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The profit-obsessed monster destroying American emergency rooms

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Re: The profit-obsessed monster destroying American emergency rooms

#151

Post by AnthonyMouse »

skhunted wrote: post #115
AnthonyMouse wrote: post #93

Earlier quoted context omitted.

> Most people in the U.S. think regulations are bad in and of themselves. Regulations as a concept are the wrong target. Regulations as a concept are the category of thing which is causing the problem. You then have to look into which specific regulations are contributing to the problem, but there are 10,000 of them. You can name some of them, like Certificate of Need laws, but that's just a representative example ra…

We tried the no regulation method after the Civil War. It lead to robber barons and an overall shitty country. Regulations as in the concept is not the problem. Bad oversight and governance is.

I honestly don't understand why someone can't say "we should get rid of these bad regulations which are causing problems" without someone hearing "we should get rid of all laws of any kind whatsoever".

Re: The profit-obsessed monster destroying American emergency rooms

#153

Post by emeril »

JamesBarney wrote: post #138
Retric wrote: post #104

Earlier quoted context omitted.

Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 no…

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

> It's not that easy to fix.

Medicare for everyone seems like an "easy" fix but we have too many red state neanderthals in the US who oppose policies that clearly benefit them claiming "personal responsibility" though they oddly still think schools, police, fire departments, etc. are just fine...

Re: The profit-obsessed monster destroying American emergency rooms

#154

Post by cherry_tree »

JamesBarney wrote: post #138
Retric wrote: post #104

Earlier quoted context omitted.

Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 no…

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

Seems like you’re misrepresenting these countries in stating that they “rely” on private insurance (these are countries with public healthcare).

Are you able to point to a completely private system that is insurance based and works well?

Or what do you think public systems that also include private insurance add to the table that is missing from the US market?

Re: The profit-obsessed monster destroying American emergency rooms

#155

Post by skhunted »

AnthonyMouse wrote: post #151
skhunted wrote: post #115

Earlier quoted context omitted.

We tried the no regulation method after the Civil War. It lead to robber barons and an overall shitty country. Regulations as in the concept is not the problem. Bad oversight and governance is.

I honestly don't understand why someone can't say "we should get rid of these bad regulations which are causing problems" without someone hearing "we should get rid of all laws of any kind whatsoever".

Because for 40 years now the Republican party has demonized regulations as a concept. So now we are in a situation where people like you write:

Regulations as a concept are the category of thing which is causing the problem.

No sensible person thinks regulations as a concept is bad but, well, roughly 1/3 of the U.S. population is not sensible on this topic. No sensible person thinks all regulations are good. Regulation is not the thing to talk about since the issue isn't regulation but bad governance and oversight. The issue is politicians in the pockets of insurance companies. The issue is that we live in a country where profit is the holy of holies that must not be messed with.

Re: The profit-obsessed monster destroying American emergency rooms

#156

Post by robertlagrant »

alan-hn wrote: post #24
robertlagrant wrote: post #16

Earlier quoted context omitted.

> Money needs to be redistributed so the ratio of dollars to brain cells is more balanced. It will likely do that naturally unless something gets in the way in the name of progress.

Money and greed naturally get in the way. Is that not obvious? People are finding any way to game the system just to get more money You're thinking of using money as a measure but everyone else is using it as a target...

No, greed (or wanting money) is one of the reasons some people with brains get paid better. if they can think of things or ways of doing things that save money or create value, or both, then they will get paid lots. They could still agree with their employer that they get paid the equivalent of a postgrad stipend, but they probably don't. You don't need to game a system for that to happen.

Re: The profit-obsessed monster destroying American emergency rooms

#157

Post by alistairSH »

philwelch wrote: post #57
ghaff wrote: post #35

Earlier quoted context omitted.

When I was covered by an employer plan, a lot of people seemed to gravitate towards high deductible plans because they were cheaper so long as you didn't consume a lot of healthcare. (Personally, I never did but a lot of people were adamant that you saved money that way.)

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

HSA contributions max at $8300 for a family.

If you require care for chronic medical issues, that often not even one treatment. So, the annual numbers might work out, but you're still left with a massive cash-flow issue at the beginning of every year (because there hasn't been time to fund the HSA, you have to float the deductible + co-pays/% up to your max OOP).

And that's assuming your income supports the max HSA contribution in the first place. Maybe after a few years, it balances out a bit, if you're lucky.

Re: The profit-obsessed monster destroying American emergency rooms

#158

Post by consteval »

JamesBarney wrote: post #84
jaco6 wrote: post #68

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on the private market. (Arguably this is a legacy of pre-modern healthcare, where hospitals were operated by charities run by nuns and funded by aristocrats and royal families, hence all the “Saint” names in hospitals nowadays). There’s a variety of weird example…

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays f…

> But there are countries that have systems similar to ours that are far more efficient as well

Typically, those countries have BOTH a public system and a private sector. This means the private sector actually has to be really competitive, because they're competing with "free" (or close to it). This isn't the case in the US, there's no competition.

Re: The profit-obsessed monster destroying American emergency rooms

#159

Post by consteval »

VancouverMan wrote: post #34
skhunted wrote: post #10

Earlier quoted context omitted.

Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people). It’s interesting that the one specific thing you mention is insurance. That particular complexity doesn’t come from regulation. It comes from the immoral insurance industry.

The widespread need for medical insurance only exists because regulation has introduced many artificial inefficiencies within the health care sector that in turn severely distort the pricing of medical services and medical products. We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, tha…

> artificial inefficiencies

To be clear, the "artificial inefficiencies" here include treating poor people, treating elderly people, and treating people regardless of their conditions.

The alternative, which we have lived, is those people just dying. We, as a collective society, decided these features are "non-negotiable". Hence, the US has a semi-socialized system in the form of insurance.

The reason your premiums are so high is because some homeless man somewhere is getting Narcan as we speak. Your woes of a communist future have come to fruition, but it has been packaged in such a way that the average American does not realize it. We have the worst of both worlds - the sheer greed of the private sector, with the burdens of a public policy.

If we seek efficiency, as you say, the answer is obvious. Abolish insurance, and provide single-payer healthcare. Delete the middle men on top of middle men.

Re: The profit-obsessed monster destroying American emergency rooms

#160

Post by JamesBarney »

emeril wrote: post #153
JamesBarney wrote: post #138

Earlier quoted context omitted.

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

> It's not that easy to fix. Medicare for everyone seems like an "easy" fix but we have too many red state neanderthals in the US who oppose policies that clearly benefit them claiming "personal responsibility" though they oddly still think schools, police, fire departments, etc. are just fine...

Medicare for everyone fixes the under and uninsured problem. It doesn't fix the cost problem, only moves it from paying private insurance companies to the government. It's true Medicare pays less per procedure but that is not because those procedures are more efficient it's because relies on pricing power. Many hospitals would go out of business or have to layoff a significant amount of their staff if they were exclusively paid Medicare rates.
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