02-23-2017, 09:59 PM
Quote:Why do most people have to opt into healthcare coverage through their employer? Why did this become a thing?
To avoid government wage controls, another government boondoggle.
Quote:Why do most people have to opt into healthcare coverage through their employer? Why did this become a thing?
Quote:No, that is the flaw, I only have to pay for it because a government agent with a gun forces me to. Hospitals are forced to provide uncompensated care. Eliminate those and free the market, let people have their freedom for good or ill.
Quote:To avoid government wage controls, another government boondoggle.
Quote:Are you in favor of eliminating a minimum wage?
Quote:If you are talking about EMTALA, it is only for emergency care, and is a trivial part of our health care costs.
Quote:You really think FICA doesn't count? How about Medicaid funding? Is that "trivial" as well?Your earlier post referred to 'uncompensated' emergency room visits, which to the best of my understanding has nothing to do with FICA or Medicaid. And from what I understand, Medicaid costs us about $300 billion, which, while not as trivial as EMTALA expenditures is nowhere near to being the main source of our healthcare woes. Having said that, I would have absolutely no problem with getting rid of Medicare, Medicaid, VA, and all other programs in favor of a reasonable universal coverage system.
Quote:Stop. There's lots of things an indivudual requires, few of them are a legitimate reason for government confiscation of private wealth to finance them. Societal greed is how you've been programmed. It's not yours.
Quote:If you are talking about EMTALA, it is only for emergency care, and is a trivial part of our health care costs.My personal experience disagrees with this. When someone comes in with a condition that they let get way out of control cause they didn't have insurance they tend to have the longest stays and linger the most. Their care won't be 'emergent' anymore, but they still stay for months demanding treatment. I had a patient who the CEO had to come down and beg to get d/ced to rehab after he stayed for months with no insurance. Guy knew he wasn't gonna followup and just kept throwing all his care on the hospital. He would just refuse discharge and the hospital wouldn't make him leave. Still don't understand why not, I guess they didn't want to look 'bad.'
Quote:Your earlier post referred to 'uncompensated' emergency roomAh here is the problem, its not just uncompensated ER visits, its uncompensated admissions, this paper puts it at 6%, the hospitals I have worked at have always told me its 10-20% (so maybe in the middle?). Either way not insignificant.
visits, which to the best of my understanding has nothing to do with FICA or Medicaid. And from what I understand, Medicaid costs us about $300 billion, which, while not as trivial as EMTALA expenditures is nowhere near to being the main source of our healthcare woes. Having said that, I would have absolutely no problem with getting rid of Medicare, Medicaid, VA, and all other programs in favor of a reasonable universal coverage system.
Quote:You think that if tax was abolished gross wages wouldn't reduce? I can see how that may be good for big business but who else?
Quote:Wages are negotiated between employers and employees based on supply and demand. Income taxes have no effect on that, nor do consumption taxes. Corporate taxes can reduce the number of jobs and thus increase the supply of unemployed workers, thus reducing wages.
Quote:You are utterly clueless.
At best it would cause inflation due to all the money taken out of taxation. So only the rich would benefit. So that's why you have been programmed to believe this.
Quote:You think that if tax was abolished gross wages wouldn't reduce? I can see how that may be good for big business but who else?
Quote:Your earlier post referred to 'uncompensated' emergency room visits, which to the best of my understanding has nothing to do with FICA or Medicaid. And from what I understand, Medicaid costs us about $300 billion, which, while not as trivial as EMTALA expenditures is nowhere near to being the main source of our healthcare woes. Having said that, I would have absolutely no problem with getting rid of Medicare, Medicaid, VA, and all other programs in favor of a reasonable universal coverage system.
Quote:As Rob said, "care" is more than ED visits. It also includes the extreme under compensation forced on Medicaid providers by that horrid program.Extreme under compensation? How so? Given previous discussion, I wonder if we are talking about the hospitals getting less than those funny money 'list prices' discussed earlier.
Quote:Ah here is the problem, its not just uncompensated ER visits, its uncompensated admissions, this paper puts it at 6%, the hospitals I have worked at have always told me its 10-20% (so maybe in the middle?). Either way not insignificant.
"uncompensated care – free or reduced cost care for patients who need financial assistance or shortfalls from patients unable to pay for care – amounts to 6% of total hospital expenses." http://www.aha.org/content/11/11costtren...report.pdf
Quote:I see a few problems that increase costs above other countries in the U.S. system. Initially, we do not have price transparency. Some other posters have referred to this. We also have market fragmentation and isolation which is part of what I think jj was talking about earlier. I don’t care whether the model is Bismarck, Beveridge, or NHI, regulation prevents the sort of abuses that are endemic to the U.S. system. Our tests can cost more, our procedures can cost more, and the consumer has no way of getting apples to apples information. Other countries limit costs through using the purchasing power of the government, even if the insurance companies are private (Bismarck model).
Second, administrative costs are out of control. Other countries have administrative costs in the 2-5% range. I believe that is about what Medicare runs. But our private insurance sucks up much more of our ‘health care’ dollars. Those administrative costs run at about 17% trending up to 20%. They are dead dollar expenditures that do not improve quality of care at all.
Part of the challenge with Health insurers is lack of true competition. If there are only 5-10 options in a given state for an HR department to choose from then its hard to find a deal that far outside the mean average. We need to incentivize capital moving into the arena of insuring the risk of health care.
Third, even outside of the ridiculous charges that can be tacked on by hospitals, or the shell games that insurance companies can play, costs are more because it is a simple fact that our doctors make more than those of most other countries. Part of this can be explained by the high cost of medical school, part by malpractice, but not all.
The high cost of Medical school is not just a line item. It's a deterrent for intellectual capital. The people that eventually make it through undergrad, med school, and residency could generally be considered Geniuses. It requires the highest level of STEM aptitude and a work ethic that transcends most people. If you were someone in the top 5% in Math and you had a choice between half a million dollars in student debt and an additional 10 years of education or getting your series 7 heading to wall street, making as much money as you can and never having to buy mal practice insurance which one would you choose. The underlying scarcity of Medical Talent is the true driver of a lot of the costs in Medicine today.
I think that part of this can be traced to k-12 education. There is very little deviation between the path of a student in 2017 as 1917. The top students may get to calc 1 upon graduating from high school. In the 12 years that they are part of the traditional school system we will waste roughly 3 years of time on vacations, and a lot more telling them which bathroom to use and studying aspects of literature and the like that will not develop anything resembling a marketable skill let alone advance their natural aptitude for STEM. We need to have a system by which the advanced students in our society are put on the fast track to absorb as much as they can while they are in k-12 so that we can mitigate the cost of under and post graduate education to make medicine more attractive.
But speaking of malpractice, there is a certain amount of waste that is due to defensive medicine. Some other countries are a bit tighter on the types of suits that are allowed, and perhaps some type of relieve could be found from doing this.
I also believe that more discussion needs to be focused on end of life care and on incentivizing good preventative care. However, the first two issues especially are the ones that I see as providing the bulk of the problem. Any solution that fails to resolve those is doomed to failure.