quote:

ORIGINAL: awmslave

quote:

Single payer does not make it possible to control prices without either rationing or decrease in overall quality. Laws don't repeal the laws of economics. Only the market can efficiently allocate resources.

I do not agree with this. Allegedly, there is the market-based system now in place.

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ORIGINAL: rulemylife

quote:

ORIGINAL: QuietlySeeking

Problem #1: Current government run programs give direct access to specialists.
Solution #1: Force government run programs to mimic for-profit systems which require people to visit primary care physicians and be referred to specialists.

How is direct access to specialists less efficient?

If I have a foot problem why should I have to go to a primary physician to tell me I have a foot problem and refer me to a podiatrist?

Wouldn't cutting out the middle man make it more efficient?

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Problem #2: Current gov't run programs allow multiple doctors to run the same diagnostic test and pay for it multiple times.
Solution #2: Require the gov't run programs to subscribe to single-diagnostic tests that are then shared amongst providers.

And this is a problem unique to government programs?

Which in itself is funny, because we've had a big outcry over computerized health records, which the health care proposals call for and which would eliminate these types of redundancy.

But, the government would know your health history if we actually put health records into databases, and that seems to be scary for some, though I've yet to understand the reasoning.

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Problem #3: Current gov't run programs do not have lifetime caps on insurance which allow people to continue to make whatever healthcare choices without consequence.
Solution #3: Almost every private insurer has lifetime caps on insurance payouts.  Only the most expensive treatments over many years would every reach these lifetime caps.

Do you really believe the majority of people enjoy going to doctors and taking advantage of the resort-like hospital atmospheres that they would take advantage of the system to spend as much time in the hospital as possible?

But what about the people who really need the treatment when they reach the private caps?

Just too bad for them and let them die?

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Problem #4: Emergency room care is the "primary care" for most below the poverty line recipients.
Solution #4: Make emergency room care via gov't run programs the same as private insurers.  If you aren't admitted, you pay a larger portion of the bill to prevent people from using ERs as physicians' offices.

Any facts to back your arguments?  Have any proof on this primary care theory?  And for that matter, what is it you are defining as primary care? 

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What makes us think that an inefficient bureaucracy is going to manage our healthcare any better?

Are you kidding me?

An inefficient bureaucracy is the very definition of any HMO or other health insurer you can name.

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ORIGINAL: MzMia

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ORIGINAL: subfever

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ORIGINAL: MzMia

come on subfever, we all know who is behind " it all". 
 
THE MAN!

If this is true, why are you focused on bigger and better band-aids?

Here is a clue by 4 for you subfever.

"THE MAN" will fight the Single Payer Health Care System with everything he has got!
The Single Payer Health Care System is one of "The Man's" biggest nightmares.
 
It is so big an issue, President Obama has not even put it on the table.
The fact, that I do NOT hear enough about it "being put on the table" is the reason I started this thread.

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ORIGINAL: tazzygirl


Now, if the government can provide such standards for them, why are they having so much difficulty modeling one for civilians?

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ORIGINAL: awmslave

quote:

Single payer does not make it possible to control prices without either rationing or decrease in overall quality. Laws don't repeal the laws of economics. Only the market can efficiently allocate resources.

I do not agree with this. Allegedly, there is the market-based system now in place. The prices in US for the same service are several times higher than in other countries. There is no evidence services being poor in quality in these countries (Japan for example has strict price control, Germany controls prices and salaries). The customer in US has very little control or choice. Medical care has a tendency  by its nature to become a monopoly. This originates from the very high price of the equipment and buildings and special labor qualifications. The result is the the customer is ripped off and he/she has no power to go elsewhere or get a fair price. HMO-s pay much less for the same service (compared to uninsured) but lot of this is allocated for the company benefits and the customer wins very little.
The single payer system would take place of HMO but with true "non profit" practice. The current non-profit health insurers are pseudo non profit organizations spending huge sums for executive compensation, vacationing, lobbying, advertising and so on.

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ORIGINAL: willbeurdaddy

quote:

ORIGINAL: tazzygirl


Now, if the government can provide such standards for them, why are they having so much difficulty modeling one for civilians?

Because there is a big difference between a plan for a limited and relatively homogeneous group and one that is supposed to fit for 300 million economically and culturally diverse people.

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ORIGINAL: willbeurdaddy

you got about half of them right...better than your average!

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1. Gatekeepers don't reduce costs, and QS ignores the fact that for-profit insurers have largely abandoned the model. But wasn't it you, RLM, that challenged me when I said people are quite capable of self-referring in most cases?

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2. Are multiple tests really that big an extra cost? When and why do they occur? How often are they really redundant.

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3. Lifetime caps. Now you run into a moral dilemma under ANY system. Obama's program claims to not have lifetime caps. Bullshit. They are disguised in the form of QALY, Quality Adjusted Life Years as its called in the UK system. It is quite simply rationing. If you dont have enough "quality years of life" to spread cost over then you dont get the treatment. Need a new knee? If youre expected to live 40 more years, no problem, if youre expected to live 5 more years, problem. "Too bad and let them die" you ask? WTF do you think happens under a QALY system? Except now its a government bureaucrat who tells a doctor.."hey doc, its your call whether he has enough years to live to justify putting him on those meds. By the way did you see the drop in your reimbursements last year because John Doe died two months after heart surgery?"

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Yes, the primary answer to cost is cost/benefit analysis...just like every other purchase decision. Who do you want to make that decision?  Who do you want to make that decision? You or some guy who wasnt smart enough to get a job in the TSA so he went to work for the Heath Care Administration?

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4. You cant seriously question whether the ER is the source of primary care for the un/under-insured. You do read the newspapers don't you?

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5. No, the government through medicare has proven that it is less efficient than HMOs and other health insurers.

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4. You cant seriously question whether the ER is the source of primary care for the un/under-insured. You do read the newspapers don't you? You do know that at least a dozen emergency rooms and urgent care clinics closed in LA and Texas because they were so overburdened with routine medical issues AND COULDNT DENY SERVICE BASED ON INABILITY TO PAY?

quote:

"Uninsured Adults Presenting to U.S. Emergency Departments," which was conducted by researchers at the University of Michigan, Ann Arbor, found several reasons for emergency room overcrowding, including a decreasing number of emergency departments and inpatient hospital beds. But it also concluded that overcrowding is directly tied to the declining number of primary care physicians, said Manya Newton, M.D., M.P.H., an emergency department physician and one of the primary authors of the study.

"Emergency department crowding is extremely multifaceted," said Newton, a clinical lecturer in the emergency medicine and internal medicine departments at the University of Michigan. "One of the interesting things is emergency department overcrowding exists in countries throughout the world, many of which have national health insurance. Everyone is insured, yet there is still crowding."

During the past 10 years, ER use has more than doubled in the United States, increasing among the insured and uninsured, said Newton. In fact, the number of ER visits by insured patients has increased in that time from 35 visits per 100 people per year to 39 visits per 100 people annually, according to Newton.

"That doesn't sound like a huge increase, but when you are looking across millions of people in America, that is enough to drive crowding," she said. "One of the reasons that is happening is a lack of access to primary care."

Insured individuals technically have access to primary care physicians, but as these physicians become more overloaded and fewer in number, people are forced to seek care from emergency departments, said Newton.

"There is a decreasing number of primary care physicians, and that is hurting everyone -- the insured and the uninsured," said Newton.

quote:

ORIGINAL: tazzygirl

quote:

ORIGINAL: willbeurdaddy

quote:

ORIGINAL: tazzygirl


Now, if the government can provide such standards for them, why are they having so much difficulty modeling one for civilians?

Because there is a big difference between a plan for a limited and relatively homogeneous group and one that is supposed to fit for 300 million economically and culturally diverse people.

The military is just as diverse. And while 300 million is definitely one thing... 50 million have no insurance at all. shouldnt we concertrate on those first since they are eating up most of the so called health care dollars causing health care to soar as the bills rise for those who DO have insurance?

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ORIGINAL: rulemylife

quote:

ORIGINAL: willbeurdaddy

you got about half of them right...better than your average!

Ohhhhhhh Willbeurrrrrrrrrrrrr!

It's always so nice to get compliments from you.

[sm=candles.gif]

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1. Gatekeepers don't reduce costs, and QS ignores the fact that for-profit insurers have largely abandoned the model. But wasn't it you, RLM, that challenged me when I said people are quite capable of self-referring in most cases?

Uhhhhh, no.

And it's RML.

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2. Are multiple tests really that big an extra cost? When and why do they occur? How often are they really redundant.

I don't know, but like you I've traveled frequently, and while I don't have any chronic conditions I find it a little wasteful when I go to an out-of-town doctor for a simple problem and go though the same tests that I've received only weeks before in a regular check-up.

Which was my point.  Why are there so many objections to computerizing health records when it would allow you to see any doctor anywhere and they would have your complete health history to aid in diagnosis at the touch of a button?

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3. Lifetime caps. Now you run into a moral dilemma under ANY system. Obama's program claims to not have lifetime caps. Bullshit. They are disguised in the form of QALY, Quality Adjusted Life Years as its called in the UK system. It is quite simply rationing. If you dont have enough "quality years of life" to spread cost over then you dont get the treatment. Need a new knee? If youre expected to live 40 more years, no problem, if youre expected to live 5 more years, problem. "Too bad and let them die" you ask? WTF do you think happens under a QALY system? Except now its a government bureaucrat who tells a doctor.."hey doc, its your call whether he has enough years to live to justify putting him on those meds. By the way did you see the drop in your reimbursements last year because John Doe died two months after heart surgery?"

I'm not familiar with the UK system, but you've made similar claims about the Canadian system and have been told you are wrong by those living in Canada.

Regardless, we are not doing comparative analysis here.

We are discussing the health care proposal here.  So do you have anything to show that what you claim is in fact being proposed?

quote:


Yes, the primary answer to cost is cost/benefit analysis...just like every other purchase decision. Who do you want to make that decision?  Who do you want to make that decision? You or some guy who wasnt smart enough to get a job in the TSA so he went to work for the Heath Care Administration?

Which you've just claimed above would be health care "rationing" and something we don't want, while now saying it is something we already have.

So who in your opinion is making the decision now?

You or some guy who works for your health insurer?

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4. You cant seriously question whether the ER is the source of primary care for the un/under-insured. You do read the newspapers don't you?

Yeah, I can, until you provide me some proof that what you are saying is true. 

Spouting off things that are supposedly well-known facts does not impress.

Offer the facts.

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5. No, the government through medicare has proven that it is less efficient than HMOs and other health insurers.

Yet again, another unsupported conclusion that we are supposed to accept as an undisputed fact.

quote:

ORIGINAL: tazzygirl




and, what is your solution to the "end of life care"?

quote:

ORIGINAL: tazzygirl

quote:

4. You cant seriously question whether the ER is the source of primary care for the un/under-insured. You do read the newspapers don't you? You do know that at least a dozen emergency rooms and urgent care clinics closed in LA and Texas because they were so overburdened with routine medical issues AND COULDNT DENY SERVICE BASED ON INABILITY TO PAY?

Sadly, rule, this part he is right on. ER's have become the primary care for underinsured people, and many insured as well.

quote:

"Uninsured Adults Presenting to U.S. Emergency Departments," which was conducted by researchers at the University of Michigan, Ann Arbor, found several reasons for emergency room overcrowding, including a decreasing number of emergency departments and inpatient hospital beds. But it also concluded that overcrowding is directly tied to the declining number of primary care physicians, said Manya Newton, M.D., M.P.H., an emergency department physician and one of the primary authors of the study.

"Emergency department crowding is extremely multifaceted," said Newton, a clinical lecturer in the emergency medicine and internal medicine departments at the University of Michigan. "One of the interesting things is emergency department overcrowding exists in countries throughout the world, many of which have national health insurance. Everyone is insured, yet there is still crowding."

During the past 10 years, ER use has more than doubled in the United States, increasing among the insured and uninsured, said Newton. In fact, the number of ER visits by insured patients has increased in that time from 35 visits per 100 people per year to 39 visits per 100 people annually, according to Newton.

"That doesn't sound like a huge increase, but when you are looking across millions of people in America, that is enough to drive crowding," she said. "One of the reasons that is happening is a lack of access to primary care."

Insured individuals technically have access to primary care physicians, but as these physicians become more overloaded and fewer in number, people are forced to seek care from emergency departments, said Newton.

"There is a decreasing number of primary care physicians, and that is hurting everyone -- the insured and the uninsured," said Newton.

http://www.aafp.org/online/en/home/publications/news/news-now/clinical-care-research/20081125jama-er-use.html

quote:

ORIGINAL: tazzygirl

so, in essence, that would decide who lives or dies. when they reach their cap... so sorry? i do believe there is a lawsuit pending over a man who was extradited from a hospital against his guardiands wishes... even though he was not a citizen. he was hit by a drunk driver, ended up with the mental capacity of a 4th grader.

Medicine isnt about health rationing. its about healing. if more people had access to better healthcare, the end of life care wouldnt be as drastic.

quote:

Once again you are back to the economic reality and bioethics crossroad, and cost/benefit analysis should drive those decisions.

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ORIGINAL: willbeurdaddy

quote:

ORIGINAL: tazzygirl

so, in essence, that would decide who lives or dies. when they reach their cap... so sorry? i do believe there is a lawsuit pending over a man who was extradited from a hospital against his guardiands wishes... even though he was not a citizen. he was hit by a drunk driver, ended up with the mental capacity of a 4th grader.

Medicine isnt about health rationing. its about healing. if more people had access to better healthcare, the end of life care wouldnt be as drastic.

Yes, so sorry. When are people going to understand that if youre going to "live forever" then you have to be prepared to pay for the medical costs for it, and why the hell should somebody else foot the bill?

And no, if more people had access to better healthcare, end of life costs would be exactly the same, just pushed off 6 months or a year, at least until someone discovers the fountain of youth.

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ORIGINAL: Arpig

quote:

Once again you are back to the economic reality and bioethics crossroad, and cost/benefit analysis should drive those decisions.

And why do you feel that an insurance company employee with no medical training and incentives to deny payment is more qualified to make that decision than a doctor?

quote:

ORIGINAL: willbeurdaddy

3. Lifetime caps. Now you run into a moral dilemma under ANY system. Obama's program claims to not have lifetime caps. Bullshit. They are disguised in the form of QALY, Quality Adjusted Life Years as its called in the UK system. It is quite simply rationing. If you dont have enough "quality years of life" to spread cost over then you dont get the treatment. Need a new knee? If youre expected to live 40 more years, no problem, if youre expected to live 5 more years, problem. "Too bad and let them die" you ask? WTF do you think happens under a QALY system? Except now its a government bureaucrat who tells a doctor.."hey doc, its your call whether he has enough years to live to justify putting him on those meds.