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The Amish health care system

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Re: The Amish health care system

#301

Post by pmiller2 »

bmelton wrote: post #300
pmiller2 wrote: post #298

Earlier quoted context omitted.

Nonetheless, the fact remains, no M4A plan proposed by any candidate in the 2020 race would disallow insurers from offering supplemental coverage. Bernie is just simplifying for purposes of making himself understood to the general public. Nobody would "need" private insurance under his plan: > In other words, while Sanders' plan doesn’t ban supplementary coverage from private insurers, it does offer such generous cov…

Whether he's simplifying or restating seems orthogonal to my point, which is that people who are worried that things are going to change and if they'd like to "just go to a private hospital instead," well - if Bernie is to be believed - in his vision of America, those may not be allowed to exist.

Where did anyone, Bernie included, say that private hospitals would not be allowed to exist?

Re: The Amish health care system

#302

Post by bmelton »

pmiller2 wrote: post #301
bmelton wrote: post #300

Earlier quoted context omitted.

Whether he's simplifying or restating seems orthogonal to my point, which is that people who are worried that things are going to change and if they'd like to "just go to a private hospital instead," well - if Bernie is to be believed - in his vision of America, those may not be allowed to exist.

Where did anyone, Bernie included, say that private hospitals would not be allowed to exist?

Firstly, it's implied when he proclaims that companies shouldn't be profiting off of health care. But to answer the question less obliquely, here's a quote of him saying it (from Politifact):

"I could whack pharmaceutical companies, and I don’t need Medicare for All to do it, but I do need Medicare prices for all to deal with what the real profits are — whether you call them profits or not — which is hospitals."

https://www.politifact.com/factchecks/2020/jan/15/bernie-san...

Re: The Amish health care system

#303

Post by pmiller2 »

bmelton wrote: post #302
pmiller2 wrote: post #301

Earlier quoted context omitted.

Where did anyone, Bernie included, say that private hospitals would not be allowed to exist?

Firstly, it's implied when he proclaims that companies shouldn't be profiting off of health care. But to answer the question less obliquely, here's a quote of him saying it (from Politifact): "I could whack pharmaceutical companies, and I don’t need Medicare for All to do it, but I do need Medicare prices for all to deal with what the real profits are — whether you call them profits or not — which is hospitals." http…

Where does that say private hospitals shouldn't exist? All it implies, and which the article explicitly states, is that private hospitals will have to deal with making lower profits under M4A, which is obvious.

You're reaching. Why are you trying to push a right wing spin on M4A, when studies show that it would reduce costs and increase access to care?

Re: The Amish health care system

#304

Post by pmiller2 »

JoeAltmaier wrote: post #295
bmelton wrote: post #294

Earlier quoted context omitted.

From a Bernie Sanders interview with NPR. Q: "Does private insurance go away under Medicare for All?" A: "Yes, it does, because you're not going to a have a need for private insurance" A tweet[1] from Bernie Sanders: You're damn right we're going to get rid of greedy health insurance companies. CNBC describes Bernie Sanders plan as "Bernie Sanders is pushing a “Medicare for All” bill, which would create a government-…

Why are we still talking about Bernie Sanders?

His ideas are still relevant, even if his candidacy is not.

Re: The Amish health care system

#305

Post by bmelton »

pmiller2 wrote: post #303
bmelton wrote: post #302

Earlier quoted context omitted.

Firstly, it's implied when he proclaims that companies shouldn't be profiting off of health care. But to answer the question less obliquely, here's a quote of him saying it (from Politifact): "I could whack pharmaceutical companies, and I don’t need Medicare for All to do it, but I do need Medicare prices for all to deal with what the real profits are — whether you call them profits or not — which is hospitals." http…

Where does that say private hospitals shouldn't exist? All it implies, and which the article explicitly states, is that private hospitals will have to deal with making lower profits under M4A, which is obvious. You're reaching. Why are you trying to push a right wing spin on M4A, when studies show that it would reduce costs and increase access to care?

I'm not pushing a spin at all. I care approximately zero about the current healthcare debate or its future direction. I think my initial statement was apolitical and factual. If it's being interpreted otherwise, that's by inference, not implication.

But to the point of why people might be wondering about changes to their healthcare policies, well, perhaps it's because they've been listening to the politicians. If folks would like to obliquely sidestep what I feel was a rather small, simple point and have an argument about efficiency gains in healthcare, you're free to, but I'm not trying to participate in that argument.

Edit: Actually, consider this my last post on the topic at hand, as I'd rather not engage in any argument where reputably sourced facts and direct quotes are regarded as "right wing spin."

Re: The Amish health care system

#306

Post by pmiller2 »

bmelton wrote: post #305
pmiller2 wrote: post #303

Earlier quoted context omitted.

Where does that say private hospitals shouldn't exist? All it implies, and which the article explicitly states, is that private hospitals will have to deal with making lower profits under M4A, which is obvious. You're reaching. Why are you trying to push a right wing spin on M4A, when studies show that it would reduce costs and increase access to care?

I'm not pushing a spin at all. I care approximately zero about the current healthcare debate or its future direction. I think my initial statement was apolitical and factual. If it's being interpreted otherwise, that's by inference, not implication. But to the point of why people might be wondering about changes to their healthcare policies, well, perhaps it's because they've been listening to the politicians. If fol…

Mischaracterizing M4A as a policy is what I'm considering "right wing spin," not "reputably sourced facts and direct quotes." Yours are exactly the words I would expect to hear from scaremongers in Washington telling people M4A "takes your freedom of choice away." If you can go to any doctor or medical facility and have your coverage accepted, and also have as much supplemental coverage as you want, again, how is that "banning private insurance," or "banning private hospitals?" Please explain.

Re: The Amish health care system

#307

Post by robomartin »

fzeroracer wrote: post #149
robomartin wrote: post #142

Earlier quoted context omitted.

> why should it cost $3000 to have an MD do it? Let me suggest you fire-up a spreadsheet and start to calculate the cost structures surrounding healthcare in the US. I don't think you have enough information yet to fully understand the subject enough to answer the question you posed. I'll suggest you model something like a team conducting surgery at a mid size hospital. You have to model the cost structure each perso…

Logically this may make sense, but in reality it does not. Other countries with more sane healthcare systems have costs that are fractional compared to ours despite having the exact same costs you mention. If the equipment is the same, the admin overhead is the same and the education is the same, then that leaves only one real difference between us and other countries. And that's our Byzantine insurance system.

> despite having the exact same costs you mention

Exact same costs? Surely you are joking.

Costs, regulatory overhead, education and taxes are different everywhere.

My wife pays tens of thousands of dollars per year in malpractice insurance...and she isn't even at the top of the scale in terms of these costs. The cost of education? An MD can graduate with anywhere from $300K and more in debt.

And lawsuits? Show me a place on earth where attorneys will go after anyone, medical industry or not, as quickly, easily and violently as they do in the US?

Show me a place on earth where the government guarantees student loans to the extent that university costs are bloated to the point of creating financial slavery for graduates.

Show me a place on earth where doctors have to order a pile of unnecessary tests in order to protect themselves from being sued.

Show me a place on earth where developing the simplest medical device costs tens of millions of dollars in regulatory fees alone (if you are lucky).

Show me a place on earth where bringing a drug to market comes with potentially billions of dollars in regulatory costs.

Show me a place on earth where a manufacturer of N95 masks and gowns is not allowed to supply them to hospitals during an emergency due to regulatory burdens, the fear of lawsuits and has to demand immunity from the president of the country before they are able to do so.

I tried to develop a relatively simple hearing device to help people who suffer from SSD (Single Side Deafness). We have someone in the family with this condition. I designed and built a device for her. She loved it. I then looked into going to market with it. The costs would run into the tens of millions of dollars (or more). There was no way to take that leap. And that doesn't include protecting from or fighting the inevitable lawsuits.

No, nothing is "the exact same". And that's my point. Unless you pull-up a spreadsheet and analyze the cost structure you will never understand why healthcare costs what it does in the US. It has nothing to do with insurance, or profit, or greed or any of the nonsense ideas being floated around --particularly by politicians who just want to manipulate the audience for votes.

This is a simple equation: If you want to lower consumer costs you have to lower the cost structure driving the process and resources necessary to deliver the goods and services they receive.

I would urge you not to form opinions as you have until and unless you have taken the time to truly understand the details of the matter, which is to say: Analyze the cost structure tree down to a good level of granularity and then see what you would change in order to reduce consumer costs. Insurance will not be on that list.

Re: The Amish health care system

#308

Post by motohagiography »

arkades wrote: post #290
motohagiography wrote: post #277

Earlier quoted context omitted.

So, I've spent over a decade consulting to public sector health agencies in charge of delivering everything from electronic health records to cancer research to chronic disease management, long terms care, mental health, and privacy, among many other areas. Before you call someone ignorant and say that the bureaucracy disagrees and so what possible standing could I have, consider a little bit of charitable reasoning…

Oh, I didn't judge you on your professional history. I judged you on the content of your comment - that is to say, on the merit of your statement rather than an appeal to authority. That you've done consulting to the healthcare sector doesn't mean much of anything to me, one way or another. Heck, the IT consultant for our CTO in my health chain can say the same, and all he does is EMR rollouts. He has about 0% unders…

The #1 job of policy analysts is to preserve their ability to make policy. While you have spent a respectable amount of time working in bureaucracies, a criticism of the legitimacy of those institutions' ability to improve outcomes is not something people encounter on the inside. Meaningful endogenous change isn't going to happen.

As the job of physician is being reduced to that of a health care service project manager who assembles and directs specialists using technology tools, it's becoming vulnerable to the same technology changes that sidelined project managers.

Skill is pareto distributed, and there is a long tail of medical services that could be done by apprenticed tradespeople, and the only thing preventing that is medical associations - and as you say, holding litigation risk.

Re: The Amish health care system

#309

Post by djannzjkzxn »

eagsalazar2 wrote: post #183
djannzjkzxn wrote: post #176

Earlier quoted context omitted.

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!

I think it’s important to have a solid answer to this question. When people believe that a plan is weak on the details, this is what they are talking about. It gives the impression that the promises of the plan stated upfront (we will save money by moving away from wasteful health care system) are some sleight of hand, moving costs from a well-defined bucket to a mystery bucket we don’t measure.

Re: The Amish health care system

#310

Post by swiley »

cmendel wrote: post #192
triceratops wrote: post #182

Earlier quoted context omitted.

> 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 kno…

My apologies, I didn't mean to come off harshly, it's approx 3 am here so I'm not exactly a ball of sunshine. Do doc's need to spend 4 years doing an undergrad before med school? Maybe. There are a lot of things that you need to learn before you can learn what you need to be a doctor. Do you need to know physics? Eh, only kind of. I'm not terribly familiar with the system in the UK, but at least where I went to schoo…

If it's anything like CS there's maybe a couple of semesters of applicable material and a bunch of filler to extract money for the university.
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