Others have mentioned it, but competition is the key imo. What incentive does any entity have to lower costs and increase quality if they have no competition? Single payer would eventually result in a bloated, inefficient, poorly ran system that provides increasingly worse relative healthcare.
Universal Healthcare
- Thread starter Chuckinden
- Start date
30% still covers a lot of people living healthy lifestyles and represents a ton of money.
Pfizer's Gross Profit is 80%+. Their operating profit is like 30%. The US government is doing everything they can to ensure these margins under the BS guise that there won't be product development if competition occurs. You know... like with cars, TVs, washing machines, etc.
A simple physical should be required annually, and people who can't pass it should pay more, plain and simple.
But how do you define a "bad decision"? Is it just smoking or drinking? Or if you're injured accidentally because you drive a fast car, like to bike, own a firearm, etc, should I pay for that? Some of those could be categorized as bad decisions too.
The fact of the matter is, you're paying for everyone now anyway. I just think we should require everyone to pay in so that when they do in fact need health care, they aren't getting it for free like they are now. We don't currently just let people die in the streets.
big moves coming in next ten years in terms of datasets to validate this hypothesis my friend. we're looking at some interesting things in the microbiome area. for example, gut bacteria have a hell of a lot of effect on neural processes, which in turn, affect things like immunity.
Yep, it's 100% ********. We need to be pulling away from single payer by any means necessary, not getting closer to it. No telling how many decades it would take to recover completely once the system takes complete control.
Enlighten me to all the insurance options I have in Kentucky. And how different they all are when it comes to service. Obamacare accelerated the disaster and pushed us toward single payer. I can't help that but I also won't ignore it. We are not going back. That's not how any of this works.
You missed the entire point.
The current complexity of the market prevents consumers from being able to efficiently bargain and, on another level, basic health insurance requires that risk of calamity is spread wide and so therefore there is a necessity for healthy people to contribute outside of their own individual risk if we are going to cover massive costs like cancer, aids, strokes, etc that occur unexpectedly.
This isn't the same thing as selling widgets.
obamacare was poorly implemented, but was one of the best ideas in our history. just for clarification, i hate that people call it obamacare; it wasn't his idea, or even hillary's a decade before. kaiser came up with the plan for hedging healthcare costs a long time ago. his implementation of this (the Kaiser network) is an example of how sustainable self-insurers can be. however, they also have issues. i think the truth is that we need to enable insurance companies to make profits by insuring as many people as possible. let the markets, not the government, decide what the right implementation is.
I understand health insurance perfectly, I deal with it on a daily basis.
My point was, the argument "we should have universal health care because eventually everyone is going to use health care" is silly. Substitute "food" for "health care" and you'll see how ridiculous it is.
In addition to the ubiquitous "waste" in our current healthcare system, another aspect of costs which is over-looked is that our current pricing system is not based on market forces. Rather, the price/reimbursement structure for most all insurance plans is based on what Medicare sets, and what Medicare sets is often quite arbitrary.
Here's an example: In 1998 (yes I know that's 20 years ago, but it's an example with which I am intimately familiar, and it will still serve my point), cataract surgery with IOL implantation -- one procedure -- accounted for about 8% of the entire Medicare budget (if pressed for a link, I can find it, but I'm not going to take the time to do so). Why? Well, one reason was in the early-mid 90s, Medicare arbitrarily reimbursed surgeons around $2,300 bucks per cataract procedure -- a procedure that takes 15 minutes max. Nowadays it's around $700-800. Ask any cataract surgeon whether they'd rather be practicing now or in the mid-90s and they'll laugh.
What changed? Nothing. The powers-that-be at Medicare decided tocut costs by cutting reimbursements. There was nothing market-based about either the initial reimbursement, nor the subsequent cut. Until we start allowing market forces to shape costs there will be no improvement in our system.
Here's an example: In 1998 (yes I know that's 20 years ago, but it's an example with which I am intimately familiar, and it will still serve my point), cataract surgery with IOL implantation -- one procedure -- accounted for about 8% of the entire Medicare budget (if pressed for a link, I can find it, but I'm not going to take the time to do so). Why? Well, one reason was in the early-mid 90s, Medicare arbitrarily reimbursed surgeons around $2,300 bucks per cataract procedure -- a procedure that takes 15 minutes max. Nowadays it's around $700-800. Ask any cataract surgeon whether they'd rather be practicing now or in the mid-90s and they'll laugh.
What changed? Nothing. The powers-that-be at Medicare decided tocut costs by cutting reimbursements. There was nothing market-based about either the initial reimbursement, nor the subsequent cut. Until we start allowing market forces to shape costs there will be no improvement in our system.
I never really advocated for universal health care. I don't know if that's the answer. I don't know what the answer is, frankly.
As far as food versus health care, it's a laughable comparison. I mean, they're both necessities of life but that's about where the comparison ends.
This I agree with. The whole insurance side of things seems secondary to figuring out how to control costs. But for some reason everyone wants to focus on what seems to be the way more complex issue in insurance.
My entire point is that it makes no sense to argue for a universal system (I'm not saying you are, but it's the point of the thread) because "everybody will eventually use it."
my prediction is that these changes won't ever come from within our country. pressure from insurers, health care providers, pharma, and clinical dx will force the issue once they have found a stable solution in a less regulated country (e.g. Malaysia, Philippines, etc.)
-Some disorganized thoughts:
-Obamacare did a lot of good but I never saw it as a long term solution. From a purely business standpoint, you simply can't force insurance companies to insure everyone regardless of medical history AND lower costs. Those people weren't insured because they were expensive to insure. I have long believed it was an avenue to bankrupt insurance companies and force the hand of a single payer system. However, insurance companies aren't willing to martyr themselves for the cause, hence the even more rapidly escalating premiums. It's not sustainable.
-Poor lifestyle is absolutely a contributor to American health care costs. We're fatter than any other country and we still smoke like crazy. I have countless examples of how they directly correlate with health care costs, especially regarding surgical care. Obese people are harder to operate on, get infected more frequently, and have more complications. They have much higher rates of diabetes and sleep apnea, which have their own host of complications associated with them. Smokers have poor wound/bone healing and thus more complications. In the hospital I used to work at, the spine surgeons wouldn't operate on you if you had any evidence of nicotine in your system. There is concrete evidence that those patients have poor outcomes and higher infection risk, and the surgeons weren't willing to assume all of the consequences of that risk from the patient. If we go to single payer, there will be rationing of care. There's just no way around it when the supply is short. Don't be surprised if you are denied elective, non-essential treatments/surgeries because of your lifestyle in such a system.
-End of life care is an incredible drain. We don't cope with death well as a society. By and large, people want everything done and are only accepting of death if it's the only remaining option after every possible intervention, treatment, medication, etc has been exhausted--- even (or especially) if it's at the expense of quality of live and dignity. And often times, it doesn't prolong life anyway. People are very understanding of the need to let people die peacefully without exhausting all possible heroics... until it's them or a loved one in the situation.
-Primary care is woefully underpaid, hence people don't go into it and there's a shortage. People don't see PCPs for that reason, and their lifestyles continue to suffer and lead to more expensive problems that require more expensive treatments. I strongly disagree with whoever said that docs don't go into medicine to help people. The problem is that the process is so long (as it should be) and thus expensive. Reality sets in. Do you want to work 80-90 hours a week forever for 120k while racking up a half million in debt during medical school (which balloons further during residency)? Or do you want to focus on a sub specialty where you can still help people but be compensated better with a better lifestyle?
There's way more wrong that that. It'll never, ever be "solved." It's just about finding the best way to utilize resources so as many people have access as possible.
-Obamacare did a lot of good but I never saw it as a long term solution. From a purely business standpoint, you simply can't force insurance companies to insure everyone regardless of medical history AND lower costs. Those people weren't insured because they were expensive to insure. I have long believed it was an avenue to bankrupt insurance companies and force the hand of a single payer system. However, insurance companies aren't willing to martyr themselves for the cause, hence the even more rapidly escalating premiums. It's not sustainable.
-Poor lifestyle is absolutely a contributor to American health care costs. We're fatter than any other country and we still smoke like crazy. I have countless examples of how they directly correlate with health care costs, especially regarding surgical care. Obese people are harder to operate on, get infected more frequently, and have more complications. They have much higher rates of diabetes and sleep apnea, which have their own host of complications associated with them. Smokers have poor wound/bone healing and thus more complications. In the hospital I used to work at, the spine surgeons wouldn't operate on you if you had any evidence of nicotine in your system. There is concrete evidence that those patients have poor outcomes and higher infection risk, and the surgeons weren't willing to assume all of the consequences of that risk from the patient. If we go to single payer, there will be rationing of care. There's just no way around it when the supply is short. Don't be surprised if you are denied elective, non-essential treatments/surgeries because of your lifestyle in such a system.
-End of life care is an incredible drain. We don't cope with death well as a society. By and large, people want everything done and are only accepting of death if it's the only remaining option after every possible intervention, treatment, medication, etc has been exhausted--- even (or especially) if it's at the expense of quality of live and dignity. And often times, it doesn't prolong life anyway. People are very understanding of the need to let people die peacefully without exhausting all possible heroics... until it's them or a loved one in the situation.
-Primary care is woefully underpaid, hence people don't go into it and there's a shortage. People don't see PCPs for that reason, and their lifestyles continue to suffer and lead to more expensive problems that require more expensive treatments. I strongly disagree with whoever said that docs don't go into medicine to help people. The problem is that the process is so long (as it should be) and thus expensive. Reality sets in. Do you want to work 80-90 hours a week forever for 120k while racking up a half million in debt during medical school (which balloons further during residency)? Or do you want to focus on a sub specialty where you can still help people but be compensated better with a better lifestyle?
There's way more wrong that that. It'll never, ever be "solved." It's just about finding the best way to utilize resources so as many people have access as possible.
You do know that perfectly healthy people can get cancer? Most Parkinson's patients haven't smoked or drank much their entire life. This line of thinking is what's wrong with the debate. And many who have diseases later in life could have possibly prevented it if they had healthcare and preventative checkups earlier in life.
If you are overweight you are raising the cost of my healthcare. Which is nearly 2/3 of America.
Europeans smoke like freight trains yet deliver better outcomes than the US. Our healthcare system is below many other developed nations.
And people don't want to admit this because of the death panel b.s., but end of life care is where somewhere in the neighborhood of 75% of our healthcare costs come in.
Missed this one. Hell yeah, i read some recent stuff how gut bacteria signals the brain to crave sugar. So the person then eats sugary **** so the gut bacteria can thrive
They just need them some obamacare to fix it, right Cardkilla? That's the REAL cure.
There certainly is no way to appease everyone. And I don't think that everyone is "entitled" to healthcare. Saying it like that sounds like they get it and don't have to pay for it. In fact, I think that if someone wants to opt out of healthcare they ought to be able to.......but they certainly must accept the consequences. And I would expect everyone who participates to contribute......from the poor to the rich.
As far as the cost. The cost of the gov't funding would be lessened a great deal by the price drops from the rest of the US competing for policies and care. Also, don't think of it as a big system. Think of it as a fraction of the cost that the current Medicare/Medicaid system is currently. Crap care. Couple this with streamlining gov't spending and consumer pay and you get a system that can be sustain itself decently.......that is, until man corrupts it.
So, why should the poor receive lesser coverage....because they're poor. If they want better coverage, then it's up to them to go get it. Right now 5000% of Southeastern Kentucky is on the gub'ment take as they ride around in their insured $45,000 lifted 4x4's..........oh, me thinks they can afford a health insurance policy at some level.
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I'm in favor of universal over the current, former and proposed future form of health care.
I don't think living or dying should be a for-profit venture, nor do I think having a car wreck, cancer or a heart attack should bankrupt a person for life if they don't make six figures+ a year.
Health care shouldn't be completely free like the left wants, nor should it be a way to save rich guys money like the right wants. Surely there's a compromise that is compassionate, yet logical. But given partisan politics in the U.S., no chance in hell.
I don't think living or dying should be a for-profit venture, nor do I think having a car wreck, cancer or a heart attack should bankrupt a person for life if they don't make six figures+ a year.
Health care shouldn't be completely free like the left wants, nor should it be a way to save rich guys money like the right wants. Surely there's a compromise that is compassionate, yet logical. But given partisan politics in the U.S., no chance in hell.
Why? You don't think doctors should profit from the services they provide, or that drug companies should profit from the products they develop?
Not a lot of discussion here about drug prices. Let it be known: I am a capitalist to the hilt, but shitheels like Valeant are proven price-gougers, and if the market won't knock them on their greedy ***, the courts should, imo. One of my oldest friends has scarring of the lungs (idiopathic pulmonary fibrosis). There is no known cause of IPF and no known cure. In short, It's a ******* death sentence. There is a new drug that has shown it can slow the progress of IPF called Esbriet. It's cost? $94,000 a year. He's been able to get into group trials so far, which reduce the cost greatly, but they are running out. Part D insurance covers little of this.
How about the humanitarians at MYLAN who raised the price of EpiPens 500% between 2009 and 2015? You know, the epinephrine injectors that save lives of those who have a sudden, often deadly allergic reaction to nearly anything (food, bugs, latex, et. al.). These are just a couple of examples, but it's happening all over. Meanwhile, we don't have access to markets like Canada where drugs are much much cheaper. Here's a giant healthcare cost-saver that could come with the stroke of a pen! We need to do this.
How about the humanitarians at MYLAN who raised the price of EpiPens 500% between 2009 and 2015? You know, the epinephrine injectors that save lives of those who have a sudden, often deadly allergic reaction to nearly anything (food, bugs, latex, et. al.). These are just a couple of examples, but it's happening all over. Meanwhile, we don't have access to markets like Canada where drugs are much much cheaper. Here's a giant healthcare cost-saver that could come with the stroke of a pen! We need to do this.
True. Just as every single poster on here (or a loved one), if they will need some necessary life-saving treatment they cannot pay for someday, will gladly let someone else pick up the tab if that is what is required to get the treatment they need. You will not be the honorable exception..
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His total bills before insurance would have been north of $100K. He had a titanium rod placed in his leg so it wasn't a run of the mill casting.
No, single payer would have the power to pay lower prices just as Medicare and Medicaid do today. The drug companies that wanted to sell to the US market would have to accept lower prices just as they do in every other country.
The side effect would be that there would be longer waits for non-critical care, less investment by pharma.
How to pay for it? What you pay in insurance premiums would become taxes.
The market is always going to price a segment out of the reach of some. Our laws and actions say that healthcare is a right. If you show up at the ER you're going to be given care regardless of ability to pay and regardless of cost. As long as medical costs can be shifted and more money extracted, that's what the market will do. Every private market has the goal of generating the most profit.
The goal of healthcare should be to deliver the most care.
Who do you think will provide that care if the profit motive is either removed or greatly restricted?
It's not nearly as attractive as $200 Tylenol or a $600 blanket.
My beef with the medical industry is it's the only "service" industry where you can't walk into a place that provides said services and a see in clear writing on the wall how much each procedure costs like you can at restaurants, tire shops, barber shops, clothing stores, grocery stores, etc.. I've even asked, as in "Doc, how much is this damn test going to cost me?" and nobody can give me an answer.
It's like if you went to Kroger, got a cart of groceries, took them home for $20, ate them and then received a bill six weeks later for $900 even though you know the grub surely to F didn't cost that damn much. I firmly believe they make the **** up, and then accept what they can squeeze out of you. I've been to medical collections before. It's amazing I've settled $2,000 bills for a couple hundred bucks, and yes, my credit sucks, but I did that when I was a 19 year old with a way-too-high-of-a-limit credit card who loved the nose candy.
I know if I walked in to a doctor's office and saw a sign that said "Bloodwork: $400" I'd probably have ole' sawbones skip that part.
On the surface, non profit healthcare sounds great and reasonable. However, having something to gain is a basic driving force for nearly everything we do as humans. Whether it be money, food, sex, whatever, if there's no carrot at the end of the stick, the overall effort to improve will cease to exist.
it's a good way to think about it. some of the changes can be a bit more subtle. one of my colleague's is doing some very interesting work in mapping microbiome to onset of autism. this is how i think about the problem:
what you eat -> modulates gut bacteria [tech still needs to be developed to measure the microbiome properly] -> gut bacteria generates chemical signals that translate to neural signal [very nascent field of science] -> neural signals translate to different gene expression in all our cells [still needs to be fleshed out, we know which genes to measure] -> proteins and **** get made [still don't know what is actually worth measuring here].
long winded way of saying, we sure has hell don't know how our bodies work yet.