Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[Kilmer17]

Is that an endorsement of single payer?

I can't see it ever getting passed though because of the AMA.

It's been my stance all along. I want NO Govt involvement at all in HC.

BUT if it HAS to be involved, the ONLY way it will work is Single Payor.

[JMS]

I can't see it ever getting passed though because of the AMA.

The AMA is not the end, it is just the beginning. Medical costs are the 800 lb gorilla in the room in budgetary talks. We will definitely see more legislation on this issue.

---------- Post added June-29th-2012 at 02:20 PM ----------

It's been my stance all along. I want NO Govt involvement at all in HC.

BUT if it HAS to be involved, the ONLY way it will work is Single Payor.

Kilmer, where have you been living for the last 42 years. Healthcare in this country is one of the most heavily regulated segments of our economy.

Ever doctor, company, medicine, procedure are all liscensed and veted through the government. Every institution is subsidized by the government.

To say you want "no government involvement in HC"; is advocateing the return to the days of Dodge city when Doc patched up all of Marshal Dillin's victems / foes.

Specialization has made "no government involvement" unworkable for 60 years.....

No government involvement is not on the table. The question is how do you ensure competition in a heavily government regulated system? Should you?

For the last 70 years the answer to that question has been no. AMA does not fundimentally change that. It could, should and hopefully eventually will.

[Koolblue13]

The question then becomes "what part does government take over?"

Do you want a Canadian single payer system? A British NHS system?

That's a good question. I don't know enough about other systems to really make the distinction.

I'd like to be able to go to the doctor and dentist and put my health above the importance of my rent. I think everybody should be allowed.

Health and education are things I feel every person should have the same access to and it's the only way a nation can grow.

[PeterMP]

Americans don't consult with doctors twice as much as the french, Germans or Italians. Nor do we get 2 or 3 times more services per capita than do these other countries... Our spending per capita difference is entirely based upon the fact that our services cost more, not that our institutions provide more services.

Our healthcare services cost more souly because it's to the benifit of our service providers to charge us more, and in the absense of competiton that's an easy way too high profits, which is the primary goal of any corporation.

I don't think this is entirely true. Right off the bat, I can tell you that we take more pharmaceuticals and the pharmaceuticals we take are the more expensive version then in other countires:

http://www.extremeskins.com/showthread.php?363484-Gov-t-is-main-cause-of-healthcare-expense&p=8900726&viewfull=1#post8900726

(Though as you can see at the link, I've told you this before.)

Oh and my favorite, mammogram usage:

http://www.extremeskins.com/showthread.php?363484-Gov-t-is-main-cause-of-healthcare-expense&p=8901244&viewfull=1#post8901244

"We also use more of other things than other countries. We get more mammograms than Canadians:

http://secure.cihi.ca/cihiweb/products/Medical_Imaging_in_Canada_2004_e.pdf

"Information from the 2002–2003 Joint Canada/United States Survey

of Health indicates that, overall,American women aged 50–69 were

more likely than Canadian women of

the same age to have had a recent

mammogram. In the survey, 82% of

American women aged 50–69

reported that they had a

mammogram in the last two years,

compared to 74% of Canadian

women in that age group"

Weren't you one of the people screaming when a goverment panel suggested that not everybody needs a mammogram starting at 40?

http://www.extremeskins.com/showthread.php?308596-Breast-exam-guidelines-now-call-for-less-testing/page6

Yup. And the great WHO says we should only do mammograms every 2 years."

Now, I'm not saying that pure costs (i.e. costs/proceduere) isn't part of the issue.

But there is evidence that usage is also part of the story, and your claiming it is SOULY due to increased costs and not usage.

I can also point you to studies that show that people that have strokes in the US do a better job of recovering from them because we have more of the stuff to treat them, which drives up health care costs, but also drives up long term productivity (I've actually posted that study for you before too). That is we have more of the pieces of equipment per capitia so everybody that has to use it has to pay more, but having more of them means people with strokes get to them faster (don't have to travel as far) and so they suffer fewer long term side affects from the stroke.

Serious question, when somebody shows you evidence that disagrees with your point of view, do you ever actually internalize that information?

Edited June 29, 2012 by PeterMP

[Jumbo]

Serious question, when somebody shows you evidence that disagrees with your point of view, do you ever actually internalize that information?

In fairness, a query that would be reasonable to apply (at least sometimes) to a sizable number of regular posters.

[PeterMP]

Would anybody really complain if the federal government went to the health insurance companies and said we want you to draw up 3 plans that meet these criteria (three different plans w/ three different criteria so people could have a selection), and then quote a price for individuals to get that insurance. Give a list of different "pretend" individuals and their health states (in a range e.g. white female from 30-35) and what you'd charge them for each of the three plans (where each company is giving quotes for the same "pretend" individuals with the same range of health states).

Then individuals could go the the health insurance industry and say I meet the criteria of this "pretend' individual and you said you'd charge such people $X, I want to buy that insurance. If the insurance company refused to sell it at that price, the person could take them to court (something akin to false advertisement) where the company would have to show that for some reason the person significanly deviated from the "pretend" person their quote was based on.

If you didn't want something that was part of one of the governments plans or you were significantly different from the "pretend" people, you'd still have some starting basis at what your cost should be.

And everybody could see the costs differentials between the different companies for different criteria pretty easily.

Edited June 29, 2012 by PeterMP

[hunterx]

It's been my stance all along. I want NO Govt involvement at all in HC.

Without some government involvement, who pays for the uninsured if they are in a bad accident and they have to be air lifted to the hospital and have limbs amputated? No government involvement seems pretty third world to me.

[HBnotBlades]

I'm not sure a state could do it by themselves. There are lots of federal regulations and issues which come up even in our existing system which is heavily supported with federal dollars.

Good luck though.

That's the reason the single payer system won't begin until 2018. There's a lot to work out between now and then.

But hey, if it can't work in the healthiest state in the nation, it definitely can't work for the nation over all.

[Kilmer17]

Without some government involvement, who pays for the uninsured if they are in a bad accident and they have to be air lifted to the hospital and have limbs amputated? No government involvement seems pretty third world to me.

It's far too late to put the genie back in the bottle.

A private system would work, but it's far too late for it.

The expansion of Obamacare makes a system currently bankrupting the country even more costly.

[70th Week]

So, what exactly does this mean?

‘‘( ABORTION SERVICES.—

‘‘(i) ABORTIONS FOR WHICH PUBLIC FUNDING IS

PROHIBITED.—The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and Human

Services is not permitted, based on the law as in effect

as of the date that is 6 months before the beginning

of the plan year involved.

‘‘(ii) ABORTIONS FOR WHICH PUBLIC FUNDING IS

ALLOWED.—The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and Human

Services is permitted, based on the law as in effect

as of the date that is 6 months before the beginning

of the plan year involved.

Does this mean tax dollars are going to fund abortions?

[Kilmer17]

So, what exactly does this mean?

‘‘( ABORTION SERVICES.—

‘‘(i) ABORTIONS FOR WHICH PUBLIC FUNDING IS

PROHIBITED.—The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and Human

Services is not permitted, based on the law as in effect

as of the date that is 6 months before the beginning

of the plan year involved.

‘‘(ii) ABORTIONS FOR WHICH PUBLIC FUNDING IS

ALLOWED.—The services described in this clause are

abortions for which the expenditure of Federal funds

appropriated for the Department of Health and Human

Services is permitted, based on the law as in effect

as of the date that is 6 months before the beginning

of the plan year involved.

Does this mean tax dollars are going to fund abortions?

Yep.

[Larry]

To say you want "no government involvement in HC"; is advocateing the return to the days of Dodge city when Doc patched up all of Marshal Dillin's victems / foes.

You're reminding me of an OT trivia question:

Who was the last person killed on the TV series Gunsmoke? (Ninja answer below.)

Gary Busey.

[/OT]

---------- Post added June-29th-2012 at 03:22 PM ----------

Does this mean tax dollars are going to fund abortions?

Yes.

If such funding was already built into law, before.

(Which, I think, means the mother's life is in danger, or rape.)

[Jumbo]

Let's deal with reality.

We already have the government up to it's neck in HC and long have.

Our HC is a mess, costs are crazy high and vary wildly (recently called on the same basic simple procedure in three towns within a 150 mile radius and got figures of $2500, $3700, and $4500).

Red-tape/paperwork on all ends is crazy.

Information-processing and billing are insanely complicated and inefficient.

Insurance companies can often seem one step above organized crime (ok, a bit of hyperbole).

The pharmaceuticals are right up there with big oil in every socially controversial angle there is, yet we are ever-directed to being a more "pill-addicted" society.

For all our parroted mouthings about the excellence of our system (and all the very real truth there is in that), annually we have a stunning volume of genuine malpractice, malfeasance, and widespread incompetence in hospitals and many other medically-related clinics and facilitaties, and even a large number of unexplained deaths while under direct medical care. On an anecdotal level, I have personally been on both the "awesome" and the "total cluster****" end of this in my own medical history.

The private sector (in any area) is just as guilty as "the government" (include local; it ain't just the feds in play here) of malfeasance, endless greed, inefficiency, stupidity, criminal activity and self-interest over any cost to society as a whole.

Why? Maybe because just as in government, the drivers seats of the "private sector" are often made up of people of certain types, and formed in a culture where materialsm rules.

So it is and has been both a scientific wonder and a complete cluster**** of a system for some time. I'd be fine with trying a major change like single payer. I've spent many years now in WA state and the rest of the PacNW and have known many Canadians who also live in the U.S at times. If I were just to go by their input, they're happy with their health system (and their government in general, btw). It's been that way in the three decades I've been mainly in this area. Obviously, it's not what I base my thinking on, but I do note it. My hope is that while there is going to be some compromised and convoluted form of reform, at best, if it's allowed to occur at all, that it will still shake things up enough that overall improvements will eventually rise to the top.

Sometimes in a seriously dysfunctional system, you make a decision to do something significant (trying to make it as well-designed an intervention as possible, of course) but mainly knowing that to do nothing isn't likely to improve matters, and at least doing something can disrupt the log-jams and rigid patterns. You hope the resulting shakeup allows for better ideas, ways, and choices to at least get a chance to breathe.

And it's not a "do it and stand back and watch" passive thing; it requires active and guided involvement of all those concerned. The people laying out the new plans have a lot of responsibility to get it as right as they can, and then that runs all the way down the line. Good luck to us.

Edited June 29, 2012 by Jumbo

[JMS]

I don't think this is entirely true. Right off the bat, I can tell you that we take more pharmaceuticals and the pharmaceuticals we take are the more expensive version then in other countires:

http://www.extremeskins.com/showthread.php?363484-Gov-t-is-main-cause-of-healthcare-expense&p=8900726&viewfull=1#post8900726

(Though as you can see at the link, I've told you this before.)

And you can see my rebuttle to your previous link. This doesn't prove what you suggest it does. In the abstract it goes on to say..

ABSTRACT: This issue brief contrasts prescription drug access' date=' affordability, and costs in the

United States with six other high-income countries, drawing from Commonwealth Fund survey

data of patient experiences as well as international spending and pricing data. The analysis

reveals that Americans,[b'] particularly the relatively young and healthy, are more likely to use

prescription drugs than are residents of [/b]Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, but they also experience more financial barriers in accessing medications and spend more out-of-pocket for prescriptions. In the U.S., there are also larger income-related inequities in pharmaceutical use. Despite access barriers and disparities, spending per person in the U.S. is far higher, likely the result of paying higher prices for similar medications and using a more expensive mix of drugs. The authors say that value-based benefit designs, reference pricing, and group purchasing could reduce financial barriers and keep down pharmaceutical spending.

Note nowhere in this study does it suggest Americans are less healthy than any other country, much less twice as unhealthy, or three times as unhealthy as the per capita spending would suggest.. Rather your paper supports my hypothesis directly that We pay more, simple because the companies charge us more... Your study also says relatively young and healthy people use more perscriptions which further disproves the hypothesis you are trying to support.

Oh and my favorite, mammogram usage:

"We also use more of other things than other countries. We get more mammograms than Canadians:

http://secure.cihi.ca/cihiweb/products/Medical_Imaging_in_Canada_2004_e.pdf

Among women age 50 to 54, Europeans get only 88% as many Pap smear tests and only 60% as many mammograms as Americans do, on a per capita basis

These are diagnostic proceedures and are generally done as a result of policy. This is not evidence that Americans are less healthy.

Now, I'm not saying that pure costs (i.e. costs/proceduere) isn't part of the issue.

But there is evidence that usage is also part of the story, and your claiming it is SOULY due to increased costs and not usage.

Neither of which are on topic. The hypothesis you are addressing is whether Americans are less healthy than every other nation combined by a factor of 100-200% as reflected in our spending per capita. That is what I was refuting, and that is what you are thus trying to prove.

Serious question, when somebody shows you evidence that disagrees with your point of view, do you ever actually internalize that information?

Serious question, when you comment on threads, do you ask yourself if you addressing the Topic before you get flipant, or only after it's pointed out to you?

There is no study which shows Americans are less healthy as a population than say France, Italy, or Germany by a factor approaching our percapita spending delta.

Yes we get more mamograms for women ages 50-54... Does that mean we are less healthy? No. Does it mean we spend more on mamograms per capita...only for women in that demographic.

I assert to you now, Americans are not the least healthy people on the planet, never have been. We pay more for healthcare almost entirely because we can and because the companies who are in a position to dictate our consumption, do so to benifit their own bottom line, which of coarse is to be expected from for profit corporations.

Edited June 29, 2012 by JMS

[Jumbo]

Serious question, when you comment on threads, do you actually ask yourself if you are answering the questioned asked ?

.

I will repeat my earlier post and say this is well-applied to many; and I'll add the themes of "reading comprehension", "stepping back and checking yourself", "emotionality", and "just being argumentative" for now. :pfft:

[sjinhan]

The pharmaceuticals are right up there with big oil in every socially controversial angle there is, yet we are ever-directed to being a more "pill-addicted" society.

lets keep the oil companies out of this mess...

everyone pays for oil/gas one way or another... you really see pricing on oil/gas be dominated by market forces in general. People's major beef with the oil industry seem to be that the oil industry does not want to give it all away for free...

[JMS]

I will repeat my earlier post and say this is well-applied to many; and I'll add the themes of "reading comprehension", "stepping back and checking yourself", "emotionality", and "just being argumentative" for now. :pfft:

Always good advice. I appologize pete if my flipant response lowered the tone of our discussion.

[PeterMP]

And you can see my rebuttle to your previous link. This doesn't prove what you suggest it does. In the abstract it goes on to say..

Note nowhere in this study does it suggest Americans are less healthy than any other country, much less twice as unhealthy, or three times as unhealthy as the per capita spending would suggest.. Rather your paper supports my hypothesis directly that We pay more, simple because the companies charge us more...

These are diagnostic proceedures and are generally done as a result of policy. This is not evidence that Americans are less healthy.

Neither of which are on topic. The hypothesis you are addressing is whether Americans are less healthy than every other nation combined by a factor of 100-200% as reflected in our spending per capita. That is what I was refuting, and that is what you are thus trying to prove.

Serious question, when you comment on threads, do you ask yourself if you addressing the Topic before you get flipant, or only after it's pointed out to you?

There is no study which shows Americans are less healthy as a population than say France, Italy, or Germany by a factor approaching our percapita spending delta.

Yes we get more mamograms for women ages 50-54... Does that mean we are less healthy? No. Does it mean we spend more on mamograms per capita...only for women in that demographic.

I assert to you now, Americans are not the least healthy people on the planet, never have been. We pay more for healthcare almost entirely because we can and because the companies who are in a position to dictate our consumption, do so to benifit their own bottom line, which of coarse is to be expected from for profit corporations.

1. I'd suggest you go back and read the post I quoted. It doesn't say anything about unhealthy.

2. The abstract supports your hypothesis IF, you ignore the second part that you didn't highlight and the fact that we also get more mammograms.

3. How our health care companies "in a position to dictate our consumption"?

4. There are a large number of studies that show when compared to most nations that we have data on that the US at least in many categories is an outlier in terms of health.

5. I never claimed that increases in charges of services was NOT a part of the differences in costs. My point is that it isn't the ONLY differences. The words SOLELY and ENTIRELY (two words you used in posts) shouldn't be part of the conversation when we discuss why our health care costs more.

Edited June 29, 2012 by PeterMP

[Jumbo]

lets keep the oil companies out of this mess...

everyone pays for oil/gas one way or another... you really see pricing on oil/gas be dominated by market forces in general. People's major beef with the oil industry seem to be that the oil industry does not want to give it all away for free...

Perhaps you should follow your own suggestion. :pfft:

Mine was a passing note used in very limited fashion. You're really extending the matter with an expansion that begs responses.

So let's all avoid that rabbit hole together.

[JMS]

lets keep the oil companies out of this mess...

everyone pays for oil/gas one way or another... you really see pricing on oil/gas be dominated by market forces in general. People's major beef with the oil industry seem to be that the oil industry does not want to give it all away for free...

I think Jumbo's point was oil companies conspire to set prices... They buy verticals in their markets such as oil production, transportation, refining, distribution of refined gasoline, storage and finally gas resellers.... When crude oil is plentiful they say refinaries are charging more... When refinaries have surplus they say storage farms have excess whicih have to be paid for. They always have a reason why gasoline goes up when it seemingly should go down and typically the bad guy they are pointing too is themselves... Regardless it doesn't matter because 3-4 companies control all the pumps and the costs go up together so the consumer has no choice but to shell out.

Contrast this with the Large Drug companies, who sell their drugs at half the price of what they charge here in the united states abroad. Canada for instance sells US drugs at half the price as the US market. Not one drug mind you, but as a general rule. So much so Bush took the extrodinary step of making it illegal for Americans to travel to Canada and buy American drugs and return to the United States with them !! US drug companies aren't selling those drugs in Canada at a loss. They sell them here for more siimple because they can... Thus the big oil comparison.

Bottom line is our economy in 2012 is more akin to the US economy of the 1890's when Trusts ran everything, and less like the US economy of the 40's - 60's when we were at our economic heights.

Edited June 29, 2012 by JMS

[Mad Mike]

Americans don't consult with doctors twice as much as the french, Germans or Italians. Nor do we get 2 or 3 times more services per capita than do these other countries... Our spending per capita difference is entirely based upon the fact that our services cost more, not that our institutions provide more services.

Our healthcare services cost more souly because it's to the benifit of our service providers to charge us more, and in the absense of competiton that's an easy way too high profits, which is the primary goal of any corporation.

Yay capitalism.

And before someone starts calling me a commie, the point isn't that capitalism is bad, the point is that it's not the best answer to everything as we have been told ad nauseum by the right.

[JMS]

1. I'd suggest you go back and read the post I quoted. It doesn't say anything about unhealthy..

Let me support myself then in this thread, since this thread is the thread you reponded too and which I am currently involved in.

#491

When looking at costs per capita, we have to figure in the fact that we have the least healthy population in the world as well...

To which I said..

#495

Americans don't consult with doctors twice as much as the french, Germans or Italians. Nor do we get 2 or 3 times more services per capita than do these other countries... Our spending per capita difference is entirely based upon the fact that our services cost more, not that our institutions provide more services.

Our healthcare services cost more souly because it's to the benifit of our service providers to charge us more, and in the absense of competiton that's an easy way too high profits, which is the primary goal of any corporation.

To which you said.

#499

I don't think this is entirely true. Right off the bat, I can tell you that we take more pharmaceuticals and the pharmaceuticals we take are the more expensive version then in other countires:

To which I said

None of that proves Americans are the least healthy people on the planet.

To which you said

I'd suggest you go back and read the post I quoted. It doesn't say anything about unhealthy

And no, Young healthy Americans taking more expensive drugs doesn't support Americans are less healthy. Nor does American Women ages 50-54 getting 40% more mamograms.

Rather both of these points support the hypothesis that our healthcare system excells at creating profits for itself, not in addressing the legitamate health needs for the population.

Edited June 29, 2012 by JMS

[PeterMP]

I want to point out that even in the US amongst populations with similar health states and similar health out comes that health care usage, and therefore costs, can vary dramatically.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

That even if we are similarily healthy to the other countries we are comparing costs too that doesn't mean we can't and don't use more health care and therefore drive up costs (even w/o any real benefits).

[JMS]

Yay capitalism.

And before someone starts calling me a commie, the point isn't that capitalism is bad, the point is that it's not the best answer to everything as we have been told ad nauseum by the right.

Capitalism is the most efficient way of distributing goods and services ever invented. If we take that as a fact.. What then does it tell us logically that Socialized Canada sells US Drugs at 50% of the cost as they are sold here? I tells us we don't have anything approaching capitalism currently in the healthcare delivery in this country...

Now that's not a bad thing, because capitalism while efficent is not exactly very equitable, and we've decided as a society we don't want to limit medical procedures to the .001% of the population who could afford to pay for them out of pocket if nobody else in the country were able to participate. IT's a fact, that given the great improvements in healthcare over the last 100 years, specialization has made affording these benifits unaffordable to any individual. Thus we knowingly use a form of collectivism to pay for services. Healthy people pay for the costs of those in need in the way of insurance.. I healthy guy, pay monthly and sick people get services on my dime, and when I'm sick other healthy people will help pay for my bills. Even those who can afford to pay as they go, and don't buy insurance today benifit from this collectivism. The biggest difference between our system and what the rest of the industrialized world employs is that our collective system is designed to create profits, and the rest of the world has systems designed to create services.

This occured in the early 1980's when Ronald Reagan (bless his soul) changed the US healthcare system from non profit, to for profit. He did so because he reasoned nobody was better at holding down expenses and ratcheting up efficiency than Big Business. Only Ronie had it wrong. Big Business is primarily great at making profits. If they can do that by efficency, or holding down expenses they will do that; but if they can do it by charging more in an economic niche already devoid of competition; they'll do that too. And that's exactly what has happenned.

The costs as a percentage of GDP which motivated Reagan to implement reform have exploded, and now we are looking at basically trying to slow down that growth in spending before it sucks us under the rapids... Set to happen sometime in the next 5-10 years when healthcare costs will reach 20% of GDP and will bankrupt the government.

For refference sake healthcare costs were 5% of GDP when Nixon was in office 9% of GDP under Reagan, 13% under Clinton...

---------- Post added June-29th-2012 at 04:39 PM ----------

That even if we are similarily healthy to the other countries we are comparing costs too that doesn't mean we can't and don't use more health care and therefore drive up costs (even w/o any real benefits).

I don't disagree with that. Since most people follow there doctors orders when seeking services, even if we get a few more services that's still a function of our healthcare system...

Ultimately though our proceedures, drugs, hospital stays, all cost more; and that is the primary reason we spend more per capita on healthcare.

Edited June 29, 2012 by JMS

[PeterMP]

Let me support myself then in this thread, since this thread is the thread you reponded too and which I am currently involved in.

Your comment wasn't entirely true

You said:

"Our spending per capita difference is entirely based upon the fact that our services cost more, not that our institutions provide more services."

I'm saying the post that includes that statement isn't entirely true. There's plenty of evidence that our institutions do provide more services. It isn't the SOLE driver of our health care costs and might not even be the primary driver of the difference, but is certainly a component of the issue. It isn't ENTIRELY absent from the equation.

From there, it is possible that our increased services don't actually benefit us that much.

But there is evidence that we are less healthy than much of the rest of the countries we are being compared to.

We do rank #1 for obeisty for the countries that I've see data for, we do rank #1 for AIDS amongst 1st world countries, we do rank #1 for accidents, we do rank #1 for gun violence, we aren't #1 for cancer, but we are above average.

How much do these issues drive the amount and type (e.g. expensive drugs) of our health care consumption? I don't know.

But I doubt you do either.

---------- Post added June-29th-2012 at 06:38 PM ----------

I don't disagree with that. Since most people follow there doctors orders when seeking services, even if we get a few more services that's still a function of our healthcare system.

I'll agree with this.

I've said in many threads, unless we can change the way we deliver healthcare information to people and doctors, I expect a pure free market in healthcare to fail.

There's a lot of evidence that people don't make good decisions with respect to their healthcare. If people can't make good decisions, then a free market will fail.

There's actually evidence that doctors don't make good decisions (e.g. they are influenced by Pharma commercials).

Edited June 29, 2012 by PeterMP