(01-31-2019, 11:18 AM)mikesez Wrote:

(01-31-2019, 04:10 AM)jj82284 Wrote: So let me get this straight.  The same government monopoly that was given tens of thousands of dollars and 13 years for my education failed to make me competent enough to understand my own healthcare.  So your solution is to put the same government monopoly in charge of said healthcare decisions?  In what world is this logical?  Self interested people with the ability to hold providers accountable do better making their own decisions than unaccountable bureaucrats.  The answer is more transparency and consumer education, not an even bigger curtain of the state that isn't governed by any real standard of honesty (Barrack Obama would have been jailed if her were a CEO of a private healthcare company.)  

I also find it interesting that, more often than not, interventionists never actually take the time to evaluate the results of intervention.  Every wart or freckle in a market result can be analyzed dissected and stated as a call to action.  Then when the government intervenes, MAKES THINGS WORSE, we blame the market?  Accreditation, Licensure, and the AMA have very little to do with a true free market economy and they account for hundreds of thousands of dollars blocking the entry of intellectual capital into medicine.   

Economics is the rationing of scarce resources.  On a fundamental level, the biggest driver in the cost of someone to cut into your chest and fix a heart valve is that there are only  few people who know how to do it.  There's only so much any "system" is going to mitigate that economic reality.  

When you look at healthcare, like any good or service, the price is also a reflection of the amounts of resources that go into bringing that product to market.  In this case we have: The actual cost of care, the cost of the Insurance bureaucracy, and the cost of the government bureaucracy.  The basic fallacy with interventionists is that somehow dramatically increasing the size of the government bureaucracy is somehow going to reduce the cost of the underlying good or service which basically defies economics.  At current, just so the administrators between the care provider, the state and the insurance companies can talk to each other people get full college degrees in billing and coding.  It takes a decade in some cases to bring certain drugs to the market.  Those are massive massive costs that are absorbed by the consumer that don't actually go into the pocket of care providers.  If you really want to reduce costs then we have to mitigate those extra expenses.  

What's the best way to do that?  Let providers develop their own risk pools. There are lots of consierge practices and cooperatives that are set up where instead of paying a premium to a third party insurance company for the majority of your healthcare, you pay a monthly membership fee to the doctor and go when needed.  This saves tons of money in cost of compliance alone.  And we couple that with CATASTROPHIC INSURANCE for the cancer diagnosis or major illness that the average person can't pay for.

I think your comment about education is garbage.  You don't seriously want primary and secondary schools to be tasked with bringing an average person's knowledge of medicine up to where they could compete with an expert, so why bring it up?
Yes, I think average people could rely on one expert to be their advocate against other experts.  That's how class action lawsuits and many other things in law work.
I agree with you about the AMA and how needlessly difficult they make it to practice medicine.  I agree that drives a lot of cost increase.  But flsportgod hated that idea when I brought it up, said I wanted a "C student" to operate on me next time I had a problem.
I agree with you that steering more people towards catastrophic plans can help lower expenditures while minimally changing outcomes.
I don't agree that concierge care is going to improve anything for anyone besides an elite few.
I think your brain is contaminated with the "government as a bogeyman" meme and you need to work on that.  The public school teacher is not the same type of person as the police officer, and neither of them are the same type of person as a judge or a city manager.  Yet they all work for the government.  Governments are really bad at certain tasks, but they are really good at other tasks.  Experience around the world shows that governments help keep costs down and quality in health care.  Just because the Fed's interventions in housing and education have been convoluted busts doesn't mean that health care would be.
All I want the government to do is
-make it so Americans pay prices for prescription drugs that are similar to what Canadians and Europeans pay
-make it so people only pay a certain % of their income in health care premiums and deductibles, and insurance can't turn anyone down
-make it so you can keep whatever health plan you're on when you change employers - the plan is tied just to you, not the employer
in that order.

Most of your objections are not really relevant to any of these three goals, and there are various ways the government could achieve them, whether by directly taking stuff over, starting new publicly owned operations to compete with what exists in the private sector today, offering vouchers, etc.

In regards to the red:
Lol, sure, if the outcomes that are minimally changing are being compared to the worst possible outcomes like needing open heart surgery.

Preventative care is cheap if people do it. Catastrophes are catastrophes by their very nature. They are always expensive and always bad. I think the problem here is maybe you mean 'like a car wreck' when you think of catastrophe. But as a medical professional, that is not what I think of. I think of a guy who hasn't seen his doc in 30 years, drinks several beers a day, smokes 2 packs, and is obese with un-diagnosised diabetes and hypertension who is rolling in my ER with chest pain. That guy is getting expensive surgery plus a 'million' dollar workup. That is a catatrophe health-wise, and that is what people do when they 'don't have to' see primary care.

So if I am an insurance company, even on my catastrophe plans, I really want my patients to actually see a primary care doctor. The problem is insurance wants to pay $42 for you to see your Family doc. So he schedules 4+ patients an hour to support the crazy amount of staff it takes him to see patients and to actually bill and get paid. Then the healthcare suffers cause how can he screen you really well in 5 minutes of room time (cause insurance requires 10 minutes worth of charting to justify paying you).

I understand the appeal of direct primary care, but it just doesn't seem to work in areas where the average wage is below 100k (i.e. outside the bay). People already pay for their insurance, and 90% will not pay more. It is where the country will head if we goto socialized medicine. Poor people will wait months to see a physician, and rich ones will pay for better access.

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