Part I: Healthcare System Problem Identification

Page 2 - Seeking answers? Join the AnandTech community: where nearly half-a-million members share solutions and discuss the latest tech.

ebaycj

Diamond Member
Mar 9, 2002
5,418
0
0
JESUS CHRIST, PEOPLE !!! STOP DEBATING FOR TWO SECONDS !!!

This post is to IDENTIFY THE PROBLEM, not to solve it.

The "solving" will come in a later thread.
 

Athena

Golden Member
Apr 9, 2001
1,484
0
0
Originally posted by: inspire
I earned this job and the benefits I have aren't for you, congress, or anybody but me and my employer to be concerned with. Why is this an issue?
Excuse me? Your employer-paid benefit is being subsidized by me and every other taxpayer. While I'm paying 100% of my own costs (and get no deduction for it), I have to subsidize yours and you think that's a "private" issue between you and your employer?

How about we try to fix what we have before we start discussing trashing it all and starting over.
How about we put an end to 60+ years of trying to fix a model that every other industrialized country has abandoned it and start talking about real reform. "Trying to fix it" is what has led to personal, corporate, and government insolvency. No company is prepared to promise that it will maintain the same coverage for the next five years from now without some sort of radical reform of the ioverall financing model.
 

imported_inspire

Senior member
Jun 29, 2006
986
0
0
Originally posted by: Athena
Originally posted by: inspire
I earned this job and the benefits I have aren't for you, congress, or anybody but me and my employer to be concerned with. Why is this an issue?
Excuse me? Your employer-paid benefit is being subsidized by me and every other taxpayer. While I'm paying 100% of my own costs (and get no deduction for it), I have to subsidize yours and you think that's a "private" issue between you and your employer?

How about we try to fix what we have before we start discussing trashing it all and starting over.
How about we put an end to 60+ years of trying to fix a model that every other industrialized country has abandoned it and start talking about real reform.

A) Fine, take the tax deduction away and we're square - oh, wait, don't you get one too?

B) Wait up, wait up - Everything I hear about how the system is broken has to do with the fact that nothing has been done for so long. Unless you have a targeted response to the issues in question, I think you're going to end up only creating more problems. better the devil you know.

@ebaycj - I'm not trying to debate the fixes, so much as whether or not these are problems.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,329
126
Originally posted by: inspire
Originally posted by: Darwin333
Originally posted by: DLeRium
Originally posted by: Darwin333
Originally posted by: RedChief
Originally posted by: Darwin333
If you sell "insurance" to anyone in a given state, you must accept all persons in that state on the same terms and at the same price.

Borrowed from Karl Denninger

And now that the insurances companies have been driven out of business we all get to join the government health care monopoly plan.

How does that drive the insurance companies out of business?

Let's see. The fact that government insurance is paid for by taxpayers. Whether or not you are going to be in it or not, you pay into the system. The people who pay for BCBS or Aetna or whatever use it. The people who don't, do not. Simple. UHC is backed by a semi-unlimited supply of funds.

I didn't realize I stepped on board the "UHC bus". I thought we where talking about specific problems and potential solutions for health care reform. Health care being tied to employment is a problem, in my opinion. Instead of selling a specific insurance product to only people that work for a specific company it would be offered to everyone in that state.


It's not a problem - it's just something you and everybody wants. It's okay to be jealous, but call a spade a spade.

Health insurance being tied to employment is not a problem?

And please elaborate on exactly what it is that I want and what I am jealous of?
 

imported_inspire

Senior member
Jun 29, 2006
986
0
0
Originally posted by: Darwin333
Originally posted by: inspire
Originally posted by: Darwin333
Originally posted by: DLeRium
Originally posted by: Darwin333
Originally posted by: RedChief
Originally posted by: Darwin333
If you sell "insurance" to anyone in a given state, you must accept all persons in that state on the same terms and at the same price.

Borrowed from Karl Denninger

And now that the insurances companies have been driven out of business we all get to join the government health care monopoly plan.

How does that drive the insurance companies out of business?

Let's see. The fact that government insurance is paid for by taxpayers. Whether or not you are going to be in it or not, you pay into the system. The people who pay for BCBS or Aetna or whatever use it. The people who don't, do not. Simple. UHC is backed by a semi-unlimited supply of funds.

I didn't realize I stepped on board the "UHC bus". I thought we where talking about specific problems and potential solutions for health care reform. Health care being tied to employment is a problem, in my opinion. Instead of selling a specific insurance product to only people that work for a specific company it would be offered to everyone in that state.


It's not a problem - it's just something you and everybody wants. It's okay to be jealous, but call a spade a spade.

Health insurance being tied to employment is not a problem?

And please elaborate on exactly what it is that I want and what I am jealous of?

If it was a problem, then why would you want it for everybody? It just sounds like it's something you want.

 

ebaycj

Diamond Member
Mar 9, 2002
5,418
0
0
Originally posted by: inspire
@ebaycj - I'm not trying to debate the fixes, so much as whether or not these are problems.

Gotcha. Really though, you can only put down what are problems for YOU.

Then we can go back and re-assess what everyone put down, decide if they are systemic problems or not. Then we decide what to do about the systemic problems.

You're two steps ahead. ;) (Technically minded people often have the same problems)
 

imported_inspire

Senior member
Jun 29, 2006
986
0
0
Originally posted by: ebaycj
Originally posted by: inspire
@ebaycj - I'm not trying to debate the fixes, so much as whether or not these are problems.

Gotcha. Really though, you can only put down what are problems for YOU.

Then we can go back and re-assess what everyone put down, decide if they are systemic problems or not. Then we decide what to do about the systemic problems.

You're two steps ahead. ;) (Technically minded people often have the same problems)

Ah, yeah, you're right. I guess we should just make the list for now. Sorry, folks.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,329
126
Originally posted by: Athena
Originally posted by: inspire
I earned this job and the benefits I have aren't for you, congress, or anybody but me and my employer to be concerned with. Why is this an issue?
Excuse me? Your employer-paid benefit is being subsidized by me and every other taxpayer. While I'm paying 100% of my own costs (and get no deduction for it), I have to subsidize yours and you think that's a "private" issue between you and your employer?

I am not sure that I would call not taxing something a subsidy. While I agree that taxes have to go up sooner rather than later for darn near everyone, wouldn't removing the tax breaks for insurance move the price in the wrong direction?
Originally posted by: Athena
Originally posted by: inspire
How about we try to fix what we have before we start discussing trashing it all and starting over.
How about we put an end to 60+ years of trying to fix a model that every other industrialized country has abandoned it and start talking about real reform. "Trying to fix it" is what has led to personal, corporate, and government insolvency. No company is prepared to promise that it will maintain the same coverage for the next five years from now without some sort of radical reform of the ioverall financing model.

What makes you think the Government can afford it? Its irrelevant who is paying for it if we don't bring the costs down which, imo, should be one of the main topics of debate. I have yet to see a proposal from Congress that would reduce the governments spending. Even the estimated increases are most likely low ball figures (How often do you see .gov projects come in at or under budget?).
 

TheSkinsFan

Golden Member
May 15, 2009
1,141
0
0
1. Annual premiums that are too high and growing too quickly, even for basic coverage -- a sub-problem would be inconsistent pricing for said premiums.

2. The denial of enrollments for pre-existing conditions needs to be stopped altogether

3. The denial of treatments, or removal from a plan altogether, at times when such treatments are critical to the survival of a patient -- this is simply unacceptable.

4. The inability to carry one policy regardless of changing jobs, moving across state boundaries, etc.

5. Flexible rates billed to insurance companies based on type of coverage -- IOW, two patients receiving the exact same care should have their insurance providers billed for the exact same amount. Too often, now, the bills will be exponentially higher for one patient than another for the exact same procedure(s).

6. Those at or below the poverty level(s) who cannot afford ANY insurance coverage need to be provided with some basic coverage -- to include both preventative and emergency care. We may not like it -- I know I don't -- but there also needs to be a stronger pool of money to cover the illegal aliens as well. Right now, covering them through increased premiums is effecting everyone and every aspect of the healthcare cycle.

7. There should be no lifetime maximums for anyone -- catastrophic protection should be mandatory for all plans.

I'll think of some more later...
 

Fern

Elite Member
Sep 30, 2003
26,907
174
106
I think this so-called problem has been brought up a lot, yet isn't on the list (pardom me if you've already considered it and decided not to include it).

People using the ER for routine medical care (I presume they mean the uninsured).

This used to be tossed around quite a bit. I never understood why this created a big cost problem, solutions seem rather common sensical:

1. Have ER staff redirect them to an out-patient/walk-in clinic staffed by PA's (physician assistants)

2. Put an outpatient facility next to the ER in the hospital.

3. Just have the PA's etc there in the ER to take care of this non-ER stuf when they show up.

Why the heck does the ER cost so much anyway? Are they using cardiac surgeons to put bandands on idots who show up at the ER?

This is sort of similar to "13) don't need full-on doctors for "simple" things (strep throat, etc.)" already on your list.

Fern
 

NaughtyGeek

Golden Member
May 3, 2005
1,065
0
71
Originally posted by: Fern
I think this so-called problem has been brought up a lot, yet isn't on the list (pardom me if you've already considered it and decided not to include it).

Tis not my list, tis ours. You topic has been added. I'm going to leave the format as is for now to see if a couple stragglers have any points to add that have been missed, then it will be on to part II. ;)

 

Athena

Golden Member
Apr 9, 2001
1,484
0
0
Originally posted by: inspire
A) Fine, take the tax deduction away and we're square - oh, wait, don't you get one too?
No, I do not. Individuals do not get any deduction for health insurance premiums. And I don't really want one; it's an artifact of post war wage controls that has distorted our national healthcare policy for too long. I want a level playing field -- either everyone pays for his/her health costs or we get real and move to some form of socialized health insurance. Here's a nice table that explains how that differs from other forms of health care financing.

Everything I hear about how the system is broken has to do with the fact that nothing has been done for so long.
I guess you haven't been paying attention for very long. Having been employed by Fortune 100 companies here with "premium" coverage, then worked in countries with single-payer systems , I have paid 100% of my own expenses ever since I returned to the US so I've given it a lot of attention for quite some time. The US has been though numerous patching attempts and none of them have effectively addressed any of the three goals that any civilized society should have for it's citizens.

Lost in the Shuffle: The Overarching Goals of Health Reform

I think you're going to end up only creating more problems. better the devil you know.

I happen to think it's better look the devil in the eye and deal with him. As a nation, we are on a course of financial ruin -- with or without the costs associated with the psuedo-reform now under discussion. There is virtually nothing in the current discussion that will do anything to stop the ruinous rise in payments.

And there can't be because the whole thing is build on the same flawed model. Employers have been warning that the current system is unsustainable for years and what do we see? Bills that are based on a crumbling model. What makes people think that corporate boards are going to sit by and go the way of GM? Do city, state, and federal employees really think their benefits are secure when taxpayers can't meet their own health expenses* What do we expect life to be like in this country 10 years from now when the boomers have hit Medicare full force? Personally, I find that much scarier then the made up boogeymen of Death Panels.

That's why it puzzles me that all the people with employer paid benefits are not marching and demanding real reform that will enable them to maintain their coverage (not "plan" but coverage) in a more sustainable form. We need reform that will allow those who are working today to to look forward to an old age as comfortable as that enjoyed by the people who are ranting at these meetings.

* The average family in this country is already spending 16% disposable income on health expenses; which is more than exceeds either ther food or housing.
 

Patranus

Diamond Member
Apr 15, 2007
9,280
0
0
Originally posted by: NaughtyGeek
2) 18% Uninsured rate (or therabouts)

That is an intellectually dishonesty figure.

First off, if you use the 40,000,000 figure which seems to creep up as poll numbers go down it is only 13%.

The majority of those included in that figure can afford health insurance but CHOOSE to spend their money on other things. Of that total uninsured in America, only roughly 3% lack insurance and don't lack it because they choose to not buy it.
 

heyheybooboo

Diamond Member
Jun 29, 2007
6,278
0
0
Originally posted by: NaughtyGeek

Tis not my list, tis ours. You topic has been added. I'm going to leave the format as is for now to see if a couple stragglers have any points to add that have been missed, then it will be on to part II. ;)

You missed:

Healthcare System Problem Identification

Old People

(should move to the top of the list)


  • Persons 65+ years in age represent 13% of the population, around 39 million people.
  • By the year 2030 this demographic will represent more than 20% of the population and total 72 million people.

About 80 percent of seniors have at least one chronic health condition and 50 percent have at least two. Arthritis, hypertension, heart disease, diabetes, and respiratory disorders are some of the leading causes of activity limitations among older people.

however

Disability among the older population is declining. Studies over the past two decades have revealed substantial declines in the rates of disability and functional limitation.

  • People aged 65 to 74 have a poverty rate of 9 percent, compared with 12 percent of those 75 and older.
(In 1959, 35 percent of people aged 65 and over lived below the poverty line. By 2003, the proportion had decreased to 10 percent.)

Some enterprising sleuth should investigate the impact the creation of medicare had on the reduction in poverty for the elderly during this period.


edit --- I like these:

If you are a white male and reach age 65 your average life expectancy is another 16.3 years (black males: 14.5 years).
If you are a white female and reach age 65 your average life expectancy is another 19.2 years (black females: 17.4 years).


65+ in the United States: 2005 (pdf)
 

Patranus

Diamond Member
Apr 15, 2007
9,280
0
0
Originally posted by: Fern
Problem:

1. Different prices for exact same service provided by any one service provider (or lack of uniformity in pricing). What I mean is, if you are on medicaid/medicare you get one price from doctor Joe. If you are on HI, you get billed a different amount. If you are unisured, you get yet another price.

And those government services only pay back $0.83 on the dollar towards total costs so not only are taxpayers paying for it but if you have private insurance, your rates are high because the government isn't reimbursing health care providers the full cost.

Huh, maybe if the government reimbursed the full cost your health insurance would cost less?
 

Athena

Golden Member
Apr 9, 2001
1,484
0
0
[q/]The majority of those included in that figure can afford health insurance but CHOOSE to spend their money on other things. Of that total uninsured in America, only roughly 3% lack insurance and don't lack it because they choose to not buy it.[/quote]
That's not true. About half the uninsured are employees of companies that do not offer insurance...and 89% of those who seek insurance in the private market are either rejected or cannot afford it.
 

Patranus

Diamond Member
Apr 15, 2007
9,280
0
0
Originally posted by: Athena
That's not true. About half the uninsured are employees of companies that do not offer insurance...and 89% of those who seek insurance in the private market are either rejected or cannot afford it.

Both of those figures do not address my point.

What does the fact that a company doesn't offer insurance have to do with the ability to pay for it privately?

What does the fact that 90% get turned down if they seek it? That figure does not account for those who CHOOSE to not have insurance.
 

Pens1566

Lifer
Oct 11, 2005
13,814
11,460
136
I'm glad someone mentioned the advertising of prescription drugs. There's no reason why those companies should be purchasing expensive tv slots so I can ask my doctor if lipitor/viagra/etc. is right for me. There are many problems with this:

1) The amount of money they spend on it
2) Patients shouldn't be telling doctors what they should be taking
3) Doctors are already quite well aware of what drugs are available from the also quite expensive drug rep. effort
 

Patranus

Diamond Member
Apr 15, 2007
9,280
0
0
Originally posted by: Pens1566
I'm glad someone mentioned the advertising of prescription drugs. There's no reason why those companies should be purchasing expensive tv slots so I can ask my doctor if lipitor/viagra/etc. is right for me.

Yes....Lets just get ride of the pesky 1st amendment

Why don't we ban those evil fast food companies from advertising on TV?
Why don't we just have government fund all TV?
Why don't we just have 24-7 government programming?
 

Fern

Elite Member
Sep 30, 2003
26,907
174
106
Originally posted by: Patranus
Originally posted by: Pens1566
I'm glad someone mentioned the advertising of prescription drugs. There's no reason why those companies should be purchasing expensive tv slots so I can ask my doctor if lipitor/viagra/etc. is right for me.

Yes....Lets just get ride of the pesky 1st amendment

Well, to be fair, we do ban tabacco and alchohol from advertising.

I think the advertising costs in presription drugs are significant and I think it at least reasonable to entertain a discussion in all this HC business as to why we need to advertise prescription drugs directly to the general public who can't prescribe them or determine their appropriateness.

Is this why our drugs sold in other countries have such a lower costs? (I.e., other countries may not permit advertising so they're cheaper for those folks.)

In considering cost reductions I think a lot of stuff ought to be put on the table for discussion.

Fern
 

Patranus

Diamond Member
Apr 15, 2007
9,280
0
0
Originally posted by: Fern
Originally posted by: Patranus
Originally posted by: Pens1566
I'm glad someone mentioned the advertising of prescription drugs. There's no reason why those companies should be purchasing expensive tv slots so I can ask my doctor if lipitor/viagra/etc. is right for me.

Yes....Lets just get ride of the pesky 1st amendment

Well, to be fair, we do ban tabacco and alchohol from advertising.
/q]
In a victory for the CTS industry, the United States Supreme Court in June struck down Massachusetts' proposed restrictions on tobacco advertising, agreeing that the ban violates retailers' First Amendment rights.
http://www.allbusiness.com/gov...ibunals/7832535-1.html

I am sure if they pushed the issue, there would be more similar outcomes.
 

imported_inspire

Senior member
Jun 29, 2006
986
0
0
Originally posted by: Athena
Originally posted by: inspire
A) Fine, take the tax deduction away and we're square - oh, wait, don't you get one too?
No, I do not. Individuals do not get any deduction for health insurance premiums. And I don't really want one; it's an artifact of post war wage controls that has distorted our national healthcare policy for too long. I want a level playing field -- either everyone pays for his/her health costs or we get real and move to some form of socialized health insurance. Here's a nice table that explains how that differs from other forms of health care financing.

Everything I hear about how the system is broken has to do with the fact that nothing has been done for so long.
I guess you haven't been paying attention for very long. Having been employed by Fortune 100 companies here with "premium" coverage, then worked in countries with single-payer systems , I have paid 100% of my own expenses ever since I returned to the US so I've given it a lot of attention for quite some time. The US has been though numerous patching attempts and none of them have effectively addressed any of the three goals that any civilized society should have for it's citizens.

Lost in the Shuffle: The Overarching Goals of Health Reform

I think you're going to end up only creating more problems. better the devil you know.

I happen to think it's better look the devil in the eye and deal with him. As a nation, we are on a course of financial ruin -- with or without the costs associated with the psuedo-reform now under discussion. There is virtually nothing in the current discussion that will do anything to stop the ruinous rise in payments.

And there can't be because the whole thing is build on the same flawed model. Employers have been warning that the current system is unsustainable for years and what do we see? Bills that are based on a crumbling model. What makes people think that corporate boards are going to sit by and go the way of GM? Do city, state, and federal employees really think their benefits are secure when taxpayers can't meet their own health expenses* What do we expect life to be like in this country 10 years from now when the boomers have hit Medicare full force? Personally, I find that much scarier then the made up boogeymen of Death Panels.

That's why it puzzles me that all the people with employer paid benefits are not marching and demanding real reform that will enable them to maintain their coverage (not "plan" but coverage) in a more sustainable form. We need reform that will allow those who are working today to to look forward to an old age as comfortable as that enjoyed by the people who are ranting at these meetings.

* The average family in this country is already spending 16% disposable income on health expenses; which is more than exceeds either ther food or housing.

A) I don't need a table - I want a level field, too. I thought even individuals had access to HSAs with tax benefits?

B) I disagree. Also based on personal experience and viewpoints.

C) Then adjust the model; don't tear it down. I'm not saying we should do nothing. We should isolate the problems, target them, and deal with them. I don't think throwing everything out is the best course here.

I won't argue the relative importance of food & housing vs. healthcare, but I thought the average cost of housing alone was over 20% - even more for lots of people. That's what got us into this ungodly recession.
 

Pens1566

Lifer
Oct 11, 2005
13,814
11,460
136
Originally posted by: Patranus
Originally posted by: Pens1566
I'm glad someone mentioned the advertising of prescription drugs. There's no reason why those companies should be purchasing expensive tv slots so I can ask my doctor if lipitor/viagra/etc. is right for me.

Yes....Lets just get ride of the pesky 1st amendment

Why don't we ban those evil fast food companies from advertising on TV?
Why don't we just have government fund all TV?
Why don't we just have 24-7 government programming?

nvm, not worth the effort