Everyone knew this.

 

[Benvolio]

When Trump said that his insurance would cover preexisting illnesses, i knew he did not know what he was talking about. Coverage of preexisting is charity, not insurance, and you cannot gouge healthy people enough to give the charity to the preexisting.

 

[thewiz]

The healthcare issue in society boils down to three basic issues: Access, Quality, and Cost. Everything else is just factors in determining how you want to juggle these three. The ideal state that everyone wants is a High, High, Low situation. Easy access, High quality and low cost. But the reality of the situation and the nature of the beast here is you can only really achieve two of those because achieving one or more will negatively effect one of the others. So you wind up having to make compromises or sacrifices. The ACA focused on improving on all three but more on access and quality so even though improvements were made in cost, cost still suffered in the mix. The question is what do we as society want most, High access and low cost at the sacrifice of quality for example.

This, in essence, is what was wrestled with in creating the ACA in the first place. I was a city manager at the time, responsible for more than 100 employees and their dependents. I also served as president of a hospital board at a rural hospital affiliated with two larger organizations. The existing health care system prior to ACA was also collapsing; it was not uncommon for us to see increases of 12 to 30% EACH YEAR. Working with our unions (I know, Ben thinks those are communist), we were able to reduce our rising costs into high single digits or the low doubles (12 being the highest). As a hospital, we were bleeding money because of uncompensated care which we were obligated to provide and being independent was not sustainable.

Fast forward to today and the hospital did have to sell to one of the two larger entities to which we affiliated. Under ACA, it is in the black once again but only after investing heavily in new technology and being able to form doctor pools that would provide coverage and the hours/working conditions desired by specialists and family practice providers.

ACA allowed access -- at a relatively affordable price if everyone had signed up and participated (mandate for another word). You can't cover everyone, including those with pre-existing conditions, under the age of 26, without lifetime caps -- unless you have healthy people that don't have those problems. What the Republicans want to focus on is a new idea of "access." All of us have access to airlines and planes that could fly us anywhere in the world today. However, most of us cannot afford to do so. The Republicans will provide access but remove the price caps and subsidies which means we will return to the conditions pre-ACA.

Quality and Cost are rarely talked about by either party because to do so would likely get into defining what treatments to provide, where, and to whom. In the US, we provide immediate intake for a wide variety of services that really don't need immediate attention. In markets that have universal one-payer systems, that care is arranged (somewhat like the VA). If you have the money, you can go outside the single-payer system and get whatever you want but you have to make the decision and look at the costs.

In the US, we never see the bill until after the treatment. Hospitals and doctors, fearing liability, order a wide range of expensive and (often) unnecessary tests. Because we don't see the bill -- who cares? The problem is that our outcomes are not any better than those who spend far less than we do on health care (Cuba has a much better outcome for cancer treatment and spends a fraction of what we do).

But no one wants to talk about this 800 pound guerilla because to do so would equate to "rationing." It would also affect the huge profits of the pharmaceutical companies that don't often cure but instead, look to treat symptoms. Again, those companies spend huge amounts on both parties and legislators; why can I buy my Allegra-D medication for a fraction of the price in Canada (manufactured, by the way, in the US)? Because Canada negotiates the price allowed.

The CDC and federal government spend millions (billions) of dollars yearly on R & D for these pharmaceutical companies, either directly or through universities and research facilities. The companies are then provided lucrative patents that prohibit anyone else from manufacturing the drug for lengthy periods of time -- including generics. The companies are free to charge whatever they liked with monopoly status. If you want to impact pricing, list what hospitals and providers charge for the services; eliminate the monopoly protections for any drug that received public R & D dollars; and prohibit insurance companies from spending on anything but direct services. If you're a monopoly manufacturer -- why do you need to spend on advertising and marketing (beyond basic information)?

As a small hospital, people would be shocked at what these companies offered. With a tight ethics policy, board or staff could not take part (but private physicians and others certainly did). Listing outcomes of every hospital and provider for services along with the prices would begin to address the costs and quality issues.

Was the ACA perfect? Not by a long shot. But if tweaked and fixed, it likely could be a much better alternative to the failing one we had prior to its passage.

 

[Benvolio]

Several comments. You sat the 800 gorilla id givin unecessary tests to avoid liability. And yes, our liabilty system increases the price at all levels. You have all seen the adds on TV of lawyers stirring up class action litigation and there is no limit to what juries can award. Recently a woman got a 72million dollar award claiming that talcom powder caused cancer. The lawyers were quickly running adds to represent other women claiming the used the powder. Trial lawyers are among the biggest democrat contributors because Repoblicans keep trying tort law reform limitimg damages.
Drnyimg a patent monopoly to drug companies recieving R and D money from the government will not work. It often takes hundreds of millions to get drugs through clinical trials and regulatory approval. There is no way to recover that if others can then sell the drug without those expenses. No all drugs researched become saleable. The companies must make enough from the good drugs to pay for the failed attempts plud raising funds for future research and development. Without a period of monopoly, all new drugs will stop, period.
Other countries control prices and drug companies are virtually forced to sell at lower prices to other companies out offering fear the the patent will not be honored. So our consumers are stuck with the cost of development.

 

[Benvolio]

Drug companies advertise to make more money. They are not wasting that money, as liberals imagine. They would not spend the money on advertising if they did not expect, based on experience, to recover the cost plus a profit. More importantly they need to sell as much of the drug as possible during the patent period to recover their investment before time runs out. Most new drug are improvements over existing drugs by other companies. Advertising helps companies sell the new drugs in competition with the old.

 

[KaraBulut]

...The existing health care system prior to ACA was also collapsing; it was not uncommon for us to see increases of 12 to 30% EACH YEAR.... As a hospital, we were bleeding money because of uncompensated care which we were obligated to provide and being independent was not sustainable...
Was the ACA perfect? Not by a long shot. But if tweaked and fixed, it likely could be a much better alternative to the failing one we had prior to its passage.

It's been interesting to see how things have shifted since several measures that passed between 2009 until today have changed the landscape of healthcare in the US.

And it's interesting to see how those outside of healthcare have forgotten how bad the uncompensated care issue was in US hospitals before ACA. It was not uncommon for emergency rooms to have waiting rooms full of uninsured patients waiting for their only option- using high cost emergency rooms as primary care clinics.

While everyone focuses on the healthcare exchanges, there were also a lot of changes that happened with HICATT and ACA that have also shifted compensation to reward providers who provide focus on prevention instead of treatment of illness. It's the irony of US healthcare- doctors and hospitals would make more money by delaying treatment until a diabetic has a crisis instead providing low-cost insulin and diabetic teaching- because the old fee-for-service system pays more when the patient gets sick.

Where ACA has failed is that it never addressed the illogical not-for-profit accounting system that allows for inflated pricing and hits the uninsured with prices that they would never be able to afford. And it never addressed unbridled profiteering by pharmaceutical companies and the hedge funds that have invested in them.

“It’s an unbelievably complex subject, nobody knew that health care could be so complicated.”

There's always a learning curve with every President. It is scary how little this President knows and even scarier how little those who supported him know about the risks of electing someone who understands so little about the country he now is President of.