Don't you dread single payer?

[dank69]

Sounds like you've exposed who hired him to shill up the forums.

The sad part is he isn't even being paid for his service. He is arguing against his own self interests to preserve his own ego. The conservative mind delivered in a nutshell.

 

[Dannar26]

Glenn's example as I already pointed out was for elective surgery. Who gives a flying fuck about elective surgery?

Looks like you're fixating on his bit about lasik in the first paragraph.

What about the rest about the ankle sprains?

It stands to reason, people will ration something better if they pay for it. Would you treat a rental car the same way you'd treat your own?

 

[dank69]

So your well being is a bigger concern, but you're willing to delegate those decisions to a government bureaucrat who could give a shit less about you as an individual since they're focused on the "greater good" of the larger population?

Okay, you're in a single payer system. Your taxes pay for your medical care, and there are effectively no out-of-pocket costs to you. You go to the hospital complaining of some kind of pains. The doctor looks you over and says it's likely indigestion, but there's also a small chance (let's say 10% for sake of argument) you could suffer a fatal heart attack in the next few minutes that could be detected via blood tests. The government paying the bill says it's an "elective test" and refuses to allow it since for the price of your test, the government could treat 20 other patients with other ailments.

Still think that consumer demand only impacts either elective or non-elective healthcare? To someone else, *any* money spent on healthcare for you is elective.

I'm glad you've moved on from the "we have to make healthcare more expensive" portion of your psyche to the "government fucks up everything they touch" portion.

 

[glenn1]

So I guess all those extra tests and procedures don't take extra time?

No, no. You guys are right. The best way to cut down on unnecessary procedures is to make them more expensive for everyone including all those that actually need them. Reducing that to it's purest form, the best way to make healthcare less expensive is to make it more expensive for the people that need it and less expensive for insurance companies.

Honestly I don't give a shit at this point. I wouldn't want or need to use government provided "single payer" healthcare in any event. Neither would most of the people who advocate for it. Both of us can afford the best quality care we can get, which is not going to be your single payer delivered crap. Whatever you want to do to the proles is fine with me, since it impacts my family in no way whatsoever.

 

[dank69]

Looks like you're fixating on his bit about lasik in the first paragraph.

What about the rest about the ankle sprains?

It stands to reason, people will ration something better if they pay for it. Would you treat a rental car the same way you'd treat your own?

You mean the part where he is proclaiming that we shouldn't all persue the best possible healthcare we can obtain? That part?

 

[yllus]

Your article made no claims about ER use and actually said: Did you even read your own link?

I don't think you understand what preventative care is - it's the opposite of ER visit care. In fact, the article specifically mentions that ER visits were part of the test that was run:

Services such as emergency room visits, prescriptions (with a lower increase for generic drugs), and hospital stays were targeted for additional copays.

I don't know why you're arguing this - do you honestly think we're making this up? There are plenty of studies on this topic.

Managed Care - ER Use Starts to Decline With $50 Copayment

Fifty is a nifty number when considering how to cut back the care given in emergency rooms for nonemergency problems, according to a recent study. It seems that levying a copayment of $50 or more results in a significant reduction in ER use for non-emergent conditions.

“Copayment Levels and Their Influence on Patient Behavior in Emergency Room Utilization in an HMO Population,” in the Journal of Managed Care Medicine, says that “with a 30 to 45 percent reduction in emergent visits, a 42 to 62 percent reduction in nonemergent visits, and overall ER reduction of 33 to 49 percent for patients with ER copayments from $50 to $150, [payers’ and employers’] consideration of increasing ER copayments at least to the $50 level may serve to continue needed reductions in ER visits for nonemergent conditions.”

The study looks at ER use for about 137,000 enrollees in the Health Alliance Plan in Michigan who are treated by the Henry Ford Medical Group. The study compares data from Jan. 1 to Sept. 30, 2006, and Jan. 1 to Sept. 30, 2007, to data from 2005, before the copayments were increased.

 

[soulcougher73]

Why cant we just have both? Single payer for everyone and if you have a lot of money and want to waste it on insurance premiums sign up for a plan that hopefully offers up better services than what singple payer covers.

 

[glenn1]

You mean the part where he is proclaiming that we shouldn't all persue the best possible healthcare we can obtain? That part?

The difference is that I think the end consumer like you or me should be the ones making the decision about the 'best possible healthcare we can obtain.' You want a government bureaucrat making that decision for us instead.

 

[dainthomas]

Because people who would have become doctors will go into other fields, why pay $300k to go to med school if you'll never be able to pay off your student loans? Most people become physicians because it pays well, if the government slashes doctor salaries, which is consistent with single payer systems in the rest of the world, we won't have nearly enough medical professionals to go around.

http://www.thelocal.de/society/20100903-29587.html

Maybe it would break the AMA stranglehold and more people could go to medical school, and medical schools could charge less for tuition (economy of scale and whatnot).

 

[dank69]

I don't think you understand what preventative care is - it's the opposite of ER visit care. In fact, the article specifically mentions that ER visits were part of the test that was run:



I don't know why you're arguing this - do you honestly think we're making this up? There are plenty of studies on this topic.

Managed Care - ER Use Starts to Decline With $50 Copayment

Sorry, I didn't read the portion you edited out in your post. I know it wasn't clear but I wasn't trying to equate ER care with preventative care, just pointing out that raising deductibles doesn't reduce preventative care.

 

[dank69]

The difference is that I think the end consumer like you or me should be the ones making the decision about the 'best possible healthcare we can obtain.' You want a government bureaucrat making that decision for us instead.

No, you want an insurance company making those decisions.

 

[yllus]

The difference is that I think the end consumer like you or me should be the ones making the decision about the 'best possible healthcare we can obtain.' You want a government bureaucrat making that decision for us instead.

In the history of modern health care, the end consumer has never made the decision about the healthcare they'll obtain - unless you're talking about that tiny percentage that is willing to relocate near the Mayo Clinic for care and can afford to do as much.

 

[glenn1]

No, you want an insurance company making those decisions.

Actually my first post (#4 in this thread) already addressed that; the only reason why we have that scenario now is because of the fucked up decision of WW2 era Democrats to impose wage controls. Offshoring the decision from insurance companies to government functionaries would only compound the mistake. My preference was stated here in this earlier post, which I guess you didn't bother to read.

http://forums.anandtech.com/showpost.php?p=35611898&postcount=53

 

[dank69]

Actually my first post (#4 in this thread) already addressed that; the only reason why we have that scenario now is because of the fucked up decision of WW2 era Democrats to impose wage controls. Offshoring the decision from insurance companies to government functionaries would only compound the mistake. My preference was stated here in this earlier post, which I guess you didn't bother to read.

http://forums.anandtech.com/showpost.php?p=35611898&postcount=53

I didn't address that post because it has zero chance of getting Republican support. I am not informed enough to tell you if any of it would work or not but it seems okay on the surface. Additionally, it seems that your plan would result in the government making the life or death decisions you just railed against.

 

[glenn1]

I didn't address that post because it has zero chance of getting Republican support. I am not informed enough to tell you if any of it would work or not but it seems okay on the surface. Additionally, it seems that your plan would result in the government making the life or death decisions you just railed against.

Who knows what will get support from one or another politician. All I know is that Obamacare is fatally flawed, and I disagree with the concept of single payer for reasons already stated. I'd honestly prefer that government focus first on providing universal primary care coverage for the poor (and no, Medicaid as currently configured doesn't count) than I would trying to "improve" things for the rest of us who have an imperfect but workable healthcare delivery model.

 

[dank69]

Who knows what will get support from one or another politician. All I know is that Obamacare is fatally flawed, and I disagree with the concept of single payer for reasons already stated. I'd honestly prefer that government focus first on providing universal primary care coverage for the poor (and no, Medicaid as currently configured doesn't count) than I would trying to "improve" things for the rest of us who have an imperfect but workable healthcare delivery model.

Interesting. What is this fatal flaw with Obamacare that you speak of?

 

[Fern]

-snip-
The basic point stands. When you're dealing with a health insurance model, the premiums are sunk costs. Ditto for taxes paid in Single Payer/government run systems. Thus there is absolutely no reason for consumers not to expend any and all services you might be entitled to. "Sure it's probably just a sprain, but let's run an MRI, blood tests, and refer to an orthopedist just to be sure." When you're not paying the bill directly (because of either "single payer" healthcare or as part of a health insurance benefit) there's no reason to turn down these services. If you had to consider whether to expend limited Health Savings Accounts on them, then consumers would probably say "thanks but no thanks."

Yep. And that's another illustration emphasizing that professional standards for care are needed in HC.

Fern

 

[Fern]

Infinite demand? What the fuck are you smoking? Look at any of the other countries, you know, the 37 ones that all score better than the US in terms of healthcare, and tell me which ones have their hospitals booked 24/7 because of "infinite demand".
-snip-

I've long wondered if those other countries employ standards of care to keep costs controlled.

Fern

 

[Juddog]

I've long wondered if those other countries employ standards of care to keep costs controlled.

Fern

They have to have standards, which is perfectly reasonable.

The hospitals in the US love to test you willy nilly because it both makes them money and helps them avoid massive malpractice lawsuits.

In order for costs to go down, there has to be a cap on how much you can sue for; the lawsuit payouts are ridiculous. Secondly the data for testing effectiveness itself has to be analyzed to see if all of this testing is really necessary. Lastly introducing a small co-pay for every visit will discourage people from showing up unless something is actually wrong.

The administration costs in the US is one of the reasons that the costs are so high; bring down administration numbers, normalize procedure costs, cap malpractice suits, allow for a single payer system (since everybody requires healthcare, similar to how everybody uses roads and bridges), and allow the AMA to graduate more doctors - you now have a recipe for bringing costs down without any change in quality of service.

The bloat in the US healthcare system has extended in all directions and it only continues to get worse. Other countries have better systems that are actually cheaper and more effective; we need to follow their lead.

There is a good article here about how other countries manage to control costs:
http://www.pbs.org/newshour/rundown...how-the-us-compares-with-other-countries.html

One major factor is more doctors.

 

[Anarchist420]

if assisted suicide is not legal, then that really screws things up even more.

it's a personal choice and i wouldnt want to live if something happened and couldn't type and walk like i can now, just one example.

 

[funks]

"Money/Insured"
USA > *

what are you talking about? Most health insurance offered by companies are PPO. Basically - it's 80/20% when hospitalized.

If you you get in a pretty bad accident, had to be airlifted, stayed in the hospital for a week, or two. Take a look at your bill, it will be north of 150K. Try paying 20% of that.

I don't have much respect for Doctor's in the US - they just get paid way too much. The only Doctors I believe that should be getting paid a lot are the research doctors, the one's doing real work to improve medicine and quality of life.

A general practitioner or a family doctor getting paid 200K+? WTF? Nurses should be able to do 90% of what these non-research / non-surgical doctors can do.

Only thing I don't like about ACA is the fact that people aren't penalized enough when they decide it's cheaper for them to pay the fine. There should be a provision in the law that if you decide to pay the fine (and not contribute) and you end up needing treatment (accident / get seriously sick - eq. Cancer) that the Hospitals have the power to garnish your wages to pay for the treatment they've given if you decide you want to live.

This way, hospitals should be able charge everyone else less as there's less risk (which they currently mitigate by charging everyone more).

 

[Agent11]

It's really too bad we don't screen children in grade school for grooming into required professions. I imagine if the government told your average parent that they had a potential future doctor and asked if they wanted to participate in such a program it would go over well.

 

[Mr. Pedantic]

Because people who would have become doctors will go into other fields, why pay $300k to go to med school if you'll never be able to pay off your student loans? Most people become physicians because it pays well, if the government slashes doctor salaries, which is consistent with single payer systems in the rest of the world, we won't have nearly enough medical professionals to go around.

http://www.thelocal.de/society/20100903-29587.html

Where did you hear this? The very first day of Med School, our Dean gave a talk, and the basic gist of what he said was, if you're in it for the money, you're going to have a bad time.

 

[Zodiark1593]

Is there a need to go strictly single-payer? What if individuals want access to tests and such that the government would likely deem superfluous, or want (non-emergency) treatments quickly. Perhaps insurance companies can provide a "supplement" to the default coverage government provides.

So while life saving treatment is absorbed trough the government's coverage and protects taxpayers from going bankrupt due to severe injury or illness, the "supplement" coverage that can be purchased will cover less critical procedures, and will even cover additional tests at request of the patient (MRI for sprained ankle).

In (a not so short) summary, provided economics works out favorably(middle of night, haven't thought this part out yet), the government will guarantee all taxpayers a minimum level of healthcare, those who want more are free to purchase additional coverage. As the government still pays out for life-saving treatments, the consumer would likely not have to pay exorbitant premiums for the additional insurance, and the insurance companies would hopefully remain profitable enough to operate. The aim being raising minimum healthcare levels for everyone (through the use of a healthcare tax), while minimizing cost increases to the middle and higher classes for maintaining their current level of healthcare (lower premiums for additional coverage)

Of course, I could be completely wrong about everything and should just hang my head in shame. (not like that hasn't happened before)

 

[funks]

It's also probably a good idea if the government can "allocate" 1 day every quarter as "paid" healthcare/time off day. Employee's will get paid vacation time for missing the day if said day is used for health purposes (eq. physical check ups / blood tests ) supporting preventative care.

Imagine how many life threatening diseases (expensive to treat) will get caught earlier if there's routine preventative check ups. Most people only go visit their Doctor when something is wrong and I'm pretty sure one of the reasons for doing so is that they don't have enough "time"..