Healthcare for all, not Trump or Obama care

SpaceNut · 2017-10-15 17:07:48

Republican senator 'very disappointed' in Trump's actions on health care ending health-care subsidies to low- and middle-income Americans under Obamacare.

“This is the equivalent of health-care arson. He is literally setting the entire healthcare system on fire
Partisan clash on Obamacare raises specter of government shutdown

“These certainly are very disruptive moves that will result in smaller numbers of people being insured, that will make it more difficult for low income people to afford their out of pocket costs, and that will destabilize the insurance market,” ..
Democrats accused President Trump of trying to sabotage the nation’s health-care system through his decision to halt payments to insurers meant to shore up the system, while Republicans countered Sunday that Trump is just pushing for a hard bargain.
Trump’s decision, announced Friday after months of criticizing the payments as an insurance industry bailout, will throw in doubt the private insurance exchanges that are part of the Affordable Care Act. Democrats vowed to use year-end negotiations on the federal agency budgets as a leverage point to reinstate the payments, vowing to pin the political blame on Republicans if premiums skyrocket next year.

AP FACT CHECK: Trump's tax plan, health care distortions

clark · 2017-10-17 03:02:12

So couple things on the previous posts...

Currently, the US healthcare model is primarily focused on reactive emergency level care. The underlying premise is that ethically, if you are in a critical state, we must care for you. Our entire system is currently predicated on that assumption. All else flows from that.

Our preventive care model is poorly designed and does not operate under the same ethical obligations. Hit by a car and bleeding out, we will help stabilize you. Hit by a car and can limp away, you better have insurance or cash if you want physical therapy.

So enter insurance, a form of legalized gambling where you are hedging against an eventuality. It used to be I pay $100 a month, regardless of if I used healthcare or not. If I did use healthcare, insurance footed the bill. If I didn't use it, insurance pocketed the money. So there was no incentive for me to NOT get healthcare. After all, the only winner here is the faceless insurance.

I didn't have to be frugal. I didn't have to shop around. I just showed up and the doctor cooked up a plan to keep me healthy. The doctor had no incentive to be frugal, or to order the generic drug or the cheaper, less complicated lab, or use the older medical device that was cheaper and 95% as effective as the newer model. Hell, outcomes didn't even matter- if I didn't get better, in a perverse way, the doctor made more money. Faceless insurance paid the bill. Times were good.

Then faceless insurance started saying, "hey, we have to approve your medical care first. We need to control costs...". And much complaining ensued. Who was insurance to decide who lived and died? Medical decisions were between patients and physicians after all.

So enter copays and deductibles. Contracted rates. In-network providers. This is a tool by faceless Insurance to get patients and providers to have skin in the game. Now, me, has to pay more than $100 a month. Now I have to think twice about that drug, that lab, that procedure. It's not a free lunch. It's not faceless insurance telling me not to get something done, it is my own self determination (based on personal financial constraints). Physicians agree to limited costs for the work they perform, which impacts how they guide care (doesn't determine it, but it does influence). Faceless insurance will approve expensive procedures based on agreed to medical conditions that must be proven by physicians (with onerous documentation and review, by design). Significantly expensive procedures or drugs are carved out in volumes of patient insurance contracts that allow insurance to shift near 100% cost to the physician or patient.

So why is it so broken? Greed. Profit motive is one of the problems with the market place. US healthcare has accepted that profit has a place in healthcare delivery. It doesn't need to be (there are proven US models that not non-profit). The other reason is that US population has a low tolerance for personal accountability/requirements when it comes to healthcare. Example: a yearly physical is not mandatory, but should be. It would help improve overall US health and begin the process of establishing preventive care as a way of life. Mandatory flu vaccines should be part of any health reform. Mandatory nutrition programs. Mandatory mental health check-ups. Mandatory dental, vision and hearing screening.

It sounds crazy, but that's what is required to fix the system- a huge societal shift that makes the deal that we as a society foot the healthcare bill, but we also hold each other accountable towards maintaining good health.

And this brand of crazy is how it will be on Mars (or space).

SpaceNut · 2017-10-17 16:06:13

The mandatory it is what is termed well care and not really health care to which the physical is used by the doctors practice to force the patient to come in once a year to keep the primary care doctor as your doctor or they dump you from there roles.

This is a tier 1 well care level premium payment to which you are entitled to use that level of benefit as implied to make sure you are doing all the right things to stay healthy at no additional cost to you the patient.

GW Johnson · 2017-10-17 16:24:04

When I was a boy, health care was payment-based, not insurance-based. You paid out-of-pocket for Dr visits. It was affordable for middle class folks, especially if there was employer-provided insurance (NOT a given for most jobs then). It was almost out-of-reach for poor folks, which is why they did not live as long. In retrospect, quite unfair!

Since then, the whole concept of insurance has been corrupted into a payment-hiding system, as regards healthcare. Routine Dr visits are no longer affordable to the middle class, much less the poor. Insurance was supposed to help with the acts-of-God that caused losses, not with routine costs. Unless you actually use that model, "insurance" becomes unaffordable very quickly, which is exactly what we have seen.

Everybody is deceiving themselves with this-or-that belief system, instead of facing the actual facts on the ground. A whole lot of things are not really rationally priced anymore, and health care is only one of them. The point is to face up to "what is", and decide how we are going to supply this need in our society from this point forward.

Government exists to supply those needs that private entities either cannot, or will not, supply. There is no other purpose for it. THAT is the basis of American government as we know it, and it has been, since our founding ~2.5 centuries ago. If private entities cannot supply healthcare to all without driving everybody to the poor house, then is it not time to consider the alternative?

GW

Last edited by GW Johnson (2017-10-17 16:25:46)

SpaceNut · 2017-10-17 17:01:57

The town had 2 Doctors when I was growing up both of which did home visits for the sick, shut ins, as well as did a walkin business location and surgical at the near by city hospital. They carried a tab on each patient, did pay as you go after each visit as well as when you can as they knew you were poor and they did take insurance. They gave out medical samples to the poor to help with medication costs. Sure they did well care, urgent care and emergency care without inflationary gouging, or robbery of the insurance company or patient.

GW Johnson · 2017-10-18 10:28:54

My mother told me our family doctor made a house call to tend me when I nearly died of chickenpox as a child in the 1950's. The housecall pretty much disappeared from America in the 1960's.

Today, the insurance delivery model forces doctors to allocate 15 minutes to your visit, regardless of your actual need for the visit. If it cannot be treated in 15 minutes, you must schedule a repeat visit. The delay for that is not just days anymore, it is verging into weeks now, as the system increasingly fails. The net effect is a shift toward very long delay of treatment: which reduces patient load by die-off of the untreated, instead of preventative care. We've already seen it with the VA.

The VA is a government entity that operates indistinguishably from a corporation: brain-dead and lacking ethics. All giant organizations, including government entities, suffer from this effect.

This accelerating failure of American health care is the "corporate ethics problem" in action in our healthcare system (which ethics problem I have railed about before): money is valued more than human life. That behavior will persist until it is punished in some way. Simple as that. And just as hard to fix.

GW

Last edited by GW Johnson (2017-10-18 10:35:26)

Terraformer · 2017-10-18 14:19:17

How long do you have to wait to see a doctor in the US? With the NHS (UK), it's around 3 weeks to see a General Practitioner.

RobertDyck · 2017-10-18 16:08:03

In Canada, I normally go to a walk-in clinic. I have to wait an hour or two. When I was a child and my sister got asthma, my mother brought her to our family physician. She waited in the waiting room, stressing over the fact my sister had difficulty breathing. Turns out she ate a candy with tree nut oil, she's allergic, the doctor gave her an injection of adrenaline. Well, that's what my mother said; it may have been Epinephrine. When I was 18 in 1980, I had a cyst on the back of my wrist. The doctor said it had coiled itself around the small bones of my wrist. I had surgery to get it removed. Surgery was scheduled in a hospital just 2 weeks after seeing the doctor. It was considered elective surgery.

I lived in the US twice: June to December 1996, and beginning of June 1999 through end of March 2000. Both times I never had to see a doctor, so can't give a personal experience there.

Last edited by RobertDyck (2017-10-21 22:19:29)

NimaiGifi · 2017-10-21 03:38:54

From the Simpsons "in One plate we have Baracolli Obama" and in the other we have "Meat Rommeny" Which do you think the Dog will choose? RELEASE THE HOUND

RobertDyck · 2017-10-21 09:20:32

NimaiGifi, your profile says you're in Bulgaria. Yet you post a quote that I've seen on Facebook. Obama's system is based on the one Romney proposed while he was governor of Massachusetts. They're the same.

Again I point out that I've seen TV news when Obama was president. He complained that many members of his party (Democrat) wouldn't be happy until they got the full Canadian healthcare system. So what's wrong with that? In the Politics thread, I suggested America adopt Canadian Healthcare. Again, it's not free, there's a premium. But it's a lot less expensive. In Canada, government healthcare is considered basic minimum. Many employers offer supplemental heath insurance on top of that.

Last edited by RobertDyck (2017-10-21 09:23:50)

GW Johnson · 2017-10-21 10:31:14

To answer Terraformer's question in post 32 above: 3 days to a week, rarely longer, to see the family general practitioner. I have noticed that the physician's patient load is so high, that I am often seen by the physician's assistant, not the physician himself. THAT is the evidence of rationing, in turn evidence of the inherent failure in misusing the insurance notion as the sole provider of a health care delivery system.

Seeing a specialist or a surgeon takes longer, unless it is patently an emergency. It takes weeks to months to get in for that kind of thing. If an emergency, the response is faster, but less cost is covered by insurance, as they usually do it via the emergency room. Which is always clogged with the uninsured, driving up costs still higher. That, too, is evidence of fundamental failure in the system we have adopted.

I think I have said this before, elsewhere on these forums: government exists to do those things that we need done, which private entities either cannot, or will not, provide. Since the all-insurance-delivery model is demonstrably failing, is it not time to consider something else?

RobertDyck's description of the Canadian system sounds fairly similar to what my Australian friends tell me about their system. His description of short wait times sounds much better than what Terraformer describes for the UK system in post 32 above. My Australian friends tell me their system is fast, as well. It is a blend of public (basic care) and insurance (for the extras).

This is just my opinion, but I think it is time to ditch the ideologies and just look objectively how some other countries do this, and what kinds of results they are getting. At least a couple of them are doing this function better than we are, maybe several of them. Then consider how we might adopt, adapt, and improve. Not amenable to campaign sloganeering, perhaps, but it could get us a functioning healthcare system that is not only more effective, but also more affordable.

GW

Last edited by GW Johnson (2017-10-21 10:34:30)

Terraformer · 2017-10-21 13:33:11

GP surgeries in the UK are paid £137 per annum per person registered. Apparently it's not enough (then again, claims that the NHS is in a funding crisis are constant, even when funding per capita is increasing in real terms). A lot of the people they see don't actually need to go to the doctor, so it seems like a privately funded service could charge £10/month per customer, with a £5 copay to see a doctor. If used to replace the existing model, the monthly charge could be waived for those on a low income, with a claim back form for the appointment charge - I'd also have it so people don't get charged when the doctor makes the appointment, such as for a blood test or a regular checkup.

Do people see their GP through insurance in the US? Wouldn't that be a separate thing, with the insurance covering whatever treatment is required?

SpaceNut · 2017-10-21 13:38:11

Cheaper Health Plans Promoted by Trump Have a History of Fraud these health plans, created for small businesses, have a darker side: They have a long history of fraud and abuse that have left employers and employees with hundreds of millions of dollars in unpaid medical bills.

The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials who regulate the type of plans Mr. Trump is encouraging, known as association health plans.

SpaceNut · 2017-10-23 21:24:52

Iowa pulls request to opt out of Obamacare requirements

Iowa on Monday withdrew a request to waive some Obamacare rules to help shore up its struggling healthcare insurance market, marking a setback in efforts by Republican-governed states to sidestep requirements of the Obama-era law.
With open enrollment for the Affordable Care Act - better known as Obamacare - set to start in just over a week, the state announced it would no longer wait to hear if federal officials would approve its request aimed at cutting individual healthcare insurance premiums and widening coverage.
Iowa Governor Kim Reynolds said the law had not been flexible enough to accommodate the state's request.
"Ultimately, Obamacare is an inflexible law that Congress must repeal and replace," the governor said in a statement, adding that premiums under Obamacare had increased by 110 percent for Iowans since 2013.

Set of rules not regulated by the insurance company that forces coverage for a given premium to which the isurance company still says what it will pay, consider not deductable, making up there own rules as to whom can be on a family policy and at what age they can not be on it regardless that they are disabled even....ect.....

This is starting to sound just like the banking industry.....

clark · 2017-10-25 22:08:56

This isn't rocket science. [wait for chuckles]

Healthcare in the US suffers from the tragedy of the commons. It is a common resource we all need, that we all expect, but individually, our own self interest is too short sighted to contribute to its long term success and health.

Healthcare is a common good. Healthcare is a shared responsibility. Healthcare is a fundamental human right. These three statements, these three facts form the foundation of any subsequent discussion or decisions. The failure to achieve consensus or agreement on these three facts (in the US) is part of the reason why Healthcare reform continues to fail in the US.

All the debates and discussions side step addressing the three main facts, or outright reject them.

SpaceNut · 2017-10-26 17:27:14

Yet we have so little that is the same from state to state, Doctor to Hospital and Pharmacy to Premium costs to what it costs to what is will not cover...Sounds like there is very little in common....At least Obamacare was an effort to correct this....

clark · 2017-10-26 20:59:30

Most of the guidelines are at the national level and dictated by CMS or other national agencies. There are state level jurisdictions that add another layer of bureaucracy, but key regulations are largely driven by federal mandates.

Reimbursement rates for providers are derived largely from the medicare fee schedule with most insurance carriers basing their own reimbursement amounts on some multiple or percentage of the medicare rate. There are carve outs, but those are largely done for strategic reasons for insurance carriers or large provider groups to remain competitive in a locality. Your personal liability may be different state to state depending on the strength of local consumer laws.

Choice is largely dictated by geographical location (urban vs. rural).

The three facts I mentioned previously are the current problem. We don't have agreement in the US on the basic foundational premise, and the fractured broken, incomplete health system we have today in the US is a reflection of this truth.

Terraformer · 2017-10-27 03:02:08

Those aren't facts, clark, they're opinions.

Antius · 2017-10-27 06:54:17

clark wrote:

So couple things on the previous posts...
Currently, the US healthcare model is primarily focused on reactive emergency level care. The underlying premise is that ethically, if you are in a critical state, we must care for you. Our entire system is currently predicated on that assumption. All else flows from that.
Our preventive care model is poorly designed and does not operate under the same ethical obligations. Hit by a car and bleeding out, we will help stabilize you. Hit by a car and can limp away, you better have insurance or cash if you want physical therapy.
So enter insurance, a form of legalized gambling where you are hedging against an eventuality. It used to be I pay $100 a month, regardless of if I used healthcare or not. If I did use healthcare, insurance footed the bill. If I didn't use it, insurance pocketed the money. So there was no incentive for me to NOT get healthcare. After all, the only winner here is the faceless insurance.
I didn't have to be frugal. I didn't have to shop around. I just showed up and the doctor cooked up a plan to keep me healthy. The doctor had no incentive to be frugal, or to order the generic drug or the cheaper, less complicated lab, or use the older medical device that was cheaper and 95% as effective as the newer model. Hell, outcomes didn't even matter- if I didn't get better, in a perverse way, the doctor made more money. Faceless insurance paid the bill. Times were good.
Then faceless insurance started saying, "hey, we have to approve your medical care first. We need to control costs...". And much complaining ensued. Who was insurance to decide who lived and died? Medical decisions were between patients and physicians after all.
So enter copays and deductibles. Contracted rates. In-network providers. This is a tool by faceless Insurance to get patients and providers to have skin in the game. Now, me, has to pay more than $100 a month. Now I have to think twice about that drug, that lab, that procedure. It's not a free lunch. It's not faceless insurance telling me not to get something done, it is my own self determination (based on personal financial constraints). Physicians agree to limited costs for the work they perform, which impacts how they guide care (doesn't determine it, but it does influence). Faceless insurance will approve expensive procedures based on agreed to medical conditions that must be proven by physicians (with onerous documentation and review, by design). Significantly expensive procedures or drugs are carved out in volumes of patient insurance contracts that allow insurance to shift near 100% cost to the physician or patient.
So why is it so broken? Greed. Profit motive is one of the problems with the market place. US healthcare has accepted that profit has a place in healthcare delivery. It doesn't need to be (there are proven US models that not non-profit). The other reason is that US population has a low tolerance for personal accountability/requirements when it comes to healthcare. Example: a yearly physical is not mandatory, but should be. It would help improve overall US health and begin the process of establishing preventive care as a way of life. Mandatory flu vaccines should be part of any health reform. Mandatory nutrition programs. Mandatory mental health check-ups. Mandatory dental, vision and hearing screening.
It sounds crazy, but that's what is required to fix the system- a huge societal shift that makes the deal that we as a society foot the healthcare bill, but we also hold each other accountable towards maintaining good health.
And this brand of crazy is how it will be on Mars (or space).

Every health service in the world is focused on reactive care because non-reactive care is usually down to the individual.

One of the good things about the US health care system is that it does encourage healthy living for the simple reason that insurance premiums go up if you put on weight and generally let things slide. The only way of keeping people healthy is to provide them with some financial incentive that doesn't require them to think years ahead into the parallel universe of the future. Insurance premiums are a very good way of doing that, because they are directly tied to a person's perceived risk of dying. It gives people a gilt-edged priority to take care of their own health.

It has been my observation that there are two types of American: the squeaky clean types fanatical about health, who look like plastic Barbie toys; and the horrendously obese ones that don't seem to give a shit. The first type pay health insurance, the second type don't. Price signals work. They can appear cruel on occasion, but there is no better way of doing things.

Last edited by Antius (2017-10-27 06:56:12)

JoshNH4H · 2017-10-27 08:37:51

FYI Antius it has never been the case that Americans paid more for health insurance based on how well they take care of themselves and such discrimination is actually illegal now. Furthermore your observation doesn't really accord with reality (the plural of "anecdote" is not "data").

RobertDyck · 2017-10-27 08:50:36

Antius wrote:

One of the good things about the US health care system is that it does encourage healthy living for the simple reason that insurance premiums go up if you put on weight and generally let things slide. ...
It has been my observation that there are two types of American: the squeaky clean types fanatical about health, who look like plastic Barbie toys; and the horrendously obese ones that don't seem to give a shit. The first type pay health insurance, the second type don't.

Very American philosophy. America has the greatest proportion of obesity in the world.
images?q=tbn:ANd9GcQKUOXpHfR9o8W_fsqYaKUaUNUWHdMmJBjZ_ZntCCATxY46MmWj

Last edited by RobertDyck (2017-10-27 08:51:20)

Antius · 2017-10-27 09:15:58

JoshNH4H wrote:

FYI Antius it has never been the case that Americans paid more for health insurance based on how well they take care of themselves and such discrimination is actually illegal now. Furthermore your observation doesn't really accord with reality (the plural of "anecdote" is not "data").

Well that undermines the whole point of health insurance doesn't it. You can't blame the system for being crap and inefficient if it is mandated that way by law. Nothing can be all things to all people.

JoshNH4H · 2017-10-27 10:50:29

The point of health insurance is to even out medical expenses to prevent healthcare expenses from causing undue financial stress. Because of the high cost of medical care in the United States, just about any medical procedure would cause financial stress to most people. As a result of this, and also as a result of a tax benefit for employee benefits, roughly 50% of Americans have health insurance that is subsidized by their employer as part of a tax-free benefits package. Of the remaining 50% of Americans, 15% are on medicare, a federal heavily subsidized health insurance program for the old, 20% are on Medicaid or CHIP, which are state-run heavily subsidized health insurance programs for poor adults and children, 9% have no insurance, and the remaining 6% get insurance either on the individual market where they will generally receive subsidies under Obamacare, through the Veterans Affairs Bureau, or through the TriCare system for federal government employees.

There are two things you should take from this:

Even if that law (called "community rating", which prevents sick people from being priced out of insurance on the individual market) didn't exist, only a very small portion of Americans would be subject to differential premiums based on health status because anyone who does not get their insurance through the individual market will be part of a group within which premiums are generally only varied based on age and number of people covered.
Healthcare costs in America are so high that almost everyone who has insurance has a substantial part of their premiums (and therefore, their healthcare costs) paid by someone else. Americans do not consume more healthcare than people in other countries, the unit costs are just higher.

JoshNH4H · 2017-10-27 10:56:27

You might look to race and class inequality in the US as a driver of health disparities. Have a look at this map of life expectancy in Baltimore:

http://cnsmaryland.org/baltimore-health … korea.html

You all are probably not familiar with Baltimore and its neighborhoods, so I'll break it down: The white areas and the rich areas have high life expectancy. The black areas and the poor areas have low life expectancy. This is one of the fundamental problems with capitalist health insurance schemes.

Antius · 2017-10-27 11:21:49

JoshNH4H wrote:

You might look to race and class inequality in the US as a driver of health disparities. Have a look at this map of life expectancy in Baltimore:
http://cnsmaryland.org/baltimore-health … korea.html
You all are probably not familiar with Baltimore and its neighborhoods, so I'll break it down: The white areas and the rich areas have high life expectancy. The black areas and the poor areas have low life expectancy. This is one of the fundamental problems with capitalist health insurance schemes.

Josh, Why would you expect people with significant differences in ethnicity, income and lifestyle to have the same life expectancy? It seems to me, that doesn't signify that the medical system is failing. People with more money can afford better food, private gym memberships and are also more likely to be intelligent, which correlates with taking better care of oneself, in terms of diet, exercise, etc.

The idea that we have somehow failed because some people have done better than others is false - we are all better off than people living 100 years ago. The fact that some people do better than others is a fact of life. We all have different abilities and also make different choices, that effect our material outcomes.

Last edited by Antius (2017-10-27 11:23:22)

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#26 2017-10-15 17:07:48

Re: Healthcare for all, not Trump or Obama care

#27 2017-10-17 03:02:12

Re: Healthcare for all, not Trump or Obama care

#28 2017-10-17 16:06:13

Re: Healthcare for all, not Trump or Obama care

#29 2017-10-17 16:24:04

Re: Healthcare for all, not Trump or Obama care

#30 2017-10-17 17:01:57

Re: Healthcare for all, not Trump or Obama care

#31 2017-10-18 10:28:54

Re: Healthcare for all, not Trump or Obama care

#32 2017-10-18 14:19:17

Re: Healthcare for all, not Trump or Obama care

#33 2017-10-18 16:08:03

Re: Healthcare for all, not Trump or Obama care

#34 2017-10-21 03:38:54

Re: Healthcare for all, not Trump or Obama care

#35 2017-10-21 09:20:32

Re: Healthcare for all, not Trump or Obama care

#36 2017-10-21 10:31:14

Re: Healthcare for all, not Trump or Obama care

#37 2017-10-21 13:33:11

Re: Healthcare for all, not Trump or Obama care

#38 2017-10-21 13:38:11

Re: Healthcare for all, not Trump or Obama care

#39 2017-10-23 21:24:52

Re: Healthcare for all, not Trump or Obama care

#40 2017-10-25 22:08:56

Re: Healthcare for all, not Trump or Obama care

#41 2017-10-26 17:27:14

Re: Healthcare for all, not Trump or Obama care

#42 2017-10-26 20:59:30

Re: Healthcare for all, not Trump or Obama care

#43 2017-10-27 03:02:08

Re: Healthcare for all, not Trump or Obama care

#44 2017-10-27 06:54:17

Re: Healthcare for all, not Trump or Obama care

#45 2017-10-27 08:37:51

Re: Healthcare for all, not Trump or Obama care

#46 2017-10-27 08:50:36

Re: Healthcare for all, not Trump or Obama care

#47 2017-10-27 09:15:58

Re: Healthcare for all, not Trump or Obama care

#48 2017-10-27 10:50:29

Re: Healthcare for all, not Trump or Obama care

#49 2017-10-27 10:56:27

Re: Healthcare for all, not Trump or Obama care

#50 2017-10-27 11:21:49

Re: Healthcare for all, not Trump or Obama care

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