The trouble I see in Obamacare

[AViking]

I'm a provider. I have to deal with the US, not Sweden. I have to spend 1 to 2 hours a day out of 12, at least four times what I did a handful of years ago trying to get what patients need. Most of that government induced. I have to interact with other providers who have to spend similar amounts of time FOR THE SAME PERSON AND PROBLEM. I emphasize that to drive home that it's not just poor me. It's me and others AND the patient, who this is supposed to be all all about to begin with. What we are dealing with now is simple stupid compared to the task of taking one of the most complicated, if not THE most complicated system to have ever existed, completely reworking it, making it better and not killing anyone in the process by making it so extraordinarily complicated that the red tape takes another life. UHC isn't anything other than a result. It isn't salvation, Jesus in a syringe, and so far the competency level demonstrated is miserable.

Before this Obamastuff came about I asked for reform, and coverage would be a part of it, but we got a diversion which now locks in a funding mechanism which is going to be extremely hard to rework. The Faithful have already opposed alternatives before, defending that which they don't understand. Nope. In THIS nation there is no political accountability while in office. Graft, incompetence, corruption are not only tolerated but part if the working day to day operations. We have two parties which own us. There is no vote of confidence, no way to say "No, this is unacceptable" but to kick out a small part of the whole. You can remove one head of the Hydra, but even then only every few years, and that is the real concern.

You didn't answer my question and I am going to hold you to it. I want to hear you tell that old woman, not some hypothetical person, but one I had to deal with in this very real world how the people who would make you a criminal for taking her test strips to her just need to get control of the whole thing and that automatically fixes it. For heaven sake don't mention Sweden unless Sweden is going to bring her what she needs.

I want not a result, but a plan to get there. Give it to me.

The problem with Obamacare was that it was a bandaid. The whole system needs trashing including these dumb rules like I guess the one you're referring to. I can't speak on personal behalf on the rules of bringing test strips.

The whole system needs a overhaul. It doesn't have to be so complicated. Dumb rules, litigation, wasteful tests, etc. All of that has to go.

As an American I understand our fear of letting our incompetent government handle our healthcare system. That's why I mentioned above that I think the best thing I've seen is private hospitals run by real medical professionals but funded by the government. That way you don't have idiotic bureaucrats putting in place idiotic rules.

The US has big issues that require big changes. We need to fix or just get rid of our corrupt two party system. We need to get rid of pork barrel legislation, graft, corporate loop holes, and a whole bunch of other things. What we also have to do though is provide healthcare, affordably, to our whole population. Somehow we need to be able to do both all of this at the same time.

Everyone has to vote. They have to stop voting for fundamentalists and crazy people. They have to seriously consider voting 3rd party when there is a reasonable candidate. They have to step up with good ideas and run for office themselves.

 

[Hayabusa Rider]

The whole system needs a overhaul. It doesn't have to be so complicated. Dumb rules, litigation, wasteful tests, etc. All of that has to go.

We're not really far apart in terms of goals, but you keep returning to the end result, ignoring mechanisms by which they will be PROPERLY applied. You highlighted my question you didn't answer and that touches on my point. We need all you say, but you have yet to address what has happened when minor reforms harm people. You know providers. Ask them if what I said is untrue. You'll find posts on this issue and while specific is illustrative of the real processes and results in this very real situation here, again not in Sweden. You say the system needn't be complex. Well it will be, staggeringly so, but complex systems can function well. I don't think you can ever find an example of where I say that there is no better possible system that what we have. In fact it's the contrary. What I don't want is "vaccine mentality", someone finds things that may or may not be true in a particular context and run with it. In the case of the latter most people are familiar with the latter and have some basis for opinion. In the case of reworking an entire system, ripping it up and putting in a new one? There is no such person. Nothing like this has ever been done, not in our situation and on this scale.

At once it's a challenge and an opportunity. I don't know the demographics of Sweden off the top of my head, but I can speak with certainty that they would be overwhelmed with ours. Two words ought to strike fear into the hearts of anyone trying to establish or maintain a health care system. Baby Boomers. A few years before Obamacare was a gleam in the eye of our current President I attended a conference on aging along with some quite expert in the field. These weren't hacks or tyros, but professionals which a worrying concern and that was an aging population. No system, none, is adequately prepared or easily funded or scaled to handle this. The government will rescue us was not on the list of cures, but concerns. Informal discussions often pointed out the inane and cumbersome that need to be dealt with. Turning reform of regulations to those who broke the situation wouldn't have been well received for good reason.

Therein lies a problem. Our government does not share. Our politicians do not facilitate, they control. We need to find some means of dealing with this significant core problem before we turn things over irrevocably. At a minimum I'd say we need a test bed of sorts. Perhaps DC?

 

[bradly1101]

Taxes is such a dirty word in this country. Don't get me wrong, we want our police and fire protection, roads, bridges, schools, parks, and other infrastructure, we just don't want to pay for it.

 

[AViking]

Scales are different but both countries have baby boomers.

You're probably right that you can't just remove the whole system and put in place a new one. I'd like to think that's possible but I imagine that would be a disaster. There's a famous picture where Sweden went from driving on the left to the right overnight and it's comical at best. With healthcare though it could be deadly.

However you could run a city, state, county with Universal Healthcare and see how it goes. Funding comes in, it's allocated out to private hospitals, people have to pay taxes to cover that funding. No unnecessary tests. If you go in with a broken arm you get an x-ray, your arm is set, you get sent home. You don't pay radiologists $500,000 a year in that area but $150,000, you don't need 50 people to run billing, you don't give an MRI just because the patient asks for one, you don't give a rabies vaccine to a someone who lives in a city, you don't give a hip replacement to someone who is 95 years old, and you significantly change how we deal with malpractice insurance and lawsuits. The problem I see with trying this though is that if I was a radiologist I would move to the next county. It kinda has to be national for it to work.

In Sweden they do something completely different with respect to malpractice. I think you just send in a form to a specific office if a doctor has wronged you. If they side with you it is sent to a panel of experts to evaluate. You request compensation, if there is some it's faultless, you get paid a non-insane amount, and the doctor can continue doing his job. Doctors misdiagnose and make mistakes. If it's gross negligence the doctor can lose his license. Everything is dealt with and resolved in a few months.

No suing. Huge difference. There are no legal costs and no punitive damages. The punishment is pretty simple if it's bad enough - they don't practice medicine. In the US almost all of the money goes to lawyers and the courts. It's a stupid system.

 

[fskimospy]

Legal costs from torts and preventative medicine comprise a very tiny fraction of US health costs.

 

[Incorruptible]

The solution is so damn simple.

1. Raise taxes
2. Universal healthcare
3. Join the rest of the modern world

/thread

It takes a pathetic excuse of a human being to advocate this. What you are advocating for would restrict freedom. Idiots like you believe healthcare is a right when it's not. A free market healthcare system is needed and not your BS system.

 

[AViking]

Legal costs from torts and preventative medicine comprise a very tiny fraction of US health costs.

True. I was referring just to the malpractice portion. The money spent on malpractice mostly goes to the court system and lawyers.

 

[Matt1970]

You either don't understand taxes or are intentionally being obtuse.

If you have some magical way of getting taxes raised to pay for healthcare other than getting it through Government, I am all ears.

 

[Hayabusa Rider]

Scales are different but both countries have baby boomers.

You're probably right that you can't just remove the whole system and put in place a new one. I'd like to think that's possible but I imagine that would be a disaster. There's a famous picture where Sweden went from driving on the left to the right overnight and it's comical at best. With healthcare though it could be deadly.

However you could run a city, state, county with Universal Healthcare and see how it goes. Funding comes in, it's allocated out to private hospitals, people have to pay taxes to cover that funding. No unnecessary tests. If you go in with a broken arm you get an x-ray, your arm is set, you get sent home. You don't pay radiologists $500,000 a year in that area but $150,000, you don't need 50 people to run billing, you don't give an MRI just because the patient asks for one, you don't give a rabies vaccine to a someone who lives in a city, you don't give a hip replacement to someone who is 95 years old, and you significantly change how we deal with malpractice insurance and lawsuits. The problem I see with trying this though is that if I was a radiologist I would move to the next county. It kinda has to be national for it to work.

In Sweden they do something completely different with respect to malpractice. I think you just send in a form to a specific office if a doctor has wronged you. If they side with you it is sent to a panel of experts to evaluate. You request compensation, if there is some it's faultless, you get paid a non-insane amount, and the doctor can continue doing his job. Doctors misdiagnose and make mistakes. If it's gross negligence the doctor can lose his license. Everything is dealt with and resolved in a few months.

No suing. Huge difference. There are no legal costs and no punitive damages. The punishment is pretty simple if it's bad enough - they don't practice medicine. In the US almost all of the money goes to lawyers and the courts. It's a stupid system.

There's things I see here I can work with. Questions of implementation though. In the US you cannot just say "Here's your pay cut". If you did handle things like that you would have a completely bankrupt profession. In essence you would be putting people who have higher educational needs at the lowest compensation among like peers. Then you have the loss of income while in school while accumulating debt. Mortages, kids, normal living costs based on realistic expectations. You've created a situation that highly intelligent people would avoid like the plague. How would you deal with this?

 

[AViking]

It's irrelevant. The US spends almost twice as much as other countries and gets less. We just need to spend our money more wisely.

 

[Matt1970]

It's irrelevant. The US spends almost twice as much as other countries and gets less. We just need to spend our money more wisely.

Well sure we do, but Obamacare did little to address that.

 

[Daverino]

It takes a pathetic excuse of a human being to advocate this. What you are advocating for would restrict freedom. Idiots like you believe healthcare is a right when it's not. A free market healthcare system is needed and not your BS system.

I want a free market military too.

The government has been restricting my freedom to get the military protection I need and I want for too long! If you can't afford a platoon of Marines to go to Afghanistan and fight for you, well then tough on you! You need to pull yourself up by the bootstraps so you can pay for your own F-35. I don't see why I need to pay my hard earned dollars so the rest of you freeloaders can be defended by a company of M1A2 Abrams. Individual demand for JDAMs will drive the price down for everyone if only the government would stop interfering with the free market! That's what we need for defense in this country, not the BS system we have now.

I'm a libertarian!

 

[AViking]

There's things I see here I can work with. Questions of implementation though. In the US you cannot just say "Here's your pay cut". If you did handle things like that you would have a completely bankrupt profession. In essence you would be putting people who have higher educational needs at the lowest compensation among like peers. Then you have the loss of income while in school while accumulating debt. Mortages, kids, normal living costs based on realistic expectations. You've created a situation that highly intelligent people would avoid like the plague. How would you deal with this?

You'll notice that I actually put a number there. $150,000. A respectable income. Now whether they get paid $125,000 or $200,000 it's going to be a lot less than the average for a radiologist today which is $500,000 in the US.

In Sweden doctors used to be grossly underpaid. So they moved to the US. My friends in the medical profession are making between $90,000 (nurses) to about $300,000 (specialist). That's my close circle of friends in the USA. Those salaries are very very high. It pissed me off to no end that I had friends who went and got a 2 year education in nursing and were making $90,000 out the door while I still had years left in my education and had a lower starting salary.

Now I have some family friends in Sweden who are doctors here today and they make a respectable living, live in the nicest parts of town, own large homes, summer homes, and are definitely rich here. Do they make $500,000 a year? I don't think any do. We have everything public here so you could actually look up a profession or an individual and see what they make at http://www.ratsit.se/ but it has a small fee.

http://www.lonestatistik.se/ is general statistics.

So the average physician and surgeon makes $93,000 in all of Sweden. A nurse makes about $45,000 a year.

I know that some of my older family friends who are nearing retirement as doctors are making about 80,000 SEK a month which is over $12,000 a month. I'm not sure what they do exactly though. I just heard that number thrown out.

These salaries used to be MUCH lower. Today I think they're high enough in Sweden to not have a brain drain. Doctors from other parts of Europe come here. One thing that's important to note is that you can't just get a medical license in most countries and move to another. You can do it within the EU but the US is not in the EU. They make you redo stuff. License, residency, and who knows how many more hoops you have to jump though. So if the US changes their system and lowers salaries to at least something respectable I highly doubt people are going to want to go through the burden of relocating to another country to make an extra 10%.

 

[AViking]

Well sure we do, but Obamacare did little to address that.

I agree. I'm not a big fan of Obamacare. I think Obama is an incredibly weak president to not have pushed for UHC when he had the ability to do so.

 

[Hayabusa Rider]

It's irrelevant. The US spends almost twice as much as other countries and gets less. We just need to spend our money more wisely.

You are backtracking here. The problems are systemic and demographic. I brought up the compensation issue, because I wanted to see if you understood the realities on the ground. Compensation isn't the reason we have significantly higher costs, but it is a sensitive factor that needs to be understood. Yes we pay more for professionals but if they worked for minimum wage we'd still be paying almost as much. When you start tweaking things you have to be careful because the natural consequences are that there are no providers. The few remaining will not be replaced because people will see what a horrible working environment has been created, and a punishing one as well. We've just taken any system to it's knees.

So yes we need to spend money more wisely, but we're chasing tails. We know that.

So what then? For a national system we need an understanding of the relationships between different concerns, different regions, and so on. We need a pretty good grasp of what's going on without political influence. Let's take duplication of services, which I submit is very expensive. Well just punch up what tests the patient has had, the patient history, current status, medications and such. Well you can't. You can find bits and pieces but there is no connected system which provides basic information on a person, and make no mistake this is about people. This is one thing we could implement, but again just who and how is important. Heaven forbid those who were responsible for the ACA sites. So here's a proposal. Get providers together along with others to hash out what their needs are. Then give it to *gasp* people who have NSA like qualities in sifting through data and handling security. Hire Google if it comes to it because we're looking at Big Data here. Not only can we keep records, but we could use the enormous processing power that agencies like the NSA have for really constructive purpose. It could be a research tool sifting through mountains of data to see what possible changes need to be made in treatments. Can you imagine the progress that could be made if we do that? People giving care and those who pay for it would know if a test or treatment has been tried. A trip to Florida and a different physician wouldn't throw people into a tizzy because the patient didn't think to tell their usual providers that changes were made or a different treatment applies. Better care more efficiently given through access of useful information readily available to those who need it. That gives better outcomes and better outcomes lead to lower costs.

That's where almost everyone get's the order of cart and horse wrong. They look to cut costs first and struggle to deal with the consequences. Instead do the right thing to provide intelligent care and the costs come down as a result.

 

[theeedude]

I agree. I'm not a big fan of Obamacare. I think Obama is an incredibly weak president to not have pushed for UHC when he had the ability to do so.

He didn't have the ability, because of the filibuster. He needed 60 votes, including Joe Lieberman of insurance company home state of CT, who was married to a health insurance lobbyist. That said, it did expand Medicaid, which is a step towards UHC. Just keep expanding it.

 

[AViking]

He didn't have the ability, because of the filibuster. He needed 60 votes, including Joe Lieberman of insurance company home state of CT, who was married to a health insurance lobbyist. That said, it did expand Medicaid, which is a step towards UHC. Just keep expanding it.

I thought he had the votes for a while. I could be wrong. I could have sworn he could have pushed it through with zero republican support.

 

[Hayabusa Rider]

I thought he had the votes for a while. I could be wrong. I could have sworn he could have pushed it through with zero republican support.

He could have investigated possibilities. Instead the entire treasury of political capital was spent on getting a political solution. You ought to understand the people involved here. They don't want good care, they want control and credit.

 

[Incorruptible]

I want a free market military too.

The government has been restricting my freedom to get the military protection I need and I want for too long! If you can't afford a platoon of Marines to go to Afghanistan and fight for you, well then tough on you! You need to pull yourself up by the bootstraps so you can pay for your own F-35. I don't see why I need to pay my hard earned dollars so the rest of you freeloaders can be defended by a company of M1A2 Abrams. Individual demand for JDAMs will drive the price down for everyone if only the government would stop interfering with the free market! That's what we need for defense in this country, not the BS system we have now.

I'm a libertarian!

Just skipped right over your BS.

 

[Matt1970]

I thought he had the votes for a while. I could be wrong. I could have sworn he could have pushed it through with zero republican support.

He could have, he got the ACA through with zero republican support.

 

[AViking]

So which is it? Could he or not? I don't remember the details.

 

[Hayabusa Rider]

So which is it? Could he or not? I don't remember the details.

I believe he could.

Qualification- I believe he could if he had complete unanimity among the party, which was unlikely.

 

[michal1980]

You'll notice that I actually put a number there. $150,000. A respectable income. Now whether they get paid $125,000 or $200,000 it's going to be a lot less than the average for a radiologist today which is $500,000 in the US..

So you just expect people to take 70% pay cuts so that you can give out "free" care.


Whats your income? maybe it should be cut by the same amount, so that whatever you do can be given away for 'free' too.

 

[Hayabusa Rider]

In any case he could have investigated and presented reforms towards better system. He did not.

 

[Incorruptible]

So you just expect people to take 70% pay cuts so that you can give out "free" care.


Whats your income? maybe it should be cut by the same amount, so that whatever you do can be given away for 'free' too.

As long as he can leech off others then why not? This is the problem with leftists.