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.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

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.

 

If you are talking about EMTALA, it is only for emergency care, and is a trivial part of our health care costs. 

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

To avoid government wage controls, another government boondoggle.

Are you in favor of eliminating a minimum wage?

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OK, I am just going to put a short version of my thoughts on health care out there and we can take it from there. Initially, I haven't really seen much discussion of goals advanced by posters. An example would be that health care costs in the U.S. should be no more than 20% above the average of the next 15 most expensive health care systems in the world. Another goal would be universal coverage of citizens. So far, I haven’t read much about what people think a healthcare system should look like, much less drilling down into the various models other countries use. To me, a good start would be a system that costs a bit more than these other countries, works somewhere near as well for most citizens, and covers all citizens. I believe the U.S. system fails on all three counts. To keep discussion more organized, I will add how we can get there in another post.

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

Are you in favor of eliminating a minimum wage?

 

Of course. The government has no right to grant itself a seat at my negotiation.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

If you are talking about EMTALA, it is only for emergency care, and is a trivial part of our health care costs. 

 

You really think FICA doesn't count? How about Medicaid funding? Is that "trivial" as well?

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

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.

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.

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.

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

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.

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

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.

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?

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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.'

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Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

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.

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

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Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

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?

 

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.

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"Why should I give information to you when all you want to do is find something wrong with it?"

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.

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.

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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.

 

Lol. Sure bud, whatever you wanna believe.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

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?

 

Who said anything about abolishing taxes? 

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

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.

 

As Rob said, "care" is more than ED visits. It also includes the extreme under compensation forced on Medicaid providers by that horrid program. 

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

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.

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

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

 

This seems like the other side of the coin wherein hundreds of thousands go bankrupt due to medical bills. Unfortunately, given the lack of transparency in the system, I have no idea of the true impact of this lack of compensation. If it is partial payment of those $1000 aspirin Samjag talked about earlier (obvious hyperbole from the OP, but you get the drift) I don't have too much concern. But regardless, it is a system where millions do not have access, hundreds of thousands are financially devastated, tens of thousands die due to lack of care, and we spend more than any of the other countries.  

 

I have posted my thoughts on why this situation occurs, but am curious as to yours. How is it that all of the other countries can do so much better and spend so much less? Or do you disagree with the premise that they are doing better and spending less?

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

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.

 

Tort reform could theoretically help. 

 

Also, its important to remember that in most cases regulation INCREASES COST efficiency and innovation generally DECREASES COST.  As an example, one of the challenges mentioned in this thread has been the inordinate cost of some medications.  We have already talked about the fact that Drug companies base their business models on belonging to a network of customers that don't really see a bill.  They don't have to compete solely on a cost basis or produce a product that the average person can afford.  This is also compounded by the fact that it takes 10 years in some cases and tens of millions of dollars for the FDA to approve a new Drug. To make matters worse, the current incentive for domestic pharma companies to traverse this maze is a market insulated from foreign competition!!!  Safety is great, I am not advocating that we just let some kid with gasoline and a pacifier sell drugs to kids.  I am stating that the inordinate cost of bringing a new drug to market creates an artificial truncation of supply and thus limitless inflation in the marketplace.  That's why you see companies being sold as soon as a drug is approved and the new owners jacking up the price 900%.

 

We need to simplify and streamline the process by which drugs are brought to market and if scarcity exists in a sector of the pharmaceutical  industry we should allow foreign drug makers to directly compete in our markets, in addition, we should have open deals with countries that inherently share our commitment to drug safety and similar standards so that they can sell their drugs in our markets to bring down overall cost to the consumer. 

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Also, its been mentioned that most have not put forth a plan for a HEALTH CARE SYSTEM.  That's because a lot of people don't think there should be a one size fits all solution for all people.  There are a lot of common sense solutions based on market principles that can bring down costs, but that has nothing to do with a TOP DOWN 5 page narrative to try and encompass 3 million people.  For some healthy kids it makes sense for them to go buy a catastrophic policy for peanuts and pay a general practitionier 100 bucks a month for conceirge care that will cover basic care, physicals, perscriptions and massive discounts on most of the drugs they would take.  For other kids it may make sense for their parents to buy a RIDER that lets their children stay on their insurance policy until they are 26.  For some 65 year olds that have acquired a large amount of wealth it may make more sense for them to self insure a larger portion of their medical costs through a derivative HSA that allows them to shelter more of what would be taxable capital gains.  For some 65 year olds it may make more sense for them to be part of medicare.  And for some people with more pronounced pre-existing conditions it may be necessary for us as a community to set up high risk pools with common sense subsidies to care for those with debilitating conditions. 

 

There are tons of things that can be done, but we have to remember that basic economics still apply.  Massive increases in capital or credit while supply remains the same CAUSES INFLATION.  Regulation stifles supply.  INcreased supply and choices is the only way to lower costs short of outright rationing care.

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