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The Amish health care system

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Re: The Amish health care system

#181

Post by fzeroracer »

triceratops wrote: post #175
fzeroracer wrote: post #151

Earlier quoted context omitted.

Dental care is also a 'free market' and I don't think I need to say how much of a disaster getting any sort of dental work can be in the US. Why haven't dental costs fallen through the floor if it's a free market?

It's covered by most employer health plans, so patients don't see the true cost and don't shop around much. That's not the case for lasik or elective plastic surgery. Of course since the latter are elective, customers have the luxury of shopping around and taking their time.

I'm not sure where you've been employed, but dental plans have always been separate from the actual health plans and generally cover nothing beyond giving a pittance per year that hardly rolls over. Once that's gone, you get to pay the full cost.

I've had to deal with the true cost of dental work and I can guarantee you anyone that's needed to deal with significant dental issues has had the same experience. So why hasn't the free market dropped down prices? Why are we still paying more for basic dental work compared to other countries?

Re: The Amish health care system

#182

Post by triceratops »

cmendel wrote: post #178
triceratops wrote: post #107

Earlier quoted context omitted.

> abbreviated training for doctors I mean do doctors really need to spend 4 years getting a bachelor's degree in "pre-med"? If you know you're going to be a doctor why not just start off with biology, anatomy, physiology, chemistry in year one and go on to cutting up bodies in year 2? It seems utterly ridiculous to spend 4 years majoring in humanities, or calculus[1] only to seek entrance to med school. The UK doesn'…

You are speaking from a place of ignorance. The prerequisites needed to take the courses that you mention alone are >1 year, yet alone all of the material needed to become a doctor. Where I went to Uni, you didn't take biochem until you were a senior. The reason for this is because before you take biochem you need General Chemistry 1 & 2, Organic Chemistry 1 & 2, and some smattering of Biology. You have to take these…

> You are speaking from a place of ignorance

You're right, I hold my hands up. I don't have any medical training.

> Where I went to Uni, you didn't take biochem until you were a senior. The reason for this is because before you take biochem you need General Chemistry 1 & 2, Organic Chemistry 1 & 2, and some smattering of Biology. You have to take these courses sequentially, they build on each other.

You obviously know what you're talking about and I won't debate you on how this works. But again, does a prospective doctor need to spend 4 years on this? How does every country other than the US and Canada manage to train their doctors without making them get a Bachelor's along the way in something non-medical? Why can't doctors study 5 or 6 years and graduate with a medical degree, ready to become a general practitioner? That's how they do it in the UK. Are you saying their docs didn't pass biochem or don't know what a nucleophile is?

> shouldn't doctors-to-be take ethics courses?

Pretty sure med students have time to take ethics courses if they do a 5/6 year medical degree.

Re: The Amish health care system

#183

Post by eagsalazar2 »

djannzjkzxn wrote: post #176
erentz wrote: post #153

Earlier quoted context omitted.

1. FWIW this is a recognized problem under M4A plans those people would be taken care of. 2. Nobody has a right to earn a living by causing suffering to others.

If they’re being “taken care of”, how is the plan to eliminate their jobs supposed to save money?

Well probably not by just giving them their salary anyway. I guess there are many other options so I imagine it would be one of those!

Re: The Amish health care system

#184

Post by hycaria »

abakker wrote: post #112
motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

My sister is a veterinarian. Honestly, I think I’d rather have her give me stitches than most doctors. She’s had to give so many more than most doctors.

I am a veterinarian too. It's ridiculous how stitches are so impossible to have access to (at least where I live). Last time I had a coworker fix me up after a bicycle fall (was on the elbow sadly, could hardly do it solo), not because of cost where I live, gladly, but because a MD can't stitch me, so it's either the emergency department, or MD and then only referal (so yet another appointment and all the trouble that is) to a surgeon.

I mean I get it, wounds can turn (really) bad, but other people than MDs (like nurses, or pharmacists were even discussed for this in France) should be able to do them, and give a follow up appointment to some MD / nurse a few days later to check if recovery is going well. Only time tells how the healing goes anyways.

Re: The Amish health care system

#185

Post by int_19h »

specialist wrote: post #73
pmiller2 wrote: post #4

Earlier quoted context omitted.

That inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The…

I currently believe rising administrative overhead accounts for most of the cost increase. Single payer is a straightforward proven solution. Switching from fee-for-service to prevention (capitation) would give us another 25% savings. But I'm newly interested in notions related to cost disease. Am keen to hear anything anyone has to say about mitigation.

Public healthcare in general, not necessarily single payer. Most of Europe is not on single payer, but they are doing fine on costs.

Re: The Amish health care system

#186

Post by austhrow743 »

erentz wrote: post #154
philwelch wrote: post #79

Earlier quoted context omitted.

Part of it is because the “Medicare for All” proposal outlaws private insurance.

M4A gives everyone, rich or poor, the same base standard of coverage. And if you want coverage for other things that aren’t included under Medicare then you can get supplemental private insurance for it. That’s absolutely not outlawed.

If that's the case then they really screwed up with the term "single payer", and a lot of Bernie's own supporters were wrong. Lot of crap all over reddit about ending private insurance for the last year.

Re: The Amish health care system

#187

Post by arethuza »

SlowRobotAhead wrote: post #58
jay_kyburz wrote: post #44

Earlier quoted context omitted.

No, what we should do is build our systems so that human nature is taken into consideration. There will always be good and bad people. Medical pricing should be simple, upfront and direct. It should not require lots of clerks and "billing professionals" It shouldn't required armies of expensive lawyers to settle disputes. Whether the bill was not paid by the customer, or the doctor failed to deliver what the customer…

Agreed... but you don’t think there is an ugly backend administrator to ? Of course there is. You don’t think the NHS has lawyers and billing professionals, they’re there, just behind the scenes.

They have lawyers, but everyone has lawyers over a certain size and the NHS is huge.

As for billing, who would they bill - I've never had a bill from the NHS or even heard of someone getting a bill from the NHS? In some parts of the UK you have to pay a small amount for prescription medicines but that doesn't go to the NHS etc.

It literally is "free at the point of delivery".

Edit: The NHS directly employs about 1.4 million people https://fullfact.org/health/how-many-nhs-employees-are-there... - and that's not including people who work in GP practices or dentists or opticians who do NHS work but aren't employed by the NHS.

Re: The Amish health care system

#188

Post by Aloha »

mannykannot wrote: post #86
_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

The past is not a useful guide, because until recently, there was relatively little that could be done medically, and costs were commensurably low. The elephant in the room is that medical technology has advanced to the point where any person's needs can potentially greatly exceed their lifetime's ability to produce. When there are relatively few who find themselves in this state, insurance (and what is described in…

Agreed, healthcare became a human right right around the time it changed from being mostly palliative care to curative care. I'll pinpoint it to somewhere between the invention of insulin and penicillin. It's at that point where healthcare outcomes really start to diverge between rich and poor.

Something I'll note, Jay Gould, one of the wealthiest men of his time died of tuberculosis - something we now think of as a poor persons disease.

Re: The Amish health care system

#189

Post by asdff »

_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

I'd be fine if it was akin to airlines. More private suites, if you are willing to pay a massive premium. Pricier food. I would find it abhorrent if standard of care is any more economically stratified than it already is.

Re: The Amish health care system

#190

Post by int_19h »

robocat wrote: post #64
hateMyIdeas wrote: post #26

Earlier quoted context omitted.

That's not how insurance works, expensive insurance has a lower max out of pocket. What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.

That is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a war…

They still pay taxes, though.

Germany allows people to opt out entirely, although there are a bunch of conditions and limitations. Most people don't, so the public system can still pay for itself.

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