Speaking of ACA

[MichaelB]

US healthcare always cost more than other countries, but the difference was much smaller in the past. In the mid-70's it began to diverge sharply, with costs in the US growing much faster than the rest of the world, with no corresponding divergence in measures of health. (see here) This implies the driving factor is not cost or health, but pricing power.

There is no doubt other countries with lower health care to GDP rations have much greater price regulation, and health care providers have lower incomes relative to the average.

But because it is more complicated now, we have the dilemma we now have to solve. Namely, how to pay for all this complication.

I am just leery of people who have a "simple" solution to this complex problem. And reading about how other nations deal with it has opened my eyes.

I agree, and am leery of any suggestion of a "solution" at all. Health care covers 17% of our GDP and employs more than 13% of the total work force. Change is a Herculean task.

 

[candrew]

Very interesting discussions here on this thread. I RE'd out of the healthcare industry after a 35 year career - most of that with a health system mega-corp.

I only have an observation to share based on my experiences on the ancillary side of a large, acute care hospital.

In the U.S., we typically excel at tertiary care - that being the most expensive and intensive care provided to the sickest patient population (I believe another poster referred to it as "complicated"). The reason we excel at tertiary care is because overall, we absolutely suck at primary care. Too many people are not accessing basic, quality, preventative care when it would make the biggest difference in their overall health by catching and treating ongoing, chronic illnesses, including obesity.

In short what we have in the U.S. is a sick-care system. And there are other aspects of health care that remain unaddressed - not the least of which is an epidemic of obesity. But again, this is where accessing quality, primary care, especially that which is community based, that can have the greatest impact for improving overall wellness and improved health outcomes based on the number of $$ spent.

IMHO, it is universal access to quality, primary care where the focus needs to be - regardless of an individual's ability to pay for it. Personally, I would rather pay more in the form of taxes to make sure that all of us are getting the most cost effective and highest quality primary care possible. Keeping patients well costs far less in the long run than having them land on the doorsteps of acute care hospitals due to untreated, undiagnosed illnesses.

 

[NW-Bound]

... IMHO, it is universal access to quality, primary care where the focus needs to be - regardless of an individual's ability to pay for it. Personally, I would rather pay more in the form of taxes to make sure that all of us are getting the most cost effective and highest quality primary care possible. Keeping patients well costs far less in the long run than having them land on the doorsteps of acute care hospitals due to untreated, undiagnosed illnesses.

I don't have statistics, but observe that some people I know don't take care of themselves as they should, even though they have access to healthcare.

And if these are white-collar workers, I don't know how bad it is with less informed people.

What do you do? Perhaps a sugar tax on soft drink is not as ridiculous as I thought. Round people up and make them exercise?

PS. And speaking of obesity, I have seen Canadians and Europeans catching up fast with Americans. Asians are next. Will see how their healthcare system handle that.

 

[ShokWaveRider]

Very interesting discussions here on this thread. I RE'd out of the healthcare industry after a 35 year career - most of that with a health system mega-corp.

I only have an observation to share based on my experiences on the ancillary side of a large, acute care hospital.

In the U.S., we typically excel at tertiary care - that being the most expensive and intensive care provided to the sickest patient population (I believe another poster referred to it as "complicated"). The reason we excel at tertiary care is because overall, we absolutely suck at primary care. Too many people are not accessing basic, quality, preventative care when it would make the biggest difference in their overall health by catching and treating ongoing, chronic illnesses, including obesity.

In short what we have in the U.S. is a sick-care system. And there are other aspects of health care that remain unaddressed - not the least of which is an epidemic of obesity. But again, this is where accessing quality, primary care, especially that which is community based, that can have the greatest impact for improving overall wellness and improved health outcomes based on the number of $$ spent.

IMHO, it is universal access to quality, primary care where the focus needs to be - regardless of an individual's ability to pay for it. Personally, I would rather pay more in the form of taxes to make sure that all of us are getting the most cost effective and highest quality primary care possible. Keeping patients well costs far less in the long run than having them land on the doorsteps of acute care hospitals due to untreated, undiagnosed illnesses.

This make the most sense. Thank you.

 

[jimandthom]

I don't have statistics, but observe that some people I know don't take care of themselves as they should, even though they have access to healthcare.

And if these are white-collar workers, I don't know how bad it is with less informed people.

What do you do? Perhaps a sugar tax on soft drink is not as ridiculous as I thought. Round people up and make them exercise?

PS. And speaking of obesity, I have seen Canadians and Europeans catching up fast with Americans. Asians are next. Will see how their healthcare system handle that.

We have met the enemy and they is us.-----Pogo

 

[joeea]

A friend of mine who is 10 year my senior used to tell me how things were simpler when he grew up. His father was a milkman, back when they still delivered jugs of milk to people's doorsteps in the morning. His family had no insurance, the same as most Americans then. My friend said that when he and his siblings were sick, his father took him to the doctor and paid with cash. That was it.

When I first heard his story, I nodded that, indeed things were a lot simpler then. Well, there was no cure for cancer or any fancy surgery, so you just died if you were among the unlucky ones, and that was that. Simpler stuff that was available, people just paid out of pocket.

Before I forgot, my friend also talked about how his father paid for child delivery for his younger sister. The hospital had an installment program, and his father paid it in a year or two.

And though I was 10 years younger, it was the same with my family, although we were not in the US. There was no million-dollar treatment, so there was not a lot of chance to bankrupt yourself seeking treatment.

And that was what I meant by saying things were simpler

Of course the real story isn't quite that simple.

Of course there was "fancy surgery" then. It's just that only the wealthy could afford it. The less wealthy did without and suffered the consequences.

You can still live the "simple life" today, if you choose. Don't have any of those fancy surgeries. Don't get those million-dollar treatments. Just get whatever you ca afford out of pocket. You won't go bankrupt that way.

And of course you could ditch the cellphone, computer, television, but keep the radio.

 

[NW-Bound]

Of course the real story isn't quite that simple.

Of course there was "fancy surgery" then. It's just that only the wealthy could afford it. The less wealthy did without and suffered the consequences.

I beg to differ. The 1st knee surgery was performed in 1968. Just plain penicillin was developed during WWII. A lot of expensive treatments was developed recently.

You can still live the "simple life" today, if you choose. Don't have any of those fancy surgeries. Don't get those million-dollar treatments. Just get whatever you ca afford out of pocket. You won't go bankrupt that way.

And of course you could ditch the cellphone, computer, television, but keep the radio.

Ah, that's a simplest solution.

How do we convince people to adopt that?

PS. Do you suppose it also solves the SS funding shortfall by the same stroke?

 

[candrew]

I don't have statistics, but observe that some people I know don't take care of themselves as they should, even though they have access to healthcare.

And if these are white-collar workers, I don't know how bad it is with less informed people.

What do you do? Perhaps a sugar tax on soft drink is not as ridiculous as I thought. Round people up and make them exercise?

PS. And speaking of obesity, I have seen Canadians and Europeans catching up fast with Americans. Asians are next. Will see how their healthcare system handle that.

I would suggest that although there are people with access to healthcare who fail to take care of themselves, that should not serve as a reason to abandon the pursuit of expanding universal access to affordable, quality, primary care.

If you haven't already, may I suggest watching a superb documentary produced by HBO titled "The Weight Of A Nation" that focuses on the obesity epidemic in the U.S.

 

[joeea]

I beg to differ. The 1st knee surgery was performed in 1968. Just plain penicillin was developed during WWII. A lot of expensive treatments was developed recently.

Surgery has been around for about 9,000 years.

Modern anesthesia has been around since the mid 1800s.

Modern plastic surgery has been around for over 100 years.

Ah, that's a simplest solution.

How do we convince people to adopt that?

You first. I'm happy with these days and not pining for the old days.

PS. Do you suppose it also solves the SS funding shortfall by the same stroke?

If the "old days" means the days before Social Security then, yes, I guess that "solves" it.

 

[candrew]

Surgery has been around for about 9,000 years.

Modern anesthesia has been around since the mid 1800s.

Modern plastic surgery has been around for over 100 years.


You first. I'm happy with these days and not pining for the old days.


If the "old days" means the days before Social Security then, yes, I guess that "solves" it.

Ah yes, "modern anesthesia" - a pint of whiskey and a stick to bite down on!

 

[joeea]

Ah yes, "modern anesthesia" - a pint of whiskey and a stick to bite down on!

View attachment 32137

No. That was the situation before modern anesthesia.

 

[NW-Bound]

I would suggest that although there are people with access to healthcare who fail to take care of themselves, that should not serve as a reason to abandon the pursuit of expanding universal access to affordable, quality, primary care.

If you haven't already, may I suggest watching a superb documentary produced by HBO titled "The Weight Of A Nation" that focuses on the obesity epidemic in the U.S.

It's not about abandoning, but about controlling healthcare cost which most of the posts in this thread has been about.

The problem with the obesity problem is that everyone knows about it including the afflicted, but there seems to be no easy solution, judging from the easy observation that no progress has been made, and in fact it's getting worse by the day. If it were easy, we would not have a problem.

 

[NW-Bound]

The way surgery was done in the old days, it would limit the practice to only those who truly wanted it. The meek did not want it.

I read that mastectomy was performed in the 1800s as a treatment for breast cancer.

Just now, learned that it was done much much earlier.

From Wikipedia,

Mastectomy for breast cancer was performed at least as early as 548 AD, when it was proposed by the court physician Aëtius of Amida to Theodora. She declined the surgery, and died a few months later.​

 

[NW-Bound]

Surgery has been around for about 9,000 years.

Modern anesthesia has been around since the mid 1800s.

Crude amputation was done then, but modern more delicate operations such as organ transplants, heart surgeries are quite recent.

... You first. I'm happy with these days and not pining for the old days.

If the "old days" means the days before Social Security then, yes, I guess that "solves" it.

Societal problems cannot be solved by the choice of an individual.

About solving SS, I was joking that limitation of healthcare would cut short life expectancy, hence also helped SS short funding.

 

[candrew]

It's not about abandoning, but about controlling healthcare cost which most of the posts in this thread has been about.

Expansion of access to routine, universal, affordable, quality, preventative healthcare will do more to control healthcare costs per dollar spent.

 

[NW-Bound]

Again, I have my doubt as I know people with good job with health insurance still having problems with weight control. It is not the lack of healthcare.

And they know they have a weight problem. And they are educated people. Something keeps them from achieving what they want.

 

[joeea]

About solving SS, I was joking that limitation of healthcare would cut short life expectancy, hence also helped SS short funding.

Ah, I see.

Yup, if limited healthcare shortens lifespans to about 65 or less, the "SS problem" is quickly solved.

 

[Montecfo]

I think the notion that everyone should receive the same level of healthcare without regard to the cost of providing it is something most people will say they support at some level.

That is until the bill arrives. Then it becomes a tad more complicated and real.

 

[urn2bfree]

How to pay for some universal coverage?
User fees (some call them taxes, but what's in a name?) for those things that generate health problems. In short, if you want to discourage something- make it cost more. And the amount people would pay would be entirely under their own control:

1) Tobacco - you don't like paying this tax? Don't smoke.
2) Alcohol - ditto. If you drink a little, you will only pay a little. If you drink alot, you likely generate a lot of health care expense, so pay a lot more.
3) Calories- this one is tricky, as there was a claim that someone like Michael Phelps (a healthy lad it seems) ate 10,000 calories a day. Surely this an exceptional case - no law is perfect. For the vast majority, too many calories equals bad health. So the more you consume, the more you pay.

This would be a long way closer to a fair sharing of the risk than anything proposed so far.

 

[joeea]

How to pay for some universal coverage?
User fees (some call them taxes, but what's in a name?) for those things that generate health problems. In short, if you want to discourage something- make it cost more. And the amount people would pay would be entirely under their own control:

1) Tobacco - you don't like paying this tax? Don't smoke.
2) Alcohol - ditto. If you drink a little, you will only pay a little. If you drink alot, you likely generate a lot of health care expense, so pay a lot more.
3) Calories- this one is tricky, as there was a claim that someone like Michael Phelps (a healthy lad it seems) ate 10,000 calories a day. Surely this an exceptional case - no law is perfect. For the vast majority, too many calories equals bad health. So the more you consume, the more you pay.

This would be a long way closer to a fair sharing of the risk than anything proposed so far.

No law is perfect? LOL!

How many government officials do you imagine will it take to track if you smoke, how many drinks you consume, and how many calories you consume?

Or is this just a fun but completely impractical thought exercise?

 

[jollystomper]

What puzzles me about the ACA are the acceptance rules by doctors. Certainly doctors can choose to accept any plans, but it is puzzling when the state says a doctor will accept a plan and the doctor then says they do not.

Our youngest son is looking at getting off our our insurance. Being a self-supporting part-time student who is also working to cover his expenses, we applaud him on trying to be independent. He would qualify for the subsidiary and his job, even though he is working part-time, you provide a stipend to bring the monthly cost down even further.

So he has started to look at ACA plans in Maryland. However, he is finding that, even though the Maryland site lists his current providers - many of whom he has been going to since very young - and the plans they take, when he calls his them they are telling him "we do not take that plan through the state, only through private insurance". He asks them why then do they show those plans on the ACA site for them, and their reply is "that does not mean we will take them".

So now to transition he will have to get a whole new set of providers.

 

[candrew]

What puzzles me about the ACA are the acceptance rules by doctors. Certainly doctors can choose to accept any plans, but it is puzzling when the state says a doctor will accept a plan and the doctor then says they do not.

Our youngest son is looking at getting off our our insurance. Being a self-supporting part-time student who is also working to cover his expenses, we applaud him on trying to be independent. He would qualify for the subsidiary and his job, even though he is working part-time, you provide a stipend to bring the monthly cost down even further.

So he has started to look at ACA plans in Maryland. However, he is finding that, even though the Maryland site lists his current providers - many of whom he has been going to since very young - and the plans they take, when he calls his them they are telling him "we do not take that plan through the state, only through private insurance". He asks them why then do they show those plans on the ACA site for them, and their reply is "that does not mean we will take them".

So now to transition he will have to get a whole new set of providers.

I feel yer pain. Arrrggghhh! Provider networks drove me nuts during my days of wage slavery with employer sponsored healthcare and continue doing so as an early retiree who is on the ACA.

Here today, gone tomorrow. Insurer says that provider "x" is in network, provider says "no". Provider says "yes" we accept your insurance and insurer says, not so fast. Only Dr. so-and-so in that same practice is in our network!!

Drives me and DW nuckin' futs!

 

[ceciledian]

I think it will affect a lot of us here (and our significant others) if it is deemed unconstitutional and removed. A disaster to the RE crowd IMHO.

[emoji817]

 

[Rianne]

How to pay for some universal coverage?
User fees (some call them taxes, but what's in a name?) for those things that generate health problems. In short, if you want to discourage something- make it cost more. And the amount people would pay would be entirely under their own control:

1) Tobacco - you don't like paying this tax? Don't smoke.
2) Alcohol - ditto. If you drink a little, you will only pay a little. If you drink alot, you likely generate a lot of health care expense, so pay a lot more.
3) Calories- this one is tricky, as there was a claim that someone like Michael Phelps (a healthy lad it seems) ate 10,000 calories a day. Surely this an exceptional case - no law is perfect. For the vast majority, too many calories equals bad health. So the more you consume, the more you pay.

This would be a long way closer to a fair sharing of the risk than anything proposed so far.

New questions:
1. How often do you eat potato chips
a. 1 bag every other day
b. 2 bags once a week
c. my vegetable choice with every meal.

2. Which are your choices for a snack?
a. yogurt
b. premium ice cream
c. pizza bites

3. How often do you eat fast food?
a. Daily
b. Never
c. Ummm, not going to answer that.

 

[Lienlord]

Qualitatively, most people would agree that spending $1M to save a newborn is more worthwhile than spending the same to extend the life of a 70-year-old by 1 year? Heck, even a 40-year-old for that matter.

But how do we set a formula? What if the chance of saving the baby is only 5%, but the chance of 1 more year of life for the geezer is 95%?

Qualitatively, things are simple. Quantitatively, many things become very difficult.

And, even without data, I would bet that cases involving $1M babies are fewer than $1M or $500K geezers.

I don't have data to back it up, but it seems the majority of healthcare costs are spent at the end of life. Modern medicine has many wonderful treatments to (possibly) extend our life by some amount, but at great cost. There is an ethical question about these expensive treatments; should everyone be given them regardless of ability to pay? Since we know that ultimately nothing is free; who will end up paying?

Insurance is simply a bucket of money that people pay into, and those who have need are paid out of that bucket. While on a moral basis I like the idea of coverage regardless of pre-existing conditions, it's fair to say that person will need more $ more often out of that bucket. So should they be required to only pay the same amount into the bucket as you?

I think of it like auto insurance; do you want share the same bucket with the careless driver with lots of tickets and accidents when you are a safe driver? I know I don't; but what if the insurance company is required to add them to your pool and charge the same amount, even though they're a much higher risk and will likely use more $ in the bucket?

Unfortunately, the hard answer is something nobody wants to speak and no politician wants to vote for, because it conflicts with the notion that healthcare (or anything else that comes with a cost) is a basic human right regardless of ability to pay. This is only a fairly recent concept, and our current mess is evidence that basic economics doesn't change.