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I'm having some conflicting views on health care reform...

Dittohead not! said:
You say that, and yet, every nation that has "socialized" the costs pays less than we do, every single one, no exceptions. Quite a lot less, as a matter of fact.
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Insurance itself socializes cost. My comment suggested that there are always ways to make a service more expensive if the recipient has no incentive to forego it based on cost.

...no one should have to go to the emergency room for something that could be treated at a doctor's office at a tenth of the cost.
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Perhaps emergency rooms should be able to turn people away who aren't there for the right reasons. In other words, if non-emergencies are weighing the system down, then just turn them around at the triage station. There's no logical reason why a non-emergency should incur outrageous costs just because someone steps foot in an ER. And there's no reason it should require an insurance mandate or a public option or any other government intervention to address that simple problem. If people with ingrown toenails were showing up to psychiatric units, would we be obligated to have a psychiatrist evaluate them?

Occam's Razor said:
I'm in pure denial? You are saying there is something other than the profit motive for insurance companies?
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What I'm saying is that our sense of entitlement to health care services makes the health insurance industry UNlike any other industry.

I'm not terribly thrilled with my money going to pave your streets so you can get to work either...
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You mean you're not one of the folks calling for more infrastructure stimulus spending?

Some do... I'd argue with you about it, but the best refutation of that myopic view is to go talk to an ED professional and really listen to what they have to say about the people they see. And don't tell my you know five and they all agree with you, I'll know it's a flat out lie. Seriously... go interview a few... then you'll get it.
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Haha, if you only knew what I do every day. But I don't want to make this an appeal to personal experience. Given the suggestion and your confidence that it will enlighten me, I'm guessing you also either know ER doctors or have interviewed some? If so, maybe ERs are different where you are than where I am.
 
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Neomalthusian said:
Haha, if you only knew what I do every day. But I don't want to make this an appeal to personal experience. Given the suggestion and your confidence that it will enlighten me, I'm guessing you also either know ER doctors or have interviewed some? If so, maybe ERs are different where you are than where I am.
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I go see them more than most people do. Would you like to talk about it?

As a matter of fact in the biz I'm referred to as a walking emergency room because I have a implanted defibrillator.
 
Neomalthusian said:
Insurance itself socializes cost. My comment suggested that there are always ways to make a service more expensive if the recipient has no incentive to forego it based on cost.



Perhaps emergency rooms should be able to turn people away who aren't there for the right reasons. In other words, if non-emergencies are weighing the system down, then just turn them around at the triage station. There's no logical reason why a non-emergency should incur outrageous costs just because someone steps foot in an ER. And there's no reason it should require an insurance mandate or a public option or any other government intervention to address that simple problem. If people with ingrown toenails were showing up to psychiatric units, would we be obligated to have a psychiatrist evaluate them?



What I'm saying is that our sense of entitlement to health care services makes the health insurance industry UNlike any other industry.



You mean you're not one of the folks calling for more infrastructure stimulus spending?



Haha, if you only knew what I do every day. But I don't want to make this an appeal to personal experience. Given the suggestion and your confidence that it will enlighten me, I'm guessing you also either know ER doctors or have interviewed some? If so, maybe ERs are different where you are than where I am.
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Trouble is - you risk turning away the real cases or stopping them from coming in the first place. Take chest pain. The heart does not have any pain receptors so what most people feel is referred pain but that could be ANYTHING from indigestion to back pain to pericarditis to oesophageal spasm to a pulled muscle!!

Because we have very effective anti-clot medication that will stop a heart attack from continuing until it takes out all of the main muscle of the heart we WANT to see any and all chest pains - even the ones that turn out to be some young "precious princess" with her bra on inside out

So, what is driving up the cost of health care in the US? And it is profit. We see it here in Private Hospitals where patients are kept "alive" far longer in ICU than they would be in the public sector - and when I say "alive" I really mean they are simply prolonging death. An 84 year old out of hospital cardiac arrest (survival rate less than 1% in healthy populations) should NOT be put through all the ICU interventions you can find only to withdraw some 2-3 weeks later.

I read one study that suggested one in five deaths in the USA happen in ICU - that is not ! in 5 ICU patients dying that is 1 death in 5 out of all deaths. That rate suggests that people who are irreversibly at the end of life are being admitted to ICU
 
bowerbird said:
Trouble is - you risk turning away the real cases or stopping them from coming in the first place. Take chest pain. The heart does not have any pain receptors so what most people feel is referred pain but that could be ANYTHING from indigestion to back pain to pericarditis to oesophageal spasm to a pulled muscle!!
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When you go into tachycardia it is a pain. Not like when one cuts theme selves but it is a pain. I know this first hand.



Because we have very effective anti-clot medication that will stop a heart attack from continuing until it takes out all of the main muscle of the heart we WANT to see any and all chest pains - even the ones that turn out to be some young "precious princess" with her bra on inside out
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Are you talking warafin? That is a medicine that requires very close supervision and blood tests often. There are some new ones on the market but they are about 7 bucks a pill.

So, what is driving up the cost of health care in the US? And it is profit. We see it here in Private Hospitals where patients are kept "alive" far longer in ICU than they would be in the public sector - and when I say "alive" I really mean they are simply prolonging death. An 84 year old out of hospital cardiac arrest (survival rate less than 1% in healthy populations) should NOT be put through all the ICU interventions you can find only to withdraw some 2-3 weeks later.
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No it is not profit to a large extent that has driven the increase in health care inflation. What has really driven it is technological advancement. MRI's are now common place and amazing drugs are now common place. Even heart transplants are known how to deal with. It is these things that are driving the incredible inflation in health care. Now tack on a for profit insurance corp and it does nothing to help the situation.

I read one study that suggested one in five deaths in the USA happen in ICU - that is not ! in 5 ICU patients dying that is 1 death in 5 out of all deaths. That rate suggests that people who are irreversibly at the end of life are being admitted to ICU
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Well that is kind of what intensive care is for right?
 
winston53660 said:
When you go into tachycardia it is a pain. Not like when one cuts theme selves but it is a pain. I know this first hand.
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Yes, I know because your heart gets it's blood supply during diastole - that is the pause between heart beats and in tachycardia your heart is beating too fast for the blood to flow to the muscle properly so you get pain. But as I said this is a REFERRED pain - is it not actually the heart that is firing off the pain receptors. Often the "pain" people feel is more a tightness or a pressure

Are you talking warafin? That is a medicine that requires very close supervision and blood tests often. There are some new ones on the market but they are about 7 bucks a pill.
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No, I cam talking about lysis. Streptokinase was the first thrombolytic agent and it was investigated in the ISIS II trial. A trial that was actually stopped before it was completed because too many people in the Streptokinase group were surviving as opposed to the "placebo" group and it was considered unethical to continue the trial with such overwhelming evidence in favour - now of course we have metylase and other thrombolytic agents but they have to be given very early in the evolution of the heart attack to "rescue" as much heart muscle as possible

No it is not profit to a large extent that has driven the increase in health care inflation. What has really driven it is technological advancement. MRI's are now common place and amazing drugs are now common place. Even heart transplants are known how to deal with. It is these things that are driving the incredible inflation in health care. Now tack on a for profit insurance corp and it does nothing to help the situation.
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That has driven some of the cost but those costs have also occurred in Australia and Europe and Canada - but unlike those countries the USA's expenses have ballooned - far far in excess of the socialised countries

Well that is kind of what intensive care is for right?
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No ICU is NOT about drawing out a natural death to become a painful and horrible experience - they are about enabling people to survive
 
Neomalthusian said:
Perhaps emergency rooms should be able to turn people away who aren't there for the right reasons. ...no logical reason why a non-emergency should incur outrageous costs just because someone steps foot in an ER.
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Or maybe emergency rooms should simply charge a reasonable cost for the treatements that they provide. A 15 minute consult with an ER intern shouldn't cost anymore than a consult with ones local doc. there's no more expense to the hospital, and no more value to the customer. Emergency rooms in my part of the country may only have a few or two actual true life or death emergencies a day. So why not utilize the time and skills of the staff and utilize the equipment and space treating non-emergency cases around the true emergancy cases (pretty much like we do now).

The number one reason that so many people don't pay the emergency room is because the billing rate of the emergency room is so rediculously high. Charge a rate that is comparable to a non-emergency room and I would expect that a heck of a lot more people would pay the bill. Charge me $800 for xraying my kids arm and I am furious, charge me $80 (what the same xray would cost at my cheapo cash only doctor) and I would be not only more willing to pay it, but more able to pay it.

Our health care crises isn't that not enough people have insurance, it's that too many people think you have to have insurance to pay for health care.
 
Neomalthusian said:
Insurance itself socializes cost. My comment suggested that there are always ways to make a service more expensive if the recipient has no incentive to forego it based on cost.
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I think you're taking liberties with the term "socialize', but nevertheless, what you're advocating is a cash for service, give them the MasterCard up front, then receive your treatment/meds, whatever. It is much the way veterinary medicine is paid for, and, if you have a pet that has had medical care, you understand that doggie and kitty medicine is orders of magnitude cheaper than human medicine. So, you have a good point.

However, when Fido has a heart attack, usually no one does a triple bypass. Fido dies, and the family gets a new puppy.

So, what is needed is a cash for service, but a backup major medical that applies to everyone and pays for that triple bypass.

Didn't someone already describe the system in Singapore, where everyone has coverage and the medical system accounts for 3% (as opposed to 17% here) of the GDP? Now, that's one worth looking at.
 
Neomalthusian said:
Insurance itself socializes cost. My comment suggested that there are always ways to make a service more expensive if the recipient has no incentive to forego it based on cost.
Click to expand...

I think you're taking liberties with the term "socialize', but nevertheless, what you're advocating is a cash for service, give them the MasterCard up front, then receive your treatment/meds, whatever. It is much the way veterinary medicine is paid for, and, if you have a pet that has had medical care, you understand that doggie and kitty medicine is orders of magnitude cheaper than human medicine. So, you have a good point.

However, when Fido has a heart attack, usually no one does a triple bypass. Fido dies, and the family gets a new puppy.

So, what is needed is a cash for service, but a backup major medical that applies to everyone and pays for that triple bypass.

Didn't someone already describe the system in Singapore, where everyone has coverage and the medical system accounts for 3% (as opposed to 17% here) of the GDP? Now, that's one worth looking at.

(This one took forever, then came up with a "you have to wait 30 seconds) message. Did it post? I wonder. this may be a duplicate. If it is, tough.
 
winston53660 said:
No it is not profit to a large extent that has driven the increase in health care inflation. What has really driven it is technological advancement. MRI's are now common place and amazing drugs are now common place. Even heart transplants are known how to deal with. It is these things that are driving the incredible inflation in health care. Now tack on a for profit insurance corp and it does nothing to help the situation.
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In any other industry, improved technology reduces cost, it doesn't increase it.

Neither of you are really getting to the root cause of increased health care costs. The root cause is that we don't have price competition in the health care industry. I can drive by any mall and see prices advertised in the windows. Now healthcare providers advertise plenty, in my town every other billboard is advertising this hospital or that urgent care facility, but non of them are advertising price. You see, since they are really looking for the insured customer, price doesn't matter to their prime customers.

The prepaid medical care industry (which many of us think of as "good" insurance) has largely defeated the free market mechanisms that keep costs low in the medical care industry. Eleminate the $15 copay, increase the $500 deductable to $5,000, and require the consumer to pay a percent of the health care cost no matter how expensive, and we would bring back price competition in the health care industry.
 
winston53660 said:
No it is not profit to a large extent that has driven the increase in health care inflation. What has really driven it is technological advancement. MRI's are now common place and amazing drugs are now common place. Even heart transplants are known how to deal with. It is these things that are driving the incredible inflation in health care. Now tack on a for profit insurance corp and it does nothing to help the situation.
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In any other industry, improved technology reduces cost, it doesn't increase it.

Neither of you are really getting to the root cause of increased health care costs. The root cause is that we don't have price competition in the health care industry. I can drive by any mall and see prices advertised in the windows. Now healthcare providers advertise plenty, in my town every other billboard is advertising this hospital or that urgent care facility, but non of them are advertising price. You see, since they are really looking for the insured customer, price doesn't matter to their prime customers.

The prepaid medical care industry (which many of us think of as "good" insurance) has largely defeated the free market mechanisms that keep costs low in the medical care industry. Eleminate the $15 copay, increase the $500 deductable to $5,000, and require the consumer to pay a percent of the health care cost no matter how expensive, and we would bring back price competition in the health care industry.
 
imagep said:
In any other industry, improved technology reduces cost, it doesn't increase it.

Neither of you are really getting to the root cause of increased health care costs. The root cause is that we don't have price competition in the health care industry. I can drive by any mall and see prices advertised in the windows. Now healthcare providers advertise plenty, in my town every other billboard is advertising this hospital or that urgent care facility, but non of them are advertising price. You see, since they are really looking for the insured customer, price doesn't matter to their prime customers.

The prepaid medical care industry (which many of us think of as "good" insurance) has largely defeated the free market mechanisms that keep costs low in the medical care industry. Eleminate the $15 copay, increase the $500 deductable to $5,000, and require the consumer to pay a percent of the health care cost no matter how expensive, and we would bring back price competition in the health care industry.
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while i agree with your conclusion, i do not concur with your preamble


in what industries does improved technology reduce cost?
 
justabubba said:
while i agree with your conclusion, i do not concur with your preamble


in what industries does improved technology reduce cost?
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Television, radio, computers, desktop printers, canning, bottling, clothing manufacture, farming, automobile manufacturing, road repaving, just about everything except healthcare.
 
Harry Guerrilla said:
Flex spending accounts are the ones where you lose the unspent dollars.
HSA money accrues over your lifetime.
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I get calls everyday from insurance salespeople, I usually hang up on them promptly, but the other day I was explaining to one of them that I have an HSA and he said "what is that", I explained what it was and he then said something about it "going away at the end of the year". Insurance companies don't want people to know about HSA's and they don't want people to know about high deductable policies. Like anyone in any other industry, they make more money when they sell larger products, so they never even mention that they have insurance plans for $100 a month, or that you can self-insure tax free.

Yes, a HSA is a bank account that anyone can setup at their local bank. It's simply a savings account which is designated as a "HSA". It has nothing to do with the insurance company, although it is only tax deductable if you have a high deductable health insurance policy.
 
imagep said:
Television, radio, computers, desktop printers, canning, bottling, clothing manufacture, farming, automobile manufacturing, road repaving, just about everything except healthcare.
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The difference is that, in the case of health care, life saving procedures are now possible that weren't possible a few years ago. Those life saving procedures are more expensive than funerals, which will have to be performed sooner or later anyway.
 
Dittohead not! said:
The difference is that, in the case of health care, life saving procedures are now possible that weren't possible a few years ago. Those life saving procedures are more expensive than funerals, which will have to be performed sooner or later anyway.
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Thats fair enough. I can't argue that tv's are more or less expensive than they were before they existed.
 
imagep said:
I get calls everyday from insurance salespeople, I usually hang up on them promptly, but the other day I was explaining to one of them that I have an HSA and he said "what is that", I explained what it was and he then said something about it "going away at the end of the year". Insurance companies don't want people to know about HSA's and they don't want people to know about high deductable policies. Like anyone in any other industry, they make more money when they sell larger products, so they never even mention that they have insurance plans for $100 a month, or that you can self-insure tax free.

Yes, a HSA is a bank account that anyone can setup at their local bank. It's simply a savings account which is designated as a "HSA". It has nothing to do with the insurance company, although it is only tax deductable if you have a high deductable health insurance policy.
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Absolutely true, although your insurance company will determine how many HSA dollars are used per healthcare service. Many people forget that part of what you pay an insurance company for is the discounted fees they've negotiated with providers.
 
roguenuke said:
I really hate the comparison between the health insurance mandate and a car insurance mandate, for one very good reason. I am 31 years old and have never had car insurance in my life and that is completely legal and has never caused me to face any sort of fine or tax penalty or punishment of any kind because I have never had a driver's license. With this health insurance mandate, however, I face such punishment for just living and choosing not to get insurance. That is wrong.
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Driving on a public road is no more a privilege than walking into a private restaurant. We demand that owners of restaurants adhere to the CRA despite the fact that their business is their business (regardless of the fact that their private business sits on a public domain). The road may be a public domain, but it certainly is no privilege of the few.
 
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