That's the way you have been programmed. Why not? Everyone requires both.

Everyone requires housing and shelter perhaps we should have public housing no one needs a mansion so we should evenly divided lots assign families to them and everyone pays an equal percentage into the housibg system, no more homeless children.

---

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. 


 

Until we get price transparency we will never have true competition. Also, I presume that the HR example was just the way things currently work, or are you suggesting that we need to keep insurance coupled with your employer? Personally I would be in favor of eliminating the whole FICA and company matching thing altogether.


 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">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. 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;"> 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">While I get your point, and believe that the high cost is definitely a problem, I think there are a few potential solutions. First, make a determination as to how much of the cost/training bottleneck is for quality and how much is a gatekeeper function. I have no problem with working to ensure quality, but loather artificial barriers on licensing to promote exclusivity and increase cost. Second, decrease barriers to foreign students to allow greater competition from those without the barrier of high school costs. Third, provide some cost relief through scholarships or other training avenues with an offset of government service. Given that other countries seem to be managing to provide much better service at lower cost and having lower doctor salaries, I also question your premise that doctor scarcity is a big part of the problem. If anything, the increased pay here should be causing more of a problem for those countries that pay their doctors less.


<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;"> 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">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. 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;"> 

No argument that K-12 education is lacking, and I would love to participate in a thread about that, but I think we can find plenty of doctors, even if they are not U.S.-educated ones.


<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;"> 

Tort reform could theoretically help. 

Agreed


 

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%.

If your premise is correct, then why are all of the other countries with far greater regulation spending far less per procedure and per pill? I disagree totally. It is the regulation that is allowing the price to be so low. And I have absolutely no concern about over-regulation in the pharma field at this point. When pharma companies start closing their doors rather than posting record profits I might reconsider. 


 

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. 

This sounds interesting. I presume that you are talking about some sort of common licensing. As long as standards are the same, I think this sounds appealing. However, to use an example from a different industry, I have read that one of the main problems with imports into Japan for automobiles is that we allow self-certification and Japan dies not. So we would need to make sure it is an apples to apples thing. 


 

<div>I would also ask you a similar question to the one I posed to Rob. How is it that all of these other countries, with much greater regulation, have better health care for most citizens and a much lower cost? 

</div>

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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 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.

 

I'm clueless?


 

Sure, there would be a short term inflation because more money in the pockets of consumers was chasing the same amount of consumer goods, but that would settle out quickly. 
How do "the rich" benefit from inflation? "The rich" have a much higher percentage of their wealth invested in savings, which becomes less valuable with inflation.

 

And explain how not having an income tax would affect a person's wages. A corporation does not gain or lose anything because of what the government takes steals from it's workers.

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

There is no open competition for health care...there are very few independent health care companies out there and about 5 or 6 major companies who own all the rest...The CEO and execs of different companies sit on the boards of the other companies so they are all controlled by the same people... 

---

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.

 

Medicaid pays about 28% of what Medicare does, so yeah, severely undercompensated.

---

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

Medicaid pays about 28% of what Medicare does, so yeah, severely undercompensated.

Interesting, I tried to find this, but no luck... source?

---

<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?

Interesting, I tried to find this, but no luck... source?

<a class="bbc_url" href='https://ahca.myflorida.com/medicaid/review/fee_schedules.shtml'>https://ahca.myflorida.com/medicaid/review/fee_schedules.shtml</a>

---

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

<a class="bbc_url" href='https://ahca.myflorida.com/medicaid/review/fee_schedules.shtml'>https://ahca.myflorida.com/medicaid/review/fee_schedules.shtml</a>

OK, well I saw nothing for a comparison from the link, but I took a few codes and plugged them into a medicare fee lookup I found online. While I had no idea what I was doing, it did look like there was a pretty significant difference between the Medicare reimbursement and the much lower Medicaid info from the link you gave. From what I understand, Florida sets the reimbursement rate for Medicaid. Are they severely underpaying compared to Medicare or am I reading it wrong?

---

<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?

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.

He is talking about medicaid, and yeah, they reimburse less.

 

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?

I have seen the price list for my hospital(s) on drugs before. I know of none that charge anywhere near $1000 for aspirin. Maybe he meant 1000% cause they charge $10 for a .10 to .25 pill? That would be closer to accurate on the sticker price.

---

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.

 

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?

Hmm, as far as doing better, that depends on who you are. If your younger and healthier, they are better. If you are older and need a relatively mundane procedure but are above the age cut off, America is great. I had a 70+ year old Canadian come for a procedure a few years ago and was paying cash. I was very curious as to why so I asked her. The Canadian Government had decided she was to old at the low 70's and didn't qualify for it. This despite the fact that she was in great health otherwise, and the procedure was relatively low risk, and would undoubtedly extend her life. So she came down to Florida and had it done for cash.

 

But then you get on the flipside where you are giving demented 96 year old hip replacements (for the 3 or 4th time) cause they keep jumping out of bed. I guarantee Australia isn't doing that. I have heard it quoted many times that something like 2/3rds of the cost of our care is in the last year of life. You wouldn't get most of that care in other countries.

 

Does it save them money? Most certainly. Should we do it? Its not an American trait to tell people to just go off to the wood shed and die. Its why there is so much talk about death panels etc. I honestly think our culture is more responsible for the cost than anything else. When people get Cancer in the US, they don't just get their affairs in order, they ask what can I do to beat this? So until just letting folks die becomes culturally acceptable, you won't won't just cut our costs. Medicare tries and just cuts the cost anyway and it doesn't work, cause more people get old and sick than ever before.

 

So its a double whammy IMO, we have a culture that is both more unhealthy on average, and more unwilling to ride off into the sunset. Combined with our leading role in medical research and development you get the highest cost system in the world. Add in some good ol fashioned greed and middle men, and it becomes even worse.  Its just not a black and white thing.

---

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.

 

Interestingly people in Australia and Canada live longer.

---

Interestingly people in Australia and Canada live longer.

I would argue that has little to do with your actual healthcare, and a lot to do with how you handle junk/processed food. The US has made it extremely cheap to eat bad (we subsidize bad food basically), and as a double whammy allow lots of pesticides that the rest of the developed world doesn't. We spray our food with known tetratogens and probable carcinogens right before harvesting. So we have a less regulated food chain (well its reverse regulated actually, the big companies pick and choose what they want like Monsanto). This is really an aside tho.

 

I am not arguing that Americans live longer than other nations, they don't. I will argue that it is not due to healthcare that they live less. Other countries, I think, tend to eat better, and exercise more.  Its the lifestyle and culture, they eat less red meat, they have better quality food, and make better choices on the whole. Canada's healthcare system rationing care at end of life didn't make their average higher, rather it was everything before that point that improves it.

---

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.

 

Aussie's have very similar health concerns. Huge problems with fast food and not enough exercise though admittedly I would trust Aussie cattle to be less pumped with drugs and less pesticides used.


But it has a world class public health system and also private system.

---

I would argue that has little to do with your actual healthcare, and a lot to do with how you handle junk/processed food. The US has made it extremely cheap to eat bad
(we subsidize bad food basically), and as a double whammy allow lots of pesticides that the rest of the developed world doesn't. We spray our food with known tetratogens and probable carcinogens right before harvesting. So we have a less regulated food chain (well its reverse regulated actually, the big companies pick and choose what they want like Monsanto). This is really an aside tho.

 

I am not arguing that Americans live longer than other nations, they don't. I will argue that it is not due to healthcare that they live less. Other countries, I think, tend to eat better, and exercise more.  Its the lifestyle and culture, they eat less red meat, they have better quality food, and make better choices on the whole. Canada's healthcare system rationing care at end of life didn't make their average higher, rather it was everything before that point that improves it.

Agree 100% It's cheaper to buy a greasy burger than a healthy salad...Being diabetic I have to eat a pretty rigid diet...The food that is healthy and good for you is so much more expensive than regular food that it's almost being priced out of the market. Here in Pa. the groceries are much more expensive than many other states and then the healthy stuff is incredibly high...I'm not even talking about the organic non gmo stuff either...

---

OK, well I saw nothing for a comparison from the link, but I took a few codes and plugged them into a medicare fee lookup I found online. While I had no idea what I was doing, it did look like there was a pretty significant difference between the Medicare reimbursement and the much lower Medicaid info from the link you gave. From what I understand, Florida sets the reimbursement rate for Medicaid. Are they severely underpaying compared to Medicare or am I reading it wrong?

Medicaid is a joint federal and state program. Each state has liberty to set their own fee schedule, but must be within the parameters of the federal guidelines if they want their share of the federal money. That's why Governor Scott's rejection of the new rulesa few years ago was a big deal, Florida didn't change our eligibilty rules and CMS withheld our funds.


Here's their page with tons of information about how that bureaucracy works.

<a class="bbc_url" href='https://www.medicaid.gov/medicaid/financing-and-reimbursement/'>https://www.medicaid.gov/medicaid/financing-and-reimbursement/</a>

---

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

Hmm, as far as doing better, that depends on who you are. If your younger and healthier, they are better. If you are older and need a relatively mundane procedure but are above the age cut off, America is great. I had a 70+ year old Canadian come for a procedure a few years ago and was paying cash. I was very curious as to why so I asked her. The Canadian Government had decided she was to old at the low 70's and didn't qualify for it. This despite the fact that she was in great health otherwise, and the procedure was relatively low risk, and would undoubtedly extend her life. So she came down to Florida and had it done for cash.

 

But then you get on the flipside where you are giving demented 96 year old hip replacements (for the 3 or 4th time) cause they keep jumping out of bed. I guarantee Australia isn't doing that. I have heard it quoted many times that something like 2/3rds of the cost of our care is in the last year of life. You wouldn't get most of that care in other countries.

 

Does it save them money? Most certainly. Should we do it? Its not an American trait to tell people to just go off to the wood shed and die. Its why there is so much talk about death panels etc. I honestly think our culture is more responsible for the cost than anything else. When people get Cancer in the US, they don't just get their affairs in order, they ask what can I do to beat this? So until just letting folks die becomes culturally acceptable, you won't won't just cut our costs. Medicare tries and just cuts the cost anyway and it doesn't work, cause more people get old and sick than ever before.

 

So its a double whammy IMO, we have a culture that is both more unhealthy on average, and more unwilling to ride off into the sunset. Combined with our leading role in medical research and development you get the highest cost system in the world. Add in some good ol fashioned greed and middle men, and it becomes even worse.  Its just not a black and white thing.

This is exactly what people dont get, our system spends it's efforts and money in two places, managing old age and combating preventable diseases. Neither of those is something our population can or will change.

---

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

I have heard it quoted many times that something like 2/3rds of the cost of our care is in the last year of life. You wouldn't get most of that care in other countries.

Japan has an older population, and their elderly has more care than in the U.S. Of course their doctors are paid much less than ours. However, I agree with your premise generally, that we spend an inordinate amount of money on the last year or month of life. That was what I was addressing much earlier when I talked about end-of-life care. You are preaching to the choir.
  :yes: 


 

Its not an American trait to tell people to just go off to the wood shed and die. 

Actually, it very much IS an American trait to do just that. That is what we do every year by not having health care systems in place that are similar to the other countries. I posted much earlier about the deaths due to lack of access that other countries simply do not have, yet have heard crickets in response.


 

So until just letting folks die becomes culturally acceptable, you won't won't just cut our costs.

Your premise is that in the U.S. it is not culturally acceptable for letting (old) folks die, but in other countries it is. So far the only evidence I have seen of this is your one anecdote from Canada. Out of curiosity, what was the procedure? On a more general level, what is the care that would be provided in the U.S. but not say, in any of the other Bismarck countries? I understand that a Beveridge system might ration care in the manner you describe. 


 

Combined with our leading role in medical research and development you get the highest cost system in the world.

No problem with medical R&D, but we are talking about everyday care.  I have yet to find a site that compares our costs, procedure by procedure, that does not have us listed in the top 3 for costs, and most often the most expensive. Same for drug costs. My premise stated earlier was pretty simple. We do not have price transparency, and when we do get information into pricing, we are more expensive than other countries. This has nothing to do with the graying of America, or with unneeded hip replacements(though i do not deny the validity of those points). I saw a commentator last week make the observation that folks would consider it crazy to go into a supermarket and pay ten times more for a carrot than the next person in line. Do you believe we can get health care costs in line without price transparency? 


 

I had asked earlier for feedback on how we ranked compared to other countries, and appreciate your views. I also had mentioned goals, such as universal coverage, or getting our health care costs in line with the the next 15 most expensive countries in the world. What would your goals for our system be and how would you get there?

---

<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?

This is exactly what people dont get, our system spends it's efforts and money in two places, managing old age and combating preventable diseases. Neither of those is something our population can or will change.

Totally agree on the managing old age part, which is something I referred to much earlier. What I haven't seen other than one anecdote, is how our system differs regarding the elderly from any other Non-Beveridge system. But this does nothing to explain why our costs for procedures or drugs are so much higher than other countries.

---

<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?

 

<blockquote class="ipsBlockquote" data-author="HandsomeRob86" data-cid="969795" data-time="1488096293">
<div>
I have heard it quoted many times that something like 2/3rds of the cost of our care is in the last year of life. You wouldn't get most of that care in other countries.

Japan has an older population, and their elderly has more care than in the U.S. Of course their doctors are paid much less than ours. However, I agree with your premise generally, that we spend an inordinate amount of money on the last year or month of life. That was what I was addressing much earlier when I talked about end-of-life care. You are preaching to the choir.  :yes: 


 

Its not an American trait to tell people to just go off to the wood shed and die. 

Actually, it very much IS an American trait to do just that. That is what we do every year by not having health care systems in place that are similar to the other countries. I posted much earlier about the deaths due to lack of access that other countries simply do not have, yet have heard crickets in response.


 

So until just letting folks die becomes culturally acceptable, you won't won't just cut our costs.

Your premise is that in the U.S. it is not culturally acceptable for letting (old) folks die, but in other countries it is. So far the only evidence I have seen of this is your one anecdote from Canada. Out of curiosity, what was the procedure? On a more general level, what is the care that would be provided in the U.S. but not say, in any of the other Bismarck countries? I understand that a Beveridge system might ration care in the manner you describe. 

 

Combined with our leading role in medical research and development you get the highest cost system in the world.

No problem with medical R&D, but we are talking about everyday care.  I have yet to find a site that compares our costs, procedure by procedure, that does not have us listed in the top 3 for costs, and most often the most expensive. Same for drug costs. My premise stated earlier was pretty simple. We do not have price transparency, and when we do get information into pricing, we are more expensive than other countries. This has nothing to do with the graying of America, or with unneeded hip replacements(though i do not deny the validity of those points). I saw a commentator last week make the observation that folks would consider it crazy to go into a supermarket and pay ten times more for a carrot than the next person in line. Do you believe we can get health care costs in line without price transparency? 

 

I had asked earlier for feedback on how we ranked compared to other countries, and appreciate your views. I also had mentioned goals, such as universal coverage, or getting our health care costs in line with the the next 15 most expensive countries in the world. What would your goals for our system be and how would you get there?

 

</div>
</blockquote>
 

Could you edit your responses to a more obvious color?

---

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

Medicaid is a joint federal and state program. Each state has liberty to set their own fee schedule, but must be within the parameters of the federal guidelines if they want their share of the federal money. That's why Governor Scott's rejection of the new rulesa few years ago was a big deal, Florida didn't change our eligibilty rules and CMS withheld our funds.


Here's their page with tons of information about how that bureaucracy works.

<a class="bbc_url" href='https://www.medicaid.gov/medicaid/financing-and-reimbursement/'>https://www.medicaid.gov/medicaid/financing-and-reimbursement/</a>

At this point I have no idea why the link you gave me the other day would authorize $100 dollar in Medicaid reimbursement for a procedure that Medicare would pay $400 for, for example. It sounds, however, that it is a state decision to set those rates so low that they would only be 28% of Medicare. Not that that makes the messiness of the program any better, just trying to understand the disparity. From the whole fund matching and oversight standpoint, it seems like a pretty crap system.

---

<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?