RE: A rather large presumption

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DesideriScuri -> RE: A rather large presumption (11/18/2013 1:19:55 PM)
quote: ORIGINAL: Zonie63 quote: ORIGINAL: DesideriScuri quote: ORIGINAL: Zonie63 My solution would be price controls, but nobody seems to like that idea. Where would you put the control, Zonie? Would you put it only on the "final" price the provider is allowed to charge, or would you put it a control on every level of service/product that goes into making that final price? I'd have to see the figures and how much the actual markup is. quote: Purely as an example, if I make gold widgets that each contain a troy ounce of gold, when gold can't be bought for less than $1300/oz., what would happen if government came in and said I'm not allowed to charge more than $1000 per gold widget? Then I suppose it wouldn't be feasible for you to go into the gold widget business, unless you found cheaper ways of obtaining your supply (such as setting up your own mine). Can a health care provider do the same, though? What happens if all the materials that go into providing the service or procedure can't be sourced at a cost lower than the price control? It's possible that the suppliers to the hospital might be able to find cost-savings, but, what happens to the hospital in the mean time? quote: quote: IMO, a price control assumes there is high profits in the system (which may or may not be the case). The only way a control will truly work well, is to place it on the most profitable input of the final price. If we can identify which input is most profitable, why isn't there competition for providing that input? Is there some legislation that is causing the failure, or is there legislation that could open the jam up (and, how do we want that legislation to act)? These are all valid questions, although it would require "looking under the hood" at most healthcare providers and insurance companies. As for competition, I don't really see a great deal of competition in the healthcare field. People will generally go to whichever hospital or doctor is closest to where they live, and overall, I find very little attention is paid to the idea of competition in healthcare. Patients generally have to do a lot of legwork and make lots of phone calls to find out and compare the costs of different services between healthcare providers. They don't make it very easy for the average person to find out all this stuff. In contrast, I can easily find comparisons and emphasis on competition when it comes to grocery stores, automobiles, computers, etc. If I need some kind of repair, I can usually get a free estimate as to how much it will cost before I agree to the work. Healthcare just doesn't operate that way, especially if you don't even know what medical services or products you'll actually need. It's like trying to navigate a Byzantine labyrinth. They don't make it very consumer-friendly, and it's not very conducive to any kind of competition. For a lot of Americans, their employer picks what insurance company to use. Is that information not easily available because it's not been something anyone has really cared much to find out? If no one was ever looking, what would the point be of creating a price list and maintaining current pricing? quote: If Americans truly want a free-market healthcare system (and I'm not sure that they do), then it should at least be structured and presented in such a way as to promote competition and fair pricing based on free market principles. Consumer choice is also important. If I'm on an insurance plan and they agree to pay X amount of dollars if I need to go to the doctor, it shouldn't matter to them whether I go "in network" or "out of network" as long as the dollar cost is the same either way. Hell, if I wanted to use my designated healthcare dollars to go to a faith healer, I should have that right. So, if we really want free market principles and competition in the medical marketplace, then let's at least do it right - or not at all. I think in-network and out-of-network costs are different for insurance companies, which leads to the difference in coverages. Promedica may not be able to negotiate the same pricing with Mercy Networks, as they are in competition for membership. quote: quote: quote: Another valid question that should be examined is: What are these healthcare products and services actually worth? Are we getting our money's worth? People might pose ancient riddles like "What is the value of a human life?" but in terms of dollars and cents and what they're actually providing, are we getting the best bang from our buck? It should be obvious that we aren't getting the best bang for our buck, as costs for individual procedures and services far surpass the costs for those same services and procedures abroad. I think it's safe to assume that we aren't getting the best bang for our buck. A better question would be "why aren't we?" I honestly don't think we've ever truly found that out. And, until we do, we aren't likely to find a good solution. Again, we have to be able to look under the hood. It seems to me that the central issue here is rising healthcare costs, but people on both sides of this issue seem to just accept it as a given. Nobody really seems to question how much it actually costs and whether it's worth it; the whole debate seems to revolve around who pays for it and how it should be organized. It's almost as if the healthcare industry is saying "Fuck you, pay me," and both parties are playing the "how-we-gonna-pay-for-it" dance. They don't even stop to consider that maybe, just maybe, they could respond to the healthcare industry by saying "Fuck you, this is how much you're going to get, and you're going to like it." The only way to do that to the industry is through price controls. That's a fantastic way to force Market failures, too. If there isn't a private supply of something because government makes it not worth the cost, then either government is going to have to provide it (if it's necessary), or the People are going to have to go without. I am absolutely not in support of that type of action, to be honest. If Government can provide a service at a lower cost to the people than private industry, then we might have to look at whether or not Government has the authority to do so. If it doesn't, what do we need to do to give it that authority? If it does, then we might really have to look at why private industry won't provide it at a lower cost. What can't happen, however, is only taking what government is budgeting, while ignoring deficits incurred.

freedomdwarf1 -> RE: A rather large presumption (11/18/2013 1:43:41 PM)
quote: ORIGINAL: Zonie63 ...It seems to me that the central issue here is rising healthcare costs, but people on both sides of this issue seem to just accept it as a given. Nobody really seems to question how much it actually costs and whether it's worth it; the whole debate seems to revolve around who pays for it and how it should be organized. It's almost as if the healthcare industry is saying "Fuck you, pay me," and both parties are playing the "how-we-gonna-pay-for-it" dance. They don't even stop to consider that maybe, just maybe, they could respond to the healthcare industry by saying "Fuck you, this is how much you're going to get, and you're going to like it." This is pretty much how the single-payer system works, even in Australia where they have a 50/50 system. What happens is, they tell big pharma and others within the healthcare industry all down the line "we have the monopoly and if you want to sell your shit to us, that's what we'll pay or you aren't getting any slice of the cake". It works remarkably well in driving costs down across the board. It's a case of reverse supply-and-demand. Normally, as demand grows (which it always will within healthcare because it's a captive market), the supply will meet it and expect higher prices. This is what is snowballing across the US. Within a single-payer system, the government control the prices and dictate what they will pay the suppliers if they want a big slice of the cake. And this is where the unit profit and volume of scale still makes it worthwhile to the suppliers to do it and make a profit. As an example: a potential market of 80,000 people in private insurance schemes wanting X product; or a guaranteed 10 million people in a single-payer system wanting that same product and you'd be the exclusive supplier for that product. The unit profit would be shit-loads less but a guaranteed sale of millions more of it. It's a win-win for both sides and the overall cost to the end-user is significantly less. To use another analogy, a farmer selling his crop to various suppliers is going to have to negotiate a price for his goods and that isn't a guaranteed price or volume. By the time that buyer gets those crops, adds it's margins and sells to distributors, and then to wholesalers, to supermarkets and other retailers with everyone making their bit all along the line, that cabbage is going to cost quite a bit and the individual farmer may still be left with unsold crops. If the supermarket buys direct from the farmer with an agreement to buy most (or all) of the crop at X price being lower than the market rate but still profitable, the farmer has no surplus to worry about, he still makes his money, the consumer gets the cabbage at cheaper prices and the supermaket deals with all the logistics and distribution and still makes their bit. Sure, the farmers bitch about the volume sales and getting lower unit profits. But at the same time, a lot of hassle is removed and he has a guaranteed sale even when it's a bad year. The same applies to the healthcare market. Too many fingers in the pie with everyone making their profits and the poor US consumer ends up paying through the nose for it with no other choice. Single-payer consumers spend less per capita for the same drugs and often superior services by sheer power of monopoly. quote: ORIGINAL: DesideriScuri That's a fantastic way to force Market failures, too. If there isn't a private supply of something because government makes it not worth the cost, then either government is going to have to provide it (if it's necessary), or the People are going to have to go without. That isn't ever going to happen in the healthcare market because it's a closed system. Everyone needs healthcare at some point and those drugs are always going to be needed. It's a captive audience and no options. The healtcare industry is nothing like any other industry where people can pick and choose models or if they want the object in the first place. The normal rules of supply and demand don't work in the same way.

GotSteel -> RE: A rather large presumption (11/18/2013 2:51:36 PM)
quote: ORIGINAL: TheHeretic quote: ORIGINAL: GotSteel shrug for some reason the "poor people should die on the emergency room curb" view of health care just doesn't poll very well. And who besides Ed Shulz thinks anyone actually holds such a position? I thought you might be better than a bullshit strawman artist, GotSteel. You disappoint me. Heretic, I'm not claiming that anybody takes that position. It's a terrible position. I think just about everybody agrees that government should keep that from happening. The only question is how to do it. The democrats have come up with a plan (or stole McCain's plan depending on who you ask). The Republican's are saying it sucks. So the Democrat's are responding "well yeah, you got a better plan?"

MariaB -> RE: A rather large presumption (11/18/2013 3:03:32 PM)
How many fully insured Americans get declined by their insurer after diagnosis? If you are fully insured and your diagnosed with an expensive illness, you can bet your bottom dollar that they will send in an investigate to scrutinize and look for a get out clause on your medical file. They will look for a crack and sweep you right into it. Having insurance is no guarantee of treatment. Your damned if you do and damned if you don't. This is an interesting article http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx What do you think when you compare the Canadian/French/English system with the American system? and do you think this sort of system could ever be part of the US?

freedomdwarf1 -> RE: A rather large presumption (11/18/2013 3:33:03 PM)
quote: ORIGINAL: MariaB How many fully insured Americans get declined by their insurer after diagnosis? If you are fully insured and your diagnosed with an expensive illness, you can bet your bottom dollar that they will send in an investigate to scrutinize and look for a get out clause on your medical file. They will look for a crack and sweep you right into it. Having insurance is no guarantee of treatment. Your damned if you do and damned if you don't. This is an interesting article http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx What do you think when you compare the Canadian/French/English system with the American system? and do you think this sort of system could ever be part of the US? A very good point. And just like any insurance business, they will always find excuses not to pay up or pay less than what you wanted or expected. We see that time and again, even in the UK, in the auto industry and anywhere else where there is a considered liability. How many homes in the UK can't get flood insurance or pay megabucks because it is deemed they live in a flood-risk postcode? How many that live in rough neighbourhoods can't get home contents insurance because the fucking insurance companies deem them to live in a rough area? Fuck, even your car insurance can leap extortionately if you live in the wrong postcode!! The same thing has happened to the private US healthcare commodity. I think, at some point in the future, the US is going to have to seriously consider some sort of single-payer national system. If not the whole hog like it is here in the UK, then maybe along the lines of the Australian system. As is stands, many Americans can't afford healthcare insurance. The government are also going to introduce escalating fines for those that don't have it. WTF?? If people can't afford the insurance and can't afford the fines either, what are they going to do with all these millions of people?? Jail them all? Give them even bigger fines that they can't afford? What happens to all the children with parents in jail or the older folk who are essentially too old or frail to be jailed? More welfare payouts and foster/care homes costing $billions? I can see that the fines, or some other part of the taxes (or both), going to pay for some sort of universal healthcare that isn't reliant on individual insurance policies. I think it's inevitable... It's just a matter of when, rather than if.

TheHeretic -> RE: A rather large presumption (11/18/2013 7:14:01 PM)
quote: ORIGINAL: evesgrden I'm not about to get into a debate about constitutional law or the founding fathers. Can't handle things when they get that real, huh? Maybe you'd be happier in a country where the subjects just do as they are told? Try to keep your mouth shut when you get there though. [8\|]

EdBowie -> RE: A rather large presumption (11/18/2013 9:10:34 PM)
Did you ever answer the question about the Constitution and your own OP, or is that something you only demand of other people but can't handle yourself? quote: ORIGINAL: TheHeretic quote: ORIGINAL: evesgrden I'm not about to get into a debate about constitutional law or the founding fathers. Can't handle things when they get that real, huh? Maybe you'd be happier in a country where the subjects just do as they are told? Try to keep your mouth shut when you get there though. [8\|]

TheHeretic -> RE: A rather large presumption (11/18/2013 9:16:40 PM)
quote: ORIGINAL: GotSteel Heretic, I'm not claiming that anybody takes that position. It's a terrible position. I think just about everybody agrees that government should keep that from happening. The only question is how to do it. The democrats have come up with a plan (or stole McCain's plan depending on who you ask). The Republican's are saying it sucks. So the Democrat's are responding "well yeah, you got a better plan?" Thank you. From here, we can work on something. I agree that we have serious problems in the pre-Obamacare system, and that there are good provisions in the new approach (of course, in a 2500 page law put together by throwing everything on the shelf into the mixing bowl, that can easily just be blind squirrels getting a nut or two). Right off the bat, my biggest objection is the individual mandate to buy insurance. I hated the idea when the Repulicans floated it, I hate the idea now. I don't believe the federal government has ever been given such an authority, and the Supremes cut the corners on the issue by essentially defining it as a sin tax if you don't. I've said for some time that I don't think Obamacare was ever intended to be a fix. I think it was intended to be a deliberate monkey wrenching, to take an imperfect system, and break it even worse, ultimately forcing something new to replace it. What makes the whole, "Republicans don't have a plan" defense so ridiculous is that neither did the Democrats. I have a favorite conservative arguments in favor of adopting universal healthcare. We could eliminate the crushing weight of retiree healthcare that is impacting both big business, and government at every level, and is only going to get worse. Those burdens drive up the cost of everything built in America, and siphon away tax dollars better spent on the needs of today. I think it is a national conversation we need to have, and I think it is impossible for us to have in a climate where to not embrace liberal idiocy is to be defined as wanting people dropping like flies outside the ER doors. The only appropriate response to that is, "fuck you," and things tend to go downhill from there. If we are going to do it, I think there is going to have to be an Amendment, and then I think we need to do it all the way, not half-assed. It amuses the hell out of me when developmentally disabled libs bleat their magical incantations of, "single payer" and "public option." Do they hear themselves? Sure thing. Let's create a whole new bureaucracy to shell out public funds to private industry. First, we finance it straight off a new income tax. Take a baseline from current costs, knock off 15% or so as a show of good faith, and to start with. One rate for individuals, one for business, and one for capital gains. Keep it simple, stupid, as a better President than we have now famously said. Show me good answers to three questions, and I will get on board for nationalizing healthcare delivery in the US. How do we prevent and minimize bureaucratic bloat and inefficiency? How do we preserve a spirit of private innovation and invention? How do we achieve a high quality of care and compassion in a non-competitive marketplace? For bonus points, how do we prevent a government tasked with our physical well-being from turning into a full-blown nanny-state, dictating how we live our lives?

TheHeretic -> RE: A rather large presumption (11/18/2013 9:29:55 PM)
quote: ORIGINAL: EdBowie Did you ever answer the question about the Constitution and your own OP, or is that something you only demand of other people but can't handle yourself? Do you mean, why is healthcare the government's responsibility? If you had reached the bottom of that post, you might have noticed that I said it isn't a given. Now, I realize that you posted your comment, while my slightly longer reply to GotSteel was still in the works, but you might find a bit more there. Just another thought. Unless you are returning from a little exile, and trying to start without the ravaged credibility of a previous douchebag incarnation, you might note that I've been conversing here for a while, and somewhat prolifically. I drone on enough, when I get going, without providing a recap of the whole last season.

EdBowie -> RE: A rather large presumption (11/18/2013 9:58:32 PM)
Snore. In other words, you aren't going to answer the question, and think you can pull a lame-ass appeal to imaginary authority on me into not calling BS when you spout hypocritical nonsense? Dream on. quote: ORIGINAL: TheHeretic quote: ORIGINAL: EdBowie Did you ever answer the question about the Constitution and your own OP, or is that something you only demand of other people but can't handle yourself? Do you mean, why is healthcare the government's responsibility? If you had reached the bottom of that post, you might have noticed that I said it isn't a given. Now, I realize that you posted your comment, while my slightly longer reply to GotSteel was still in the works, but you might find a bit more there. Just another thought. Unless you are returning from a little exile, and trying to start without the ravaged credibility of a previous douchebag incarnation, you might note that I've been conversing here for a while, and somewhat prolifically. I drone on enough, when I get going, without providing a recap of the whole last season.

DesideriScuri -> RE: A rather large presumption (11/18/2013 9:58:59 PM)
quote: ORIGINAL: freedomdwarf1 quote: ORIGINAL: Zonie63 ...It seems to me that the central issue here is rising healthcare costs, but people on both sides of this issue seem to just accept it as a given. Nobody really seems to question how much it actually costs and whether it's worth it; the whole debate seems to revolve around who pays for it and how it should be organized. It's almost as if the healthcare industry is saying "Fuck you, pay me," and both parties are playing the "how-we-gonna-pay-for-it" dance. They don't even stop to consider that maybe, just maybe, they could respond to the healthcare industry by saying "Fuck you, this is how much you're going to get, and you're going to like it." This is pretty much how the single-payer system works, even in Australia where they have a 50/50 system. What happens is, they tell big pharma and others within the healthcare industry all down the line "we have the monopoly and if you want to sell your shit to us, that's what we'll pay or you aren't getting any slice of the cake". It works remarkably well in driving costs down across the board. Then why hasn't anyone been able to show that? It's not like I haven't asked. So, now I'm asking you to prove that statement. Prove that it works remarkably well in driving costs down across the board. quote: It's a case of reverse supply-and-demand. Normally, as demand grows (which it always will within healthcare because it's a captive market), the supply will meet it and expect higher prices. This is what is snowballing across the US. Within a single-payer system, the government control the prices and dictate what they will pay the suppliers if they want a big slice of the cake. And this is where the unit profit and volume of scale still makes it worthwhile to the suppliers to do it and make a profit. As an example: a potential market of 80,000 people in private insurance schemes wanting X product; or a guaranteed 10 million people in a single-payer system wanting that same product and you'd be the exclusive supplier for that product. The unit profit would be shit-loads less but a guaranteed sale of millions more of it. It's a win-win for both sides and the overall cost to the end-user is significantly less. To use another analogy, a farmer selling his crop to various suppliers is going to have to negotiate a price for his goods and that isn't a guaranteed price or volume. By the time that buyer gets those crops, adds it's margins and sells to distributors, and then to wholesalers, to supermarkets and other retailers with everyone making their bit all along the line, that cabbage is going to cost quite a bit and the individual farmer may still be left with unsold crops. If the supermarket buys direct from the farmer with an agreement to buy most (or all) of the crop at X price being lower than the market rate but still profitable, the farmer has no surplus to worry about, he still makes his money, the consumer gets the cabbage at cheaper prices and the supermaket deals with all the logistics and distribution and still makes their bit. Sure, the farmers bitch about the volume sales and getting lower unit profits. But at the same time, a lot of hassle is removed and he has a guaranteed sale even when it's a bad year. How does government know what price will allow some profit, though? What level of profit is acceptable? quote: The same applies to the healthcare market. Too many fingers in the pie with everyone making their profits and the poor US consumer ends up paying through the nose for it with no other choice. Single-payer consumers spend less per capita for the same drugs and often superior services by sheer power of monopoly. quote: ORIGINAL: DesideriScuri That's a fantastic way to force Market failures, too. If there isn't a private supply of something because government makes it not worth the cost, then either government is going to have to provide it (if it's necessary), or the People are going to have to go without. That isn't ever going to happen in the healthcare market because it's a closed system. Everyone needs healthcare at some point and those drugs are always going to be needed. It's a captive audience and no options. The healtcare industry is nothing like any other industry where people can pick and choose models or if they want the object in the first place. The normal rules of supply and demand don't work in the same way. They don't? Under my ex's insurance, I had the option of a branded drug, or the generic version. I paid a higher co-pay for the branded drug, so I always chose the generic. Hell, I've even told my physician to write the script for the generic. WalMart started this pharmacy pricing war for many of the most common medications (non-controlled substances, IIRC). What happened after they did this? Other pharmacies made similar choices. I have 5 or 6 (not sure if Giant Eagle has a pharmacy, as I don't shop there) pharmacies within 5 minutes of my house. I have no restrictions on which one I get a Rx filled. The only time you probably won't have a choice is in an emergency situation, where time is of the essence. You're going to the closest facility. You could shop for a primary physician if you want. You can shop for specialists if you want. Few do that because they aren't actually paying for themselves.

TheHeretic -> RE: A rather large presumption (11/18/2013 10:15:48 PM)
quote: ORIGINAL: EdBowie Snore. In other words, you aren't going to answer the question, and think you can pull a lame-ass appeal to imaginary authority on me into not calling BS when you spout hypocritical nonsense? LOL. Not even a nice attempt to cover the short attention span, dude. If you can't handle the concept except in terms of what various talking heads say, I'm not going to bother trying to help you. If you want to strain to reach it, I'll see if I can point you to some low-hanging fruit. No. I don't think the structure of our government currently gives it the authority to assume control of the healthcare system. We have a way to change that, and I might be brought on board to support such a change, if I believe the benefits will outweigh the costs and risks. Absent that, I believe our government does have the power and authority to expand public health facilities and services, and take a lot of load off emergency rooms in a system that is straining. Clear as mud?

tj444 -> RE: A rather large presumption (11/18/2013 11:07:11 PM)
quote: ORIGINAL: TheHeretic I don't think the structure of our government currently gives it the authority to assume control of the healthcare system. your govt is outsourcing to the insurance industry, hiding that and the increased cost to taxpayers while being a windfall for insurance corps (as this report from 2009 shows, & imo they are gonna keep doing this even with Obamacare).. The American voters need to get the insurance corps out of health care.. jmo "It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older. But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry. But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors. A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage. In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more." http://www.cbsnews.com/8301-500690_162-3062725.html

Phydeaux -> RE: A rather large presumption (11/19/2013 2:48:59 AM)
quote: ORIGINAL: tj444 quote: ORIGINAL: TheHeretic I don't think the structure of our government currently gives it the authority to assume control of the healthcare system. your govt is outsourcing to the insurance industry, hiding that and the increased cost to taxpayers while being a windfall for insurance corps (as this report from 2009 shows, & imo they are gonna keep doing this even with Obamacare).. The American voters need to get the insurance corps out of health care.. jmo "It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older. But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry. But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors. A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage. In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more." http://www.cbsnews.com/8301-500690_162-3062725.html Of course it costs more to run medicare advantage. You had a lot more things covered under medicare advantage than medicare. Things like hearing aids, glasses, dental. Those accounts - which obama care gutted were actually innovative and a bloody good idea. The premise was this: as the elderly grow older their medical bills increase. Making them less desirable to be insured by private industry. So medicare was dumped with old, sick people. So, by offering a subsidy to insurance companies, those companies would keep people on their roles. Prtty much win win. Elderly liked being able to choose a plan that worked for them. Government got to avoid sick people being dumped into medicare. Private industry got to defray costs of sick elders.

EdBowie -> RE: A rather large presumption (11/19/2013 5:00:04 AM)
Clear that you are afraid to answer the question, and have nothing but a desperate tap dance of avoidance. quote: ORIGINAL: TheHeretic quote: ORIGINAL: EdBowie Snore. In other words, you aren't going to answer the question, and think you can pull a lame-ass appeal to imaginary authority on me into not calling BS when you spout hypocritical nonsense? LOL. Not even a nice attempt to cover the short attention span, dude. If you can't handle the concept except in terms of what various talking heads say, I'm not going to bother trying to help you. If you want to strain to reach it, I'll see if I can point you to some low-hanging fruit. No. I don't think the structure of our government currently gives it the authority to assume control of the healthcare system. We have a way to change that, and I might be brought on board to support such a change, if I believe the benefits will outweigh the costs and risks. Absent that, I believe our government does have the power and authority to expand public health facilities and services, and take a lot of load off emergency rooms in a system that is straining. Clear as mud?

freedomdwarf1 -> RE: A rather large presumption (11/19/2013 6:02:31 AM)
quote: ORIGINAL: DesideriScuri Then why hasn't anyone been able to show that? It's not like I haven't asked. So, now I'm asking you to prove that statement. Prove that it works remarkably well in driving costs down across the board. Considering a lot of the drugs are made in the US and the services are similar... Compare: US pricing with UK pricing. Compare: US pricing with Canadian pricing. Compare: US pricing for Australian pricing. Compare: US pricing with.... any other European pricing. Those in the US are paying 10x or more for the same products and most equipment even though the cost of transporting them overseas is shitloads more expensive than moving them around within the US. Every element within the US system needs mega-buck malpractice insurance because they allow such huge claims to be made. Everywhere else, those payouts are bucket-loads less than the US. quote: ORIGINAL: DesideriScuri quote: If the supermarket buys direct from the farmer with an agreement to buy most (or all) of the crop at X price being lower than the market rate but still profitable, the farmer has no surplus to worry about, he still makes his money, the consumer gets the cabbage at cheaper prices and the supermaket deals with all the logistics and distribution and still makes their bit. Sure, the farmers bitch about the volume sales and getting lower unit profits. But at the same time, a lot of hassle is removed and he has a guaranteed sale even when it's a bad year. How does government know what price will allow some profit, though? What level of profit is acceptable? As I keep telling you... in healthcare, it's not a business and doesn't need to make a profit. People need to stop thinking of it as a business too. Stop trying to put a national service into a business model - it will never fit and isn't designed to do so. quote: ORIGINAL: DesideriScuri They don't? Under my ex's insurance, I had the option of a branded drug, or the generic version. I paid a higher co-pay for the branded drug, so I always chose the generic. Hell, I've even told my physician to write the script for the generic. WalMart started this pharmacy pricing war for many of the most common medications (non-controlled substances, IIRC). What happened after they did this? Other pharmacies made similar choices. I have 5 or 6 (not sure if Giant Eagle has a pharmacy, as I don't shop there) pharmacies within 5 minutes of my house. I have no restrictions on which one I get a Rx filled. You are still thinking inside that little box of yours. Start thinking of no-pay rather than co-pay and still have that same choice. quote: ORIGINAL: DesideriScuri The only time you probably won't have a choice is in an emergency situation, where time is of the essence. You're going to the closest facility. You could shop for a primary physician if you want. You can shop for specialists if you want. Few do that because they aren't actually paying for themselves. Again, you're still thinking inside that little commercial box at a local level. In a single-payer system, there is no need to shop around. Your physician is doing the same work for the national hospitals as he is for the private ones. The same applies to all the specialists and their teams around them. An emergency is an emergency - it won't matter where you go for the treatment.

Zonie63 -> RE: A rather large presumption (11/19/2013 6:04:54 AM)
quote: ORIGINAL: DesideriScuri Can a health care provider do the same, though? What happens if all the materials that go into providing the service or procedure can't be sourced at a cost lower than the price control? It's possible that the suppliers to the hospital might be able to find cost-savings, but, what happens to the hospital in the mean time? If it's really the case that the materials are too expensive that they have no other choice, then it would seem to me there would be provision for that contingency. I don't see that as being an insurmountable problem. quote: Is that information not easily available because it's not been something anyone has really cared much to find out? If no one was ever looking, what would the point be of creating a price list and maintaining current pricing? I think some people have been looking, but not enough. More people probably would look if they knew how. As I said, it requires a lot of homework and comparison shopping for the healthcare consumer. quote: I think in-network and out-of-network costs are different for insurance companies, which leads to the difference in coverages. Promedica may not be able to negotiate the same pricing with Mercy Networks, as they are in competition for membership. I would ask why that is, though. If the insurance company states that they'll pay a certain amount for services, what difference does it make to them whom they pay the money to? If it's only a matter of dollars and cents to the insurance company and nothing more, then it really shouldn't matter whose name is on the check they send. quote: The only way to do that to the industry is through price controls. That's a fantastic way to force Market failures, too. If there isn't a private supply of something because government makes it not worth the cost, then either government is going to have to provide it (if it's necessary), or the People are going to have to go without. I think healthcare would qualify as a necessity, just as police and fire departments are a necessity. Government has to provide those services, too. One could also say that the military is a necessity which the government has to provide. We don't really think about "the market" during times when any of those services become necessary. We had a discussion about price controls a while back, as I recall. I think I mentioned that price controls were done during World War II, and they worked quite well under John Kenneth Galbraith. It was clearly a national crisis and they needed to get our defense industries operating right away, so they didn't really have time to muck around with "market forces." I suppose it's more a value judgment than anything else, whether healthcare is as critical to the public good as national defense, police, or fire - and that may be where some of the debate comes from. Nobody really talks about market failures when it comes to the police or fire departments. The discussion is slightly different with the Defense Department (such as when the issue of base closures comes up), although the free market is not much of a factor there either. quote: I am absolutely not in support of that type of action, to be honest. If Government can provide a service at a lower cost to the people than private industry, then we might have to look at whether or not Government has the authority to do so. If it doesn't, what do we need to do to give it that authority? If it does, then we might really have to look at why private industry won't provide it at a lower cost. What can't happen, however, is only taking what government is budgeting, while ignoring deficits incurred. I agree. I'm not advocating that the government go bankrupt. As for the government's authority to do something, if Congress passes it, the President signs it, and the Supreme Court says it's Constitutional, then they have the authority. Of course, there are still mechanisms in place to change the law and/or the Constitution, which can give or take away the government's authority on any number of issues. It can be done, if the people feel that strongly about it. I'm not saying that price controls isn't without flaws, but I think it would solve a lot of the problems and sticky points that get mentioned. I don't think that I ever had much of a problem with the actual "system" that has been in place, but the costs just keep going up and up. When I see things like the head of United Healthcare earning an 8-figure salary, I just have to wonder just what in the heck we're paying for with these increased costs. I don't think there's anything about the principles of free market economics which says that We the People have to keep being saps. I'm not totally against the free market, but I don't think "The Market" is so holy and sacrosanct that we should throw common sense out the window. I don't really have a lot of confidence in economists' predictions about what will happen to the economy if we do this, that, or the other thing. The government is a necessary evil, and to be quite frank, I am troubled by perceptions of waste, bloat, inefficiency, and corruption - among other things that frustrate me about that institution and the people within it. There's also a more philosophical question of whether "lower costs" should really be at issue when it comes to life or death situations. That's another sticky point, which is why some people are concerned about how some things might be implemented. (I remember people talking about "death panels" a while back, although I think they were spreading it on a bit thick.) Still, the insurance companies and hospitals also have to think about costs and the resources they have available. They have to be ready for anything, in case of disaster or some major accident. They could potentially get overwhelmed in all kinds of worst-case scenarios (which probably won't happen, but still, they have to be prepared for it, and that costs money too).

TheHeretic -> RE: A rather large presumption (11/19/2013 6:11:13 AM)
quote: ORIGINAL: EdBowie Clear that you are afraid to answer the question, and have nothing but a desperate tap dance of avoidance. Why don't you clearly state exactly what question you don't believe I'm answering? Be specific, or be dismissed.

MariaB -> RE: A rather large presumption (11/19/2013 6:42:22 AM)
quote: ORIGINAL: TheHeretic quote: ORIGINAL: evesgrden I'm not about to get into a debate about constitutional law or the founding fathers. Can't handle things when they get that real, huh? Maybe you'd be happier in a country where the subjects just do as they are told? Try to keep your mouth shut when you get there though. [8\|] What country would that be then?! Omg you don't mean in one of those awful little European countries that have snippets of socialism here their and everywhere? Sorry, have to run. The sirens just gone off and its communal exercise time. Goes to turn the radio off which has been playing those lovely old Lenin speeches. [8\|]

TheHeretic -> RE: A rather large presumption (11/19/2013 6:47:12 AM)
Alrighty. You hit up the two-minute hate, and I'm going to get ready for work. Somebody has to pay for all this shit, you know. [;)]

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