How can you add 30,000,000 million people to a program and reduce costs?

Discussion in 'Too Hot for Swamp Gas' started by dadx4, Aug 2, 2013.

  1. asuragator
    Offline

    asuragator Well-Known Member

    Joined:
    Sep 26, 2009
    Messages:
    20,531
    Likes Received:
    4,090
    Trophy Points:
    113
    Ratings Received:
    +6,082
    To your first q, I do not know (and am too lazy to look)...but not having a supermajority is not really a good reason to not do anything about the problem. It's not like prices weren't spiraling upward in the 1990s and early/mid 2000s.

    Yep, had to get that in there. I think not doing anything about it while in power and then complaining when not in power is kind of bogus. I am sure there are dem issues you can dig up that are similar. I might even agree :laugh:

    Medicare might be a problem; don't necessarily disagree, but I look around the world, particularly at Japan of which I have some knowledge about and see them doing more for quite a bit less (of the gpd) and think to myself (as I asked gatordowneast) "why can't we?"

    We are still a great economic power and we still have an embarrassment of riches relatively speaking and should be able to do it as good or better than the rest of the world.
  2. QGator2414
    Online

    QGator2414 VIP Member

    Joined:
    Aug 24, 2009
    Messages:
    12,947
    Likes Received:
    168
    Trophy Points:
    63
    Location:
    Ocala
    Ratings Received:
    +629
    I agree we could do it for less though our system being overrun with large corporations and government together will not allow that.

    I also personally do not want cheap healthcare (does not mean we can't do it cheaper) as it costs money to provide the best. But maybe we do need to tier it...for example one who uses Medicaid for the birth of a baby might share a room at the hospital with others (I would require both parents to perform community service as well by the child's first birthday). I believe it was mastoid that brought this point up about the difference in service and used something along those lines as an example.

    The public hospital here in Marion just signed a lease with a corporate hospital group and that company was just bought by another to create the largest hospital group in the country if I heard right. With the other major hospital now being run by the second largest hospital group I believe.

    We will still have the best healthcare but unfortunately it will not be getting cheaper as it could...
  3. mocgator
    Offline

    mocgator Well-Known Member

    Joined:
    Apr 10, 2007
    Messages:
    6,472
    Likes Received:
    315
    Trophy Points:
    83
    Location:
    The ATL
    Ratings Received:
    +669
    no. of course not.
  4. asuragator
    Offline

    asuragator Well-Known Member

    Joined:
    Sep 26, 2009
    Messages:
    20,531
    Likes Received:
    4,090
    Trophy Points:
    113
    Ratings Received:
    +6,082

    Japan doesn't do it "cheap" Though you'd have to define that better. They just do it for less. Now, I don't know off the top of my head (again to lazy to go look right now) enough to give a point by point breakdown, but they do have access to world class medical care. But not only that, Japanese use their system much more than we do, on average.

    But if we talk about big business, I tend to think this is part of the problem; and the big biz of hospitals and costs along with it. Government might be the problem too, at least in the sense that they do things that make matters worse, even while maybe on the other hand doing things that can make it better.

    And I am not opposed to throwing ideas in as mastoid has suggested. It's part of compromising to get at some goal. I mean, I know a lot of women for instance who stay only one night in the hosptial or not even stay after having a baby (or not having on in the hospital at all) to save on expenses, not necessarily because they can't afford it.

    And you do recognize working in the field so to speak (I won't give away what you do, but I am pretty sure it would fall under healthcare, or for you specifically the biz side of it, if I remember correctly) that while capitalism absolutely has upsides in creating fantastic wealth, opportunity, innovation etc..., in a sense healthcare cannot and I personally believe should not just be dictated by the whims of the marketplace or of the capitalist, so to speak. If only because the downside of capitalism is often over-promising, over-charging, and under-delivering on those promises, and that can be very bad for the consumer.
  5. dirigo
    Offline

    dirigo Member

    Joined:
    Apr 3, 2007
    Messages:
    453
    Likes Received:
    7
    Trophy Points:
    18
    Ratings Received:
    +23
    First let me say that I'm somewhat stunned by the quality of the debate. If we could have this on more threads we might see a wider array of posters, a broader range of opinions, and a forum that would expose all of us to worthy arguments that could actually expand our understanding of important issues. Now I'm not saying that many of us will change our opinions but we'll be better informed and our opinions and arguments will be battle-tested and improved to the point that we can comfortably roll them out while tailgating with fans who share only our love of our University and the mighty Gators. Congrats to all.

    A number of excellent points have been made. For what their worth here are my thoughts on some of them.

    1. QGator, Washington state and about a half-dozen other states launched programs with universal coverage and no individual mandate (similar to what the President proposed in his debates worth Hillary in 2007-08). They were disasters and closed down within only a few years of their launch. If you're going to have universal coverage (and that element is favored by a wide margin) then you must have the individual mandate.

    Getting rid of the middleman would be ideal but its 2013 in the United States of America. Their may only be one group with more muscle than the insurance industry (banking) but I'm not even sure they do. If he was going to get anything through even a Dem controlled Congress the President had to let both the insurers and big pharma into the game. The Feds did gain a bit of leverage with legislation that requires a certain % of premiums be spent on care but its not much. If I'm still around in 25 years I won't be surprised to see the insurers treated more like regulated utilities. I will be very surprised if they are eliminated. The sheer cost of buying them out would be humongous. Q, I'm wondering if I missed something in your post. We're you arguing that we ought to eliminate the law that requires that hospitals provide care to all those that show up at their door, regardless of their a Lilith to pay? If so, I think that ship sailed long ago and I see nothing that tells me that either party/persuasion has the stomach to repeal that law.

    2. Downeast, as to your sister-in-law's situation. I feel for her and your family but very little of the ACA has been launched so its more likely that the increase is just a function of the experience of her group if she's on COBRA or the rather typical gyrations we've been seeing for years in the individual markets. If she is under an individual policy then this is an area that will actually be improved under the ACA whenever the exchanges are able to get up and running.

    Downeast, as to your earlier post regarding the portion of the nation who are receiving services abd not paying for them. As I see it the taxpayers are already picking up the tab for those under the current system that we all agree is horribly broken. Will the ACA do a better job of providing those services and controlling overall costs. There are strong arguments on both sides but most agree that it's not likely to be as bad as what we have now. We can't help but think of the ACA in terms of how it will impact our separate families. I contend that this country would never stand for the kind of things that would be required to "solve the problem" over even a 3-5 year period regardless of whether the solution was 100% crafted by either the libs or the cons. It seems that the goal is to slow the rate of growth over the first 10-20 years and then in 25-30 years seeing a system that impacts GDP more in line with our trading partners/competitors. We think in terms of a lifespan of 75 maybe 80 years with the last 20-25 years being the most intense in terms of healthcare. The nation has a much longer life span. 80 years is the equivalent of our spending 4 years in Gainesville and 20 years is like your last summer vacation. This is a big shift and it won't be a le to be properly assessed for years to come. In the mean time we're going to see lots of disappointments but also some pleasant surprises. I'm in the camp that thinks those pleasant surprises will over time outweigh the disappointments. I know that you disagree but faced with the inevitability of the ACA I suspect you begrudgingly hope that for the good of our nation, that's the outcome.
  6. QGator2414
    Online

    QGator2414 VIP Member

    Joined:
    Aug 24, 2009
    Messages:
    12,947
    Likes Received:
    168
    Trophy Points:
    63
    Location:
    Ocala
    Ratings Received:
    +629
    I agree big business is a problem in medicine but I think it is more from government allowing it to happen. Being in the dental industry I have no issues competing with the corporate chains. But we fortunately fly under the radar and are able to be more FFS as insurance is a pain but nothing like medical. :)

    To be clear I was not saying mastoid supports what I put out as an idea. I believe it was him who was providing an example of the difference in our system vs other countries (believe this specific example was England and think it was pregnancy related) anfpd the service rendered.

    I actually think capitalism is great for medicine. We try provide the best technology that makes sense to provide the best care possible. A lot of stuff out there is amazing and would create a wow factor wrt technology but makes no sense when you look at the whole picture in our field.

    While it is an indirect view I see our biggest competitor the mindset of Americans. Our government has created this idea that medical care is suppose to be some copay as most people never see their premiums being paid.
  7. QGator2414
    Online

    QGator2414 VIP Member

    Joined:
    Aug 24, 2009
    Messages:
    12,947
    Likes Received:
    168
    Trophy Points:
    63
    Location:
    Ocala
    Ratings Received:
    +629
    I totally agree with you about the power of the insurance industry and find it quite concerning.

    I am for eliminating EMTALA...and I agree it probably has no chance of happening.
  8. asuragator
    Offline

    asuragator Well-Known Member

    Joined:
    Sep 26, 2009
    Messages:
    20,531
    Likes Received:
    4,090
    Trophy Points:
    113
    Ratings Received:
    +6,082
    I agree, capitalism has been great for medicine. But there are limits to what capitalism can do and there are important non-capitalistic considerations that play a role. With health care this is particularly true given the nature of what "health care" is and how it can really affect folks lives.

    There is a convergence of sorts too. Many of the innovations in healthcare, like other industries, come not just from the private sector. They come from public universities using gov funding or a mix of gov/private funding. There is much to be cooperative about it in this way. But on the delivery side of things, I don't have a problem, in principle at least, with private health care. Only that given the state of our society and the fact that it is, imho, immoral that in this day and age, we have tens of millions of uninsured, and folks losing everything just because they are sick.

    I don't think gov needs to cover everyone's every need but I think they can and should play a positive role in providing against such catastrophes. That's my liberalism, perhaps. As a pragmatic though, I do recognize that maybe some of what I "want" might be out of the realm of the possible, or maybe not.

    Yeah, that mindview does play a role. This was a long time coming and the idea of a copay goes back a long ways. On the flip side, I am not so sure that hospitals and physician practices are actually always so "aboveboard" with the way that they charge. I keep thinking of that hard hitting Bitter Pill expose in Time. I am not saying I believe every word of it, only that it raises some issues that certainly deserve to be scrutinized more closely
  9. QGator2414
    Online

    QGator2414 VIP Member

    Joined:
    Aug 24, 2009
    Messages:
    12,947
    Likes Received:
    168
    Trophy Points:
    63
    Location:
    Ocala
    Ratings Received:
    +629
    Besides the fact that many insured also lose a lot when they get sick and many uninsured do pay for healthcare.

    I find it unbelievable how much we complain in this country considering most of the world deals with every single day. From health insurance (not even healthcare) to our two bedroom apartments to our mode of transportation while others are living in a 12X12 box with no utilities IMHO shows the arrogance we Americans have... :)

    I wish no one had to struggle but that is just not life. :)
  10. asuragator
    Offline

    asuragator Well-Known Member

    Joined:
    Sep 26, 2009
    Messages:
    20,531
    Likes Received:
    4,090
    Trophy Points:
    113
    Ratings Received:
    +6,082
    Very true, my friend. And me neither.

    But, the embarrassment of riches we have in the US, imho, points to us being "victims" of our own success. Our standard of living has increased so much over time it can only follow that our expectations would change...driven of course by both the govt/politics and by capitalism.
  11. dirigo
    Offline

    dirigo Member

    Joined:
    Apr 3, 2007
    Messages:
    453
    Likes Received:
    7
    Trophy Points:
    18
    Ratings Received:
    +23
    It seems that we're beginning to stray away from the debate. Lets get back to writing about our ideas and alternative solutions. We need not waste much time proposing practical impossibilities - big business and capitalism in medicine are here to stay and so is EMTALA so let's work around them. It's largely irrelevant which political party is more to blame; the dems are easily as responsible for the current system as the GOP; a Republican, Teddy Roosevelt was the first to propose a national health care plan and President Nixon rolled out a realistic plan in the late 60s. Heck we all know that the ACA's (and before it Romneycare's) superstructure was developed by a GOP think tank (Heritage Foundation) to respond to and add to the defeat to Hillarycare.

    I like the idea of greater use of HSA's but I doubt more than 20% of the families in this country could fund one on a regular basis. Are we ready to provide wide-spread federal grants to individuals to fund them and then the almost certain fraud and abuse by some who will be tempted to access that cash other needs? I like the idea but would need a lot more detail about how it would be I implemented.

    I'm even more pessimistic about catastrophic only coverage. Who takes care of the non-catastrophic broken wrist heart attack that turns out to be indigestion? Its my understanding that doctors and hospitals are stiffed regularly under the even the more modest current co-pay program. People who won't or can't pay for the services they receive is one of the main reason our current system is broken. Tell me how you think it would work.
  12. QGator2414
    Online

    QGator2414 VIP Member

    Joined:
    Aug 24, 2009
    Messages:
    12,947
    Likes Received:
    168
    Trophy Points:
    63
    Location:
    Ocala
    Ratings Received:
    +629
    I actually think HSA's are not a good product for most in this country because of our tax code right now.

    Which makes this debate messier and messier... :)

    With regards to catastrophic only coverage...IMO it won't work unless we have a true free market system. Are you going to have outlier situations where a family has crazy extra costs trying to figure out what is wrong? Sure. But that happens today. But if we are negotiating patient to doctor instead of doctor/insurance company/patient/ government we can lower costs. Now I will admit that I am not sure how many Americans are willing to prioritize their health over their luxieries. But if forced to decide...
  13. bludigal
    Offline

    bludigal New Member

    Joined:
    May 15, 2007
    Messages:
    4,973
    Likes Received:
    2
    Trophy Points:
    0
    Ratings Received:
    +2
    Is it a program to distribute cyanide?

Share This Page