She may have family or friends who are. She may feel Healthcare is a universal right.

On a certain level I agree with this. Not every aspect is, but the other day I had a physician friend whose colleague tried to refer a patient to a prestigious private hospital system in TN. The patient had a condition which would lead to meningitis if not treated and which they were specially equipped to treat. The hospital system refused her because she didn't have insurance. I have never heard of this happening before, but it felt wrong to him and to me. If you have a condition which can be treated and is life-threatening, I do not believe you should be rejected just because you cannot pay. But at the same time, that surgeon/hospital team does deserve pay too. This is where having a universal 'option' would make sense.

---

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.

 

Because politicians lie.

The truth for the vast majority.

---

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.

 

Based on your definition, unless you have the means to finance the total cost of an injury or disease you cannot get health care without health insurance. So arguing over your semantics is quite literally an absolute waste of time. 

As many illegal immigrants prove every year. This is not true in general. Although as mentioned above individually ymmv

---

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.

 

How much does it cost for a normal person to visit their doctor?

If your paying cash, calling around can get it done for 50 to 60 bucks.

---

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.

 

Not sure what you mean by your first sentence. Can you clarify? I agree about preventative care, and along with big pharma I might add over-prescription as a potential reason for high costs.

I'm of the mindset that a countries economics and tax base play a large role in what system exists. If you look at each system you gave as examples, each country is drastically different economically, heck, even socially. I'm more incline to believe a combination of single payer and OOP needs to exist in America.


Additional issue...We get trapped into thinking one size fits all. In regards to ACA, that is it's largest fault. If I am a 35 year old male, why do I need pregnancy and birth control coverage? It is a tricky mess for sure, but can't have the costs continuing to skyrocket, especially Medicaid.

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Take a break from money excuses. and he law's ripple-down effect. The OP's question is about how we should fix it, not what wrong seven years ago. I suggested one. Now it is someone else's turn.

A public option.

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Medicare, which creates the foundation of all fee schedules, pays about $70 for an acute visit of midling severity.

 

Can you provide more detail for the statement that Medicare creates the foundation for all fee schedules? I have read some stuff that there can be a great deal of variance in rates. 

---

<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?

1) You assume the state government is the only barrier to entry. It may simply not make financial sense to build a hospital. There may be no demand for one. 

 

2) Not sure why you wouldn't want the oversight of a physician. They are your primary healthcare provider. 

 

3) There is a good reason they don't sell across state lines. Insurers would cherry pick where they provided business, potentially to the states with the healthiest populations. This would create a race to the bottom as insurers would get to choose both their regulator and their risk pool. 

1) I actually agree with this somewhat. Thats why you see the proliferation of stand alone ER's (cause no certificate of need required). But at the same time having more competition in an area isn't a bad thing, but hospitals don't compete on cost, they compete for patients cause when you need care you rarely get to pick (except maybe in where you have babies/ get treated for cancer etc.)

2.) agree I am in favor of physician oversight of clinics, why people want a less educated and trained provider is beyond me. The proliferation of 'way less trained' but 'almost as good' is kind of nonsense. There is a reason midlevels usually have a physician as backup and its not because they are just as good as that physician.

 

3) This is what they currently do. Removing the lines would incentivize them to expand to other states.

---

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.

 

It's a complex issue for sure. I think the problem is largely in the cost of the healthcare itself. $1000 for an aspirin ect ect. I think a large portion of why the costs are out of control is that we use insurance to pay for everything. Insurance as a concept, is supposed to be to cover the unexpected and things that would be too expensive to budget for but by spreading the risk over a large pool of people, it becomes manageable. When insurance pays for everything, it distorts the prices of things. Instead of making a choice about whether you have x or y done, you get everything done because the insurance is paying, so there is no natural price control set by limits on the demand, that causes prices to explode. 

 

Why is more expensive for my family members to use their insurance to get some medications than to just pay $4 out of pocket and not use the insurance? See, that seems like a scam to me? What price is it really when the insurance pays?

 

If you look at some things that insurance does not cover, that you pay out of pocket for, those prices often come down a lot. Take LASIK, that used to thousands and thousands of dollars, now you can get that done for about 300 dollars an eye in many places. 

 

I don't have all the answers to this mess but I think many people need insurance that covers what they actually need and not what they don't. I'm a pretty young guy and in good health, I don't need the same plan as a 55 year old with hypertension and diabetes. I just need a plan that covers me if I get cancer or something. I don't need every bell and whistle, every hangnail covered by my insurance. If we stopped using insurance to cover trivial crap like that, the prices on that trivial stuff should come down a lot. 

 

Tort reform would also make a lot of sense. I wonder how much of the cost of medicine is there simply because of frivolous law suits and people who got care but could not pay the bill or illegals who don't belong here in the first place. 

Law suits are 6% directly of the cost, but drive a large amount of the tests. You would see a significant cost reduction with caps. But at the same time people do deserve good care. Got to balance, but with the lawsuit happy generations right now its hard.  

---

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.

 

Samjag, I do not necessarily disagree with you, but your point totally ignores the fact that expected medical expenses includes drugs for conditions that patients had most or all of their lives. I can only use my own situation as an example, so please don't think I am being selfish. Millions of Americans are in the same boat.

 

I have epilepsy. Treatment is two drugs - one twice a day, the other once a day. Both drugs are unaffordable despite being on the formulary for my health insurance plan. The only way to get them is free from the manufacturers. Luckily I qualified for that, but why should it be necessary when the drug are covered? Mom said the problem was she "fell into the doughnut hole." Although the doughnut hole is still legal I felt like I was scammed because the insurance companies Mom talked to gave her misinformation when she was shopping for a cheaper plan.

 

She also told me the price difference for regular vs. extended release forms of the same drug is ridiculously high. If I could take the regular version of my drugs, they would be dirt cheap. But I medically require an extended release prescription - otherwise I would get seizures before it was time to take my next dose. What an ACA replacement bill needs (I accept the fact there will be one) is a mandate to make all forms of a drug the same price - or at least a low cap on the price difference - so people don't see medication costs soar out of control just by getting new prescriptions.

I actually agree here. It is crazy that the long acting form of many drugs is so much more expensive. I mean I can understand a little more cost for the convenience but still.

---

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.

 

It's a complex issue for sure. I think the problem is largely in the cost of the healthcare itself. $1000 for an aspirin ect ect. I think a large portion of why the costs are out of control is that we use insurance to pay for everything. Insurance as a concept, is supposed to be to cover the unexpected and things that would be too expensive to budget for but by spreading the risk over a large pool of people, it becomes manageable. When insurance pays for everything, it distorts the prices of things. Instead of making a choice about whether you have x or y done, you get everything done because the insurance is paying, so there is no natural price control set by limits on the demand, that causes prices to explode. 

 

Why is more expensive for my family members to use their insurance to get some medications than to just pay $4 out of pocket and not use the insurance? See, that seems like a scam to me? What price is it really when the insurance pays?

 

If you look at some things that insurance does not cover, that you pay out of pocket for, those prices often come down a lot. Take LASIK, that used to thousands and thousands of dollars, now you can get that done for about 300 dollars an eye in many places. 

 

I don't have all the answers to this mess but I think many people need insurance that covers what they actually need and not what they don't. I'm a pretty young guy and in good health, I don't need the same plan as a 55 year old with hypertension and diabetes. I just need a plan that covers me if I get cancer or something. I don't need every bell and whistle, every hangnail covered by my insurance. If we stopped using insurance to cover trivial crap like that, the prices on that trivial stuff should come down a lot. 

 

Tort reform would also make a lot of sense. I wonder how much of the cost of medicine is there simply because of frivolous law suits and people who got care but could not pay the bill or illegals who don't belong here in the first place. 

Good feedback, thanks. I think cost control is a very important issue, and agree that there is a risk of overuse due to not having an immediate hit in the wallet. Regarding malpractice, I have read that it accounts for about 1/3 of 1% of the cost of healthcare. While every billion here and there add up, I am not sure it is a primary driver in the cost. Also, I think that figure does not count defensive medicine, which adds a few percent to the cost. From what I recall, some countries have laws in place that limit liability if doctors are performing the generally accepted treatment and are not grossly negligent. Seems pretty reasonable to me.

---

<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?

Can you provide more detail for the statement that Medicare creates the foundation for all fee schedules? I have read some stuff that there can be a great deal of variance in rates. 

Insurance will always try and copy what Medicare does. Look at when Medicare said they would no longer pay for certain "hospital acquired infections," all the insurances followed suit. They copy big time, which is annoying, because they claim they are superior and yet play follow the leader to the government all the time.

---

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.

 

Take a break from money excuses. and he law's ripple-down effect. The OP's question is about how we should fix it, not what wrong seven years ago. I suggested one. Now it is someone else's turn.

 

with respect, if we are going to have an informed conversation we are going to have to be specific about what challenges arise, whether those challenges are on the coverage side or the care provision side and what methods could be used to fix them.  I'll be honest, when I saw the term "donut hole" It looked out of place to me too.  When talking about insurance you we are talking about contracts with specific provisions with direct correlation to actuarial values.  It's not about making excuses its about clearly communicating. 

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On a certain level I agree with this. Not every aspect is, but the other day I had a physician friend whose colleague tried to refer a patient to a prestigious private hospital system in TN. The patient had a condition which would lead to meningitis if not treated and which they were specially equipped to treat. The hospital system refused her because she didn't have insurance. I have never heard of this happening before, but it felt wrong to him and to me. If you have a condition which can be treated and is life-threatening, I do not believe you should be rejected just because you cannot pay. But at the same time, that surgeon/hospital team does deserve pay too. This is where having a universal 'option' would make sense.

I believe that many folks think that you can't be turned away from an emergency room. From what I understand, that is true in an emergency situation, but not otherwise. I do not believe EMTLA covers the meningitis case you cite above, for example. If the person had an immediately life-threatening situation, that would be different.

---

<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?

Good feedback, thanks. I think cost control is a very important issue, and agree that there is a risk of overuse due to not having an immediate hit in the wallet. Regarding malpractice, I have read that it accounts for about 1/3 of 1% of the cost of healthcar
e. While every billion here and there add up, I am not sure it is a primary driver in the cost. Also, I think that figure does not count defensive medicine, which adds a few percent to the cost. From what I recall, some countries have laws in place that limit liability if doctors are performing the generally accepted treatment and are not grossly negligent. Seems pretty reasonable to me.

Not true, see above. Even tho it is a "low percentage" it drastically increases the amount of test and diagnostics order in the name of CYA. When you are paying 20k a year for malpractice insurance for a single provider you know its a big issue.

---

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.

 

Law suits are 6% directly of the cost, but drive about 90% of the tests. You would see a significant cost reduction with caps. But at the same time people do deserve good care. Got to balance, but with the lawsuit happy generations right now its hard.  

Source? That is significantly above some info that I have seen.

---

<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?

A public option.

VA

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I believe that many folks think that you can't be turned away from an emergency room. From what I understand, that is true in an emergency situation, but not otherwise. I do not believe EMTLA covers the meningitis case you cite above, for example. If the person had an immediately life-threatening situation, that would be different.

You are correct. EMTALA wouldn't apply until she gets the Meningitis, even tho it is guaranteed because of her condition, and its location. By refusing her care, that system is guaranteeing she will experience a life threatening disease.

---

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.

 

Insurance will always try and copy what Medicare does. Look at when Medicare said they would no longer pay for certain "hospital acquired infections," all the insurances followed suit. They copy big time, which is annoying, because they claim they are superior and yet play follow the leader to the government all the time.

Well, I can certainly see that when a for-profit company can use a 'Medicare did it' justification to cut costs they might be on that like catnip, but I meant the relationship of all other charges to Medicare. I am not sure I am reading it right, but it looks like there might be a 2.5X average excess compared to medicare rates as opposed to other charges in this JAMA article, and I have seen elsewhere reports of standard 500% markups in different specialties compared to Medicare schedules. I am not an expert on this stuff, and find it rather confusing. I remember back in the dark ages I worked for a truckine. Tariffs had to be published(I believe with the ICC). It seems a shame that there doesn't seem to be any transparency regarding health care rates. 

---

<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?

Source? That is significantly above some info that I have seen.

yes 2 to 11% of direct cost sounds correct. Its the hidden cost of extra tests and screens run. It cannot be exactly determined. But notice your estimate of 'defensive medicine' 45 billion.

 

Consider this: "the American Academy of Orthopedic Surgeons cited estimates that, by reducing defensive medicine, liability reform could result in yearly savings from $54 billion to $650 billion."

Source: http://medicaleconomics.modernmedicine.c...e-medicine

 

Also this from Jackson Healthcare: ""If physician estimates are accurate, this means that $650-850 billion per year is spent on lawsuit-driven medicine." Once again about 30 - 34%.

http://www.jacksonhealthcare.com/media-r...lease.aspx

 

That is about a third the cost of healthcare. Personally I believe that it is more like 40-50% total and a majority of tests are done defensively. It goes far beyond just the 'lawsuit.'

 

I read the JAMA article that the lower estimate comes from. They were fairly selective in their methodology and only included what they called 100% defensive. You can't do that. Its a false low.

---

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.