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GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

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Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#281

Post by arcticbull »

conanbatt wrote: post #276
arcticbull wrote: post #269

Earlier quoted context omitted.

Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.

Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.

That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal.

When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve.

Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?!

[1] https://www.cbsnews.com/news/most-americans-cant-afford-a-50...

[2] https://en.wikipedia.org/wiki/Personal_income_in_the_United_...

[3] https://www.prnewswire.com/news-releases/us-median-rent-hits...

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#282

Post by conanbatt »

arcticbull wrote: post #244
arcticbull wrote: post #209

Earlier quoted context omitted.

(1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere el…

Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousa…

Since you specifically wanted me to answer about this topic: Preventative care has some nuance. Increased preventative services are not necessarily better, there is an actual ongoing debate about annual physicals in the medical community (http://time.com/5095920/annual-physical-exam/)

From an economic perspective, its not clear pushing for preventative will lower cost or increase quality. (many times it even has negative value, as reassuring a patient of being healthy when they aren't).

Fundamentally, if preventative cares are good people will naturally choose to invest in their own health. There is research showing that people are pretty good about healthcare utilization if they bear the cost (except poor peoeple)

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#283

Post by arcticbull »

conanbatt wrote: post #254
arcticbull wrote: post #247

Earlier quoted context omitted.

No, I'm saying it's strange having the people in charge of the government touting a privatized health program for the entire nation except themselves. If private care was so much better than socialized government care, why are the senators, the house members and everyone in the armed forces so staunchly in favor of keeping their socialized care? Don't you think if socialized medicine was murder and death panels and b…

This program is about selecting insurance, it doesnt provide healthcare. It doesnt have doctors that work for the program, its just an insurance selection scheme. Don't worry about the senators: they are all using private healthcare. Probably even the opposite of your speculation: if they use state solution due to their age, its medicare advantage.

I was mistaken, on two counts. One being the FEHB and what it is, you're right; also the FEHB was replaced with exchanges as part of the affordable care act, although the government does subsidize them. Of course many of them are old enough to end up in Medicare.

[1] https://www.marketplace.org/2017/07/17/health-care/ive-alway...

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#284

Post by arcticbull »

arcticbull wrote: post #280
GabrielBen wrote: post #277

Earlier quoted context omitted.

> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bill…

>>> Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries? Again, we addressed this. It's literally all the old, sick and dying in a single pool allowing private insurers to be profitable. It's not comparable. It's like asking why a government-run fire insurance program that takes in only buildings that are already on fire is expensive. They o…

Read up some more on the Canadian system from the perspective of a doctor in Canada. I'd love your thoughts: https://www.npr.org/2017/09/24/553336111/a-canadian-doctor-e...

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#285

Post by arcticbull »

conanbatt wrote: post #282
arcticbull wrote: post #244

Earlier quoted context omitted.

Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousa…

Since you specifically wanted me to answer about this topic: Preventative care has some nuance. Increased preventative services are not necessarily better, there is an actual ongoing debate about annual physicals in the medical community ( http://time.com/5095920/annual-physical-exam/ ) From an economic perspective, its not clear pushing for preventative will lower cost or increase quality. (many times it even has ne…

You're absolutely right about that. Also with regards to increased frequency of tests; finding the inflection point between where the risk and adverse effects of false-positive tests out-weight the benefits of early detection. Point taken.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#286

Post by conanbatt »

maxxxxx wrote: post #279
conanbatt wrote: post #275

Earlier quoted context omitted.

Above the deductible it doesn't matter. Below the deductible is easier to manage. Primary care generally has public pricing.

That doesn't match my experience. Do you have direct experience? Your other responses sound more ideological than direct experience.

Yes, for example sutter health has public pricing on their Primary care services (https://www.sutterhealth.org/for-patients/health-care-costs-...). They treat millions of patients so its a pretty big driver.

Price opaqueness is a big issue, but there is no transparency with so much distortion.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#287

Post by arcticbull »

conanbatt wrote: post #286
maxxxxx wrote: post #279

Earlier quoted context omitted.

That doesn't match my experience. Do you have direct experience? Your other responses sound more ideological than direct experience.

Yes, for example sutter health has public pricing on their Primary care services ( https://www.sutterhealth.org/for-patients/health-care-costs-... ). They treat millions of patients so its a pretty big driver. Price opaqueness is a big issue, but there is no transparency with so much distortion.

Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#288

Post by conanbatt »

arcticbull wrote: post #287
conanbatt wrote: post #286

Earlier quoted context omitted.

Yes, for example sutter health has public pricing on their Primary care services ( https://www.sutterhealth.org/for-patients/health-care-costs-... ). They treat millions of patients so its a pretty big driver. Price opaqueness is a big issue, but there is no transparency with so much distortion.

Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.

Transparency is important to choose any service and care is one of them. The vast majority of healthcare services are not urgent. There's a case for price insensitivity for emergency care, but that is also resolved by choosing insurance before hand: the same way there is price sensitivity to life insurance.

A bigger problem to me than transparency is distortion: the value of the service being public means little if the patient is not paying for it. A patient that has 20% co-insurance or 20$ copay have completely different price sensititivities. They are also price-insensitive when they select insurance because they get it through the employer that picked it and payed it for them.

As a patient, the price tag on a service is relevant to you depending on insurance: validating insurance is much more important than seeing the price.

A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#289

Post by conanbatt »

arcticbull wrote: post #281
conanbatt wrote: post #276

Earlier quoted context omitted.

Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.

That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien a…

It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#290

Post by arcticbull »

conanbatt wrote: post #289
arcticbull wrote: post #281

Earlier quoted context omitted.

That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien a…

It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.

Sorry, would you require everyone get a raise in the amount of their health insurance benefits? Sounds like interventionist overreach into the free market to me. Remember how the 2017 tax windfall for companies would yield huge raises for everyone, but instead, only lead to stock repurchases? What makes you think this would be any different?

Since you also suggested in a different thread that it'd no longer be tax deductible, that $5000 would drop immediately to $3000 or less -- $250/mth. That's still dancing on a razor's edge.

Your key metric of "cheaper" and "more available" and "better utilized" is provably solved with a socialized model. There's no active private care model that outperforms one of the OECD socialized models, or else you'd have at least mentioned it by now. Instead, we keep revisiting unsubstantiated ideological libertarian talking points. I've got real world implementations to support my theories.

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