The Future of US Healthcare

[Mr. DJ]

if I don't have to spend $150 to see a doctor in the ER because I don't have any insurance, I'd like to see where healthcare reform goes...

[Kyuusai]

Originally Posted by Mentar

I never mentioned the Republicans by name. I was only responding to justinstrife, who tried to pin the blame for the economic meltdown (not HCR!) on Carter and Clinton - a lie which I consider patently absurd, and which is actively peddled by GOP propaganda outlets.

However, I am strongly convinced that out of the myriads of contributing factors leading to the meltdown, the decisive one was the deregulation drive which removed the few token protection mechanisms which were in place. In consequence, the financial market degenerated into a huge casino where a criminal collusion helped white collar criminals to enrich themselves. By knowingly pushing bad loans via doorstep brigades, repackaging them while sprinkling the holy pee of rating agencies on them, and then hiding them in the books for personal PROFIT [tm] via obscene bonuses. Smart minds were gaming the system because the referees had been fired.

And nowadays, I'm disgusted to no end how now, with a global meltdown just barely averted, primarily Republican politicians fight reinstating oversights and regulations which would help prevent disasters like these, and which would also help identifying other forms of scams which the white collar criminals would come up with. THIS is where I do place the blame indeed, and while there certainly are corrupt, bought Democratic senators aswell, it's mostly the Republican side which peddles the "Market must not be restrained, the free market sorts everything out" snake oil. If that were the case, all the big banks would be bankrupt by now, and the world economy totally in ruins.

The back-and-forth jumping from discussing general economic decline issues and health care economy decline issues without delineation are getting a bit murky. Admittedly, I pulled the wrong string out of the ball of yarn.

Blaming the general economic meltdown on things that happened during the Carter and Clinton administrations (actually with the personal help of those presidents) is not a lie, however. It is not the whole story, but it's a large part of it. The Community Reinvestment Act required federal financial institutions to give home loans to subprime borrowers. It was a significant driver in the meltdown that came later.

You're right, though. Oversight WAS needed, and badly. That's why the Bush administration and several in the Republican party were pushing for more regulation over the federal companies at the top of the debt chain. It didn't go through, though.
Blocked by Democrats that then blamed the Republicans for not doing anything (Even though the Democrats didn't bother to introduce anything until things had already blown up.)

Originally Posted by Mentar

So who killed the important measures? Who is lobbying against meaningful reform? Who prevented direct negotiations for drug prices? Who is fighting against lifting the local monopolies? And why?

Originally Posted by Mentar

And this is where you are not convincing me, I'm sorry. The projections I've seen indicate that enabling the latest version of HCR will be preferable to just keeping the status quo. And with all due respect: First battling any kind of meaningful measures, and then complaining about a lack of them would be amazingly hypocritical even for modern US politics standards.

The Republican "contribution" to HCR has been 99% destructive and obstructive. Fig leaves like Olympia Snowe don't count. Feel free to place all the blame on the nature of the American political system if you wish - but I can't see this as a valid excuse.

This is pretending that any chance of meaningful reform from either side ever had a chance to begin with and pretending that either side was unified along with the solutions being advocated by either the party's top leaders or a small part of their constituents.

If some one on the republican side started advocating a total lassiez faire health care system and democrats balked, then continued to balk as it was first watered down and then replaced by a mishmash of highly questionable "solutions" that were more likely to pass by both the opposing party and the majority of their own, and made deals to establish most of its support base for it, would we then accuse the democrats of "blocking health care reform"?

Originally Posted by Nosauz

Medicare didn't really reform the system, it just add drug prescriptions to the "poorly run, bloated, and fraud ridden" medicare system. To claim Medicare part D was some victory for the consumer or the Nation is being disingenuous at best and outright lying at the worst. Not to mention this was an unfunded liability under supposedly fiscal conservatives. If the political system is broken, it doesn't mean we just sit our asses and twiddle our thumbs, because insurance premiums will keep going up and people will continue to be dropped once they need that care.

I never claimed that Medicare Part D was a proper solution. I only said it was introduced with the intention to improve the lacking benefits.

I think I get what you're saying, though: Well-intentioned, underfunded solutions that have the net effect of reinforcing the abuses that caused the problem in the first place were bad then, but they're good now.

Originally Posted by Nosauz

And to claim that you can pay cash for all your medical procedures... well that would work, but next time you need surgery, chemotherapy, or an extended stay for a possible life threatening disease and let's see how many of those procedures you'd be able to pay out of your savings to see the doctor for.

I never said that you could pay cash for all of your medical procedures. I specifically pointed out that was not possible. What I said was that it IS possible to get care--just not all the care you need and what you can get doesn't come without the risk of crushing debt. Which is a lot like a lot of insurance policies, actually.

Originally Posted by Nosauz

So insurers aren't raising their rates year after year after year? What? this doesn't make sense because like the cable companies insurance rates will always go up and never come down. Getting less service? Price stays the same, Getting "more" service price goes up, this is a zero sum game and on the losing side is the consumer.

Again, I never said that. Personal insurance plan rates have skyrocketed in price. Doubling, on average, since 1994, and they were far out of control then. You made a really apt comparison by bringing up cable companies. Just like cable companies, a lack of competition and collusion on a massive scale brought us here.

Originally Posted by Nosauz

And social security has always made more money then they had been paying out, it was misappropiations of social security funds and constant dipping into the account that has created the shortfall in SS.

The social security system was not designed to be a permanently viable solution, but it wasn't intended to be. It was designed to help the people weather a crisis. It is continually a less viable solution (inflation, rising ages and falling birth rates, etc). Social Security is scheduled to run out, including cashing out its backup options. Borrowing from the fund (and there isn't really a fund--the money isn't earmarked) only changes the date at which that happens.

Originally Posted by Nosauz

Again Johnson was an idiot because he wanted to further FDR's agenda with a more patronizing tone but in the end even neocons have painted the new deal as some evil government monolith even though the west was struck with famine and roaring great depression had strangled all but the most prominent of high society.

It was half-baked. It was a combination of some bad ideas and some good-but-intended-to-be-temporary measures. The problem was that no one wanted to let go of it--not the recipients of benefits and not the people it empowered. You can blame it on neocons (which is kind of funny as that describes a foreign policy ideology), but that's just derailing the argument.

Originally Posted by Nosauz

Also in these industries where capital is critical to creating market share, the end result of capitalism is the forming of monopolies that later become detrimental to society and consumers. It's reached this point that's why regulation is so important, and again blaming failed regulations or lack of regulation the reason to not have regulation really doesn't make logical sense.

Ah, that's it. That's the key. Not the key to the health care solution, but the key to understanding what drives your partisan arguing: You view capitalism as evil. It is not. Capital, though, is required in every type of economic system.

Now, allowing abuses in a capitalistic system is evil. Regulation is important, I agree, but it requires a very light touch to prevent it from being stifling to the economy.

Originally Posted by DjTrizz

if I don't have to spend $150 to see a doctor in the ER because I don't have any insurance, I'd like to see where healthcare reform goes...

Hospitals are expensive to run. ER care does cost too much, but it will always be more expensive than not going to the ER. Talk to a local clinic and you will find better prices. Odds good that you can enroll in a local clinic network to have affordable walk-in prices for primary care and possibly even basic emergency services. It isn't a whole solution (nor is it available to everyone), but it's something a lot of people don't know about that can make basic care affordable enough that they don't have to choose between hoping they won't really need a doctor or being an ER patient due to lack of ability to pay.

[synaesthetic]

It requires a very light touch indeed, yet most politicians are more battle-axe than scalpel.

[Rajura]

On a semi-on-topic note, I just wanted to share the good news... I just found out today that I did match for a residency position!

Now, I just have to wait until Thursday to find out where I will be working and training for the next 5 years.

[Nosauz]

@kyuusai

No i believe that capitalism is great, but there are too many people in this world willing to do anything to make the quick buck, look at the derivatives market, or commodities. Monopolies and the consolidation is counter productive to "capitalism" and that's what I believe, when the big companies go to restrict the consumer that they depend on it does become a warped world where the consumer has now become dependent on the corporations. I strongly favor small business, and consumer rights, and the way collusion and monopolies have been taking hold is really counter to the American dream.

[synaesthetic]

The American Dream never really existed to begin with, but it's true that the current system is unworkable, an endless procession of tall peaks and deep valleys, which seem to get deeper as time goes on.

I think perhaps the worst problem was allowing a business to be an individual in the eyes of the law (a corporation). Organizations don't have rights, only individuals do, so this was meant to sidestep that ruling...

[Netto Azure]

Economist Tsung-Mei Cheng three Universal Laws of Health Care Systems.

1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue it is not enough.
3. The last reform always failed.


Wow, ONLY 36 pages? The BMGf version has more than 120! (Now Ver. 2.0!) XD

Anyways for those who have seen me somewhere else before you'll know know my beliefs.

Although I am a proponent of a Single Payer National Health Insurance system, medical inflation is a worry that will be with us in ANY Healthcare system. But sadly, the US magnifies this problem and sends it to turbo speed due to our fragmented for-profit payment system.
I mean, the United States is the only country in the world that manifests all types of healthcare systems which leads to cost shifting.

Anyways to summarize the 3 options (subject to modification) available to us if we answer a resounding yes to the moral question of HealthCare as a right (As all the other Industrialized countries have, with Taiwan and Switzerland being the latest in 1994 due to the fact that we can never establish a working healthcare system without this in mind...)

1. The Bismark Model (US Equivalent: Employer Based Insurance. Used in Germany, France and Japan)
YES IT'S NOT ALL SOCIALISM OUT THERE \o\
Well since this is the most likely reform we're going to get, whether it's the Democrat's bill, Or the Wyden-Bennet Bill then it's better to discuss this. In order to make this work first the For-Profit incentive HAS to be taken out. Seriously, with 20c of every Dollar (aka 80% preferred medical spending ratio in the stock market) spent on Healthcare being used on things that have no correlation on a person's health. Then this is the biggest way to save costs under this system.

2. The Beviridge model (US Equivalent: The VA System, Military Care, and The Native American reservation hospitals. Used in Britain's "NHS")
Now here is where the usual cat-calls of "Socialized medicine" come in mind. (Although it's not fully Socialized, GP's/Primay Care Physicians are Private and quite Capitalistic) Although we'll never even bother going with this system, It does have the best Preventive Medical Care in the world, as the NHS has the primary concern of keeping people healthy to loweroverall costs.

3. The National Health Insurance System (US Equivalent: Medicare. Used in many countries such as Canada, Taiwan, etc.)
Well here is another thing that draws the jeers of Americans. But essentially loved by those who use it. It's low-administrative costs and universal coverage are a hallmark of this system. Although the wait times (On elective surgery) are corollary to the amount spent on care, it is certainly better in terms of most Healthcare indicators.

And of course for those of us who are uninsured, we have the...

4. Out of Pocket System (US Equivalent: Uninsured. Used in many Developing countries)
Well, you get the gist out of the name, basic class warfare. The Rich get the best, the poor die on the curb. :|

Anyways just an outline for you guys. Awesome book to read is The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

[Nightbat®]

Originally Posted by Nosauz

@kyuusai

No i believe that capitalism is great, but there are too many people in this world willing to do anything to make the quick buck, look at the derivatives market, or commodities. Monopolies and the consolidation is counter productive to "capitalism" and that's what I believe, when the big companies go to restrict the consumer that they depend on it does become a warped world where the consumer has now become dependent on the corporations. I strongly favor small business, and consumer rights, and the way collusion and monopolies have been taking hold is really counter to the American dream.

But for healthcare, you need a big pot of money to make it work
but there I say is where the Govt is the best choice being able to handle it as a "non-profit" insurance

Something never possible in the free market (especially if you have shareholders to keep happy)

[Mentar]

Originally Posted by Kyuusai

The back-and-forth jumping from discussing general economic decline issues and health care economy decline issues without delineation are getting a bit murky. Admittedly, I pulled the wrong string out of the ball of yarn.

True. Anyway, I wasn't really complaining, just trying to set the records straight.

Blaming the general economic meltdown on things that happened during the Carter and Clinton administrations (actually with the personal help of those presidents) is not a lie, however. It is not the whole story, but it's a large part of it. The Community Reinvestment Act required federal financial institutions to give home loans to subprime borrowers. It was a significant driver in the meltdown that came later.

Not according to most experts, no. Only a minor fraction of the loans even fell under the CRA (see for example http://www.bis.org/publ/work259.htm). Contributed, yes. But the real problem was the missing oversight and the exploitation.

You're right, though. Oversight WAS needed, and badly. That's why the Bush administration and several in the Republican party were pushing for more regulation over the federal companies at the top of the debt chain. It didn't go through, though.
Blocked by Democrats that then blamed the Republicans for not doing anything (Even though the Democrats didn't bother to introduce anything until things had already blown up.)

I'm sure you're able and willing to back this up with sources, right? Because it goes exactly AGAINST what I remember about these times.

The real father of the economic meltdown was the GOP's Gramm–Leach–Bliley Act. Which killed the cornerstones of oversight, and essentially deregulated the entire market. It was heralded and celebrated by Bush and the entire Republican elite as a major breakthrough. And up to this very day, the GOP is the party of DEREGULATION.

Trying to make it sound as if it were the Republicans who'd be pushing for oversight is fairly absurd. I'm flabbergasted you're even trying. Do you HONESTLY think so???

This is pretending that any chance of meaningful reform from either side ever had a chance to begin with and pretending that either side was unified along with the solutions being advocated by either the party's top leaders or a small part of their constituents.

The GOP side was whipped to obstruct ANYTHING which came to the table, right from the start. That's common knowledge, and was one of the reasons why for example Arlen Specter defected. Please don't play dumb, you should be above that.

If some one on the republican side started advocating a total lassiez faire health care system and democrats balked, then continued to balk as it was first watered down and then replaced by a mishmash of highly questionable "solutions" that were more likely to pass by both the opposing party and the majority of their own, and made deals to establish most of its support base for it, would we then accuse the democrats of "blocking health care reform"?

Democrats are much less "disciplined" when it comes to governing. Republicans are different creatures, they're much less willing to oppose the leader line. Just look at what happens to Crist in Florida.

The Republicans immediately went into "we're gonna filibuster everything" mode and never even brought anything remotely credible on the table. NOTHING. Sorry, tort reform isn't going to save America.

[Kyuusai]

Originally Posted by Mentar

I'm sure you're able and willing to back this up with sources, right? Because it goes exactly AGAINST what I remember about these times.

The real father of the economic meltdown was the GOP's Gramm–Leach–Bliley Act. Which killed the cornerstones of oversight, and essentially deregulated the entire market. It was heralded and celebrated by Bush and the entire Republican elite as a major breakthrough. And up to this very day, the GOP is the party of DEREGULATION.

Trying to make it sound as if it were the Republicans who'd be pushing for oversight is fairly absurd. I'm flabbergasted you're even trying. Do you HONESTLY think so???

http://www.nytimes.com/2003/09/11/bu...annie-mae.html
The administration continued to make these pushes even through 2008.

And I know that the providers of the video are quite partisan and quite despised 'round these parts, but video records stand regardless of who produced/posted them (these are just what I turned up in a quick Google Search). In these you can see a variety of Republicans calling for more regulation over Fannie Mae/Freddie Mac and a variety of Democrats objecting proudly, saying there was no problem.
http://www.youtube.com/watch?v=VgctSIL8Lhs
http://www.youtube.com/watch?v=_MGT_cSi7Rs

Also, the Gramm–Leach–Bliley Act was passed by a bipartisan majority in the house (although not the senate) and signed by Clinton, who still sees no problem with it. It didn't significantly change what types of assets banks held, just who the customer-base was--although it did allow certain very large companies to merge. Still, the assets being separately held even under the same umbrella, the act didn't have much effect in the later crisis. It also contained more regulation for how financial institutions handle personal data.

Now, having cited that those stereotypes and generalizations invalid, I'll save my time and not respond to your following assertions which have no grounding except in stereotypes and generalizations.

[LusterFlare]

Somewhat relevant clip:

[MeoTwister5]

On the assumption that the video is real, and that the old man is really suffering from Parkinson's disease and not some random drug-induced muscular tremors, then as someone who's actually seen a full blown case of the disease I can conclude that those are horrible fucking people.

Then again the video is supposedly paid for by the democratic party, which makes it's validity suspect.

[cors8]

Originally Posted by MeoTwister5

On the assumption that the video is real, and that the old man is really suffering from Parkinson's disease and not some random drug-induced muscular tremors, then as someone who's actually seen a full blown case of the disease I can conclude that those are horrible fucking people.

Then again the video is supposedly paid for by the democratic party, which makes it's validity suspect.

Well, I wouldn't be shocked if it were real. Remember the whole Limbaugh/Michael J. Fox fiasco?

[Rajura]

Just to update everyone, since this is the most closely related thread.

I just found out that I will be doing my residency in Internal Medicine and Psychiatry at the West Virginia University Charleston Regional Medical Center!

Woohoo!!!!!!!!!!!!!!!!

[synaesthetic]

Originally Posted by MeoTwister5

On the assumption that the video is real, and that the old man is really suffering from Parkinson's disease and not some random drug-induced muscular tremors, then as someone who's actually seen a full blown case of the disease I can conclude that those are horrible fucking people.

Then again the video is supposedly paid for by the democratic party, which makes it's validity suspect.

I wouldn't be shocked if it were a big fat lie perpetrated by Pelosi-worshippers. People are fucking horrible.

Originally Posted by cors8

Well, I wouldn't be shocked if it were real. Remember the whole Limbaugh/Michael J. Fox fiasco?

I wouldn't be shocked if those people really were that douchebaggy. People are fucking horrible.

[Kyuusai]

Relevant news that slipped by me until today:
http://news.walgreens.com/article_di...rticle_id=5288

Walgreens is not accepting new Medicaid prescriptions in Washington state.

For those that don't know, Medicaid is the US's health program for low-income and disabled persons/families, and is jointly funded and managed by federal and state goverment. Many providers have trouble breaking even due to the rates Medicaid pays, and will generally compensate by raising rates for other patients. Now Walgreens is facing a situation where filling prescriptions for Medicaid recipients is almost a guaranteed loss in the state of Washington. Of course, the state isn't eager to spend more money on a whim. It's a constant struggle, but a corporation this large throwing in the towel (hopefully temporarily) is news. Now the losses will be shifted to smaller businesses, who may have to face the same decision.

It is worth noting that it isn't unusual for some providers (speaking generally, rather than just about pharmacies) to stop accepting Medicaid. Considering that there is often also savings in staff or service for billing Medicaid, some are able to lower their rates significantly and continue provide pro bono services.

[Nosauz]

Keith Olberman's special comment tonight was extremely poignant. He stated what health care really is. It is part of our human nature, to survive, whether its for another year another day or another sec, we will want to do anything to preserve our lives, it's what makes us human, to not want to is to sacrifice our humanity. The one time where I found him to be more compelling and less hyperbole.

[iLney]

Well yes, "we."

[Vexx]

Originally Posted by Kyuusai

Relevant news that slipped by me until today:
http://news.walgreens.com/article_di...rticle_id=5288

Walgreens is not accepting new Medicaid prescriptions in Washington state.

For those that don't know, Medicaid is the US's health program for low-income and disabled persons/families, and is jointly funded and managed by federal and state goverment. Many providers have trouble breaking even due to the rates Medicaid pays, and will generally compensate by raising rates for other patients. Now Walgreens is facing a situation where filling prescriptions for Medicaid recipients is almost a guaranteed loss in the state of Washington. Of course, the state isn't eager to spend more money on a whim. It's a constant struggle, but a corporation this large throwing in the towel (hopefully temporarily) is news. Now the losses will be shifted to smaller businesses, who may have to face the same decision.

It is worth noting that it isn't unusual for some providers (speaking generally, rather than just about pharmacies) to stop accepting Medicaid. Considering that there is often also savings in staff or service for billing Medicaid, some are able to lower their rates significantly and continue provide pro bono services.

Just as an fyi, its not even that Walgreens is for-profit -- the *base wholesale cost* (labor, materials) of filling a prescription is not sufficiently covered by Medicaid. Even under a single-payer or a "all medicals work for state" system, Medicaid is not being sufficiently realistic in their price expectations.

[LynnieS]

Originally Posted by Kyuusai

Relevant news that slipped by me until today:
http://news.walgreens.com/article_di...rticle_id=5288

Walgreens is not accepting new Medicaid prescriptions in Washington state.

For those that don't know, Medicaid is the US's health program for low-income and disabled persons/families, and is jointly funded and managed by federal and state goverment. Many providers have trouble breaking even due to the rates Medicaid pays, and will generally compensate by raising rates for other patients. Now Walgreens is facing a situation where filling prescriptions for Medicaid recipients is almost a guaranteed loss in the state of Washington. Of course, the state isn't eager to spend more money on a whim. It's a constant struggle, but a corporation this large throwing in the towel (hopefully temporarily) is news. Now the losses will be shifted to smaller businesses, who may have to face the same decision.

It is worth noting that it isn't unusual for some providers (speaking generally, rather than just about pharmacies) to stop accepting Medicaid. Considering that there is often also savings in staff or service for billing Medicaid, some are able to lower their rates significantly and continue provide pro bono services.

If Walmart is throwing in the towel in Washington state, chances are fairly good that the smaller businesses would give up as well. Given the size of Walmart, it should be the price leader in many - if not all - of the areas in which it's involved.

I'm a bit confused on why the news release is saying that a decision in Massachusetts is affecting elsewhere, though. Medicaid is a federal program, no? (Edit: Ah, it's managed by the states, so one state's decision affects (or could affect) the whole thing for everyone. Nasty...)

The new version of the health bill looks to be on track to be passed, and interestingly, the CBO is projecting a savings for it. OTOH, given the number of promises made to win votes as well as the [expected] caveats, I'm not sure if any of the savings will actually be realized in the end. The fact that the House's version is voted upon this week and the Senate's is next week does make things look iffy, IMHO.