World is Falling Apart Thread (Locked forever)

[TSTR]

Compensation≠Profit

[Blu]

You want some Marketplace insurance in North Carolina? Look at all the wonderful choices you get:

BCBS of NC

Something ain't right here, and I say that as a broke motherfucker who is gaming the system himself. Working in an insurance office for a while has shown me some shit.

Exactly. I have a friend that works in a medical insurance office. His default procedure usually revolves around denying benefit, so that it's on the patient to have to call and get things reclassified, which results in a constant tug of war between the insurance and hospital that the patient is in between.

Single payer would be a dream, and there's ways along the way to provide incentive to the profession as it is demanding and a lot of hard work, but damn if we're on one end of an extreme. Like TSTR said, compensation isn't the issue here, it's the way in which a hospital's leadership runs itself on the business end.

[ElkinFencer10]

Doctors deserve to be compensated extremely well IMO as they provide a service without which society cannot function. Patients also deserve to be able to seek whatever treatment they need without worry about being able to afford it.

[Sarge]

Yeah, I don't see the government managing that part very well at all. They're not even doing a good job with a subset of it now, so I don't expect it to be any better should we go to a single-payer system.

One of the major problems I see is how we treat insurance in the first place. It should really only be for catastrophic care, not for routine care.

[Sarge]

Welp, that was quick. Trump and others weighed in on the Ethics Commission kerfuffle, and the plans have been scrapped. Good deal.

[MrPopo]

One of the major problems I see is how we treat insurance in the first place. It should really only be for catastrophic care, not for routine care.

I think this hits the nail on the head. Look at every other kind of insurance we have:

Car insurance
Homeowners insurance
Mortgage insurance

All of these are to insure against something catastrophic happening. Geico doesn't pay for me changing my oil or getting my 30k maintenance done. Even Life Insurance is you insuring against you dying early. The fact that medical insurance is paying for stuff like physicals and small stuff is the real problem, as it's driving up costs across the board.

[marurun]

Yeah, I don't see the government managing that part very well at all. They're not even doing a good job with a subset of it now, so I don't expect it to be any better should we go to a single-payer system.

One of the major problems I see is how we treat insurance in the first place. It should really only be for catastrophic care, not for routine care.

What part of this is the government not managing well? Medicaid and Medicare are actually managed pretty effectively, and are a great example of public/private partnership, in that local administration is often handled by private partners.

The problem right now is that even routine care is horribly expensive. Without insurance most people couldn't afford routine care. If insurance is just for catastrophic events, then we need some other system to help normalize routine care expenses. Further, what about expensive events like pregnancy? Those aren't catastrophes or necessarily emergencies, but they cost a great deal more than a Dr visit every 6 months. What do we do about those expenses? This is why single-payer health care is advantageous, because it helps normalize health care costs and provides a counter-balance to corporations and organizations that want to monopolize key elements of health care in order to generate profit.

Welp, that was quick. Trump and others weighed in on the Ethics Commission kerfuffle, and the plans have been scrapped. Good deal.

Well, I'm glad Trump was watching the news, otherwise he might've missed it! The House Republicans didn't give anyone much advanced notice.

[Sarge]

If you look at the payout for Medicare and Medicaid, it's gotten to the point that some doctors won't even take those patients because they lose money on them.

https://www.bloomberg.com/news/articles ... h-medicaid

Furthermore, look at how the VA is managed. In most cases, care there is absolutely hideous.

The point about insurance is that we have to ask ourselves why we can't afford routine care. Since consumers use insurance for pretty much everything now, the hospitals know they can charge higher rates for services and get away with it, because the customer isn't paying, the insurance is. Of course, the insurance isn't going to eat the cost, so it gets passed on in the form of higher premiums and deductibles to the consumer. It's currently a market that is pretty much completely devoid of market forces, and thus operates more like a monopoly. Return insurance to its original intent, and you'll see routine services become cheaper as individuals start paying attention to what they're shelling out during a visit to the doc.

That's also the reason I don't think single-payer will work. Between the Medicare/Medicaid parallels, and the dreadful mismanagement of the VA, I think you'd see a drop in quality in the general medical populace, and the best doctors would operate in a more mercenary fashion, perhaps even returning to the days where only the rich had their own private doctors and we just have to make do.

I don't think the current situation is tenable at all, but I also don't think single-payer will work, either. I think we have to completely rethink how we treat health care, because the way it is right now, I'm not sure there is a solution.

[CRTGAMER]

Welp, that was quick. Trump and others weighed in on the Ethics Commission kerfuffle, and the plans have been scrapped. Good deal.

Well, I'm glad Trump was watching the news, otherwise he might've missed it! The House Republicans didn't give anyone much advanced notice.

Trump's twitter strikes again; this time influencing the House to back off the Ethics power strip. The Republicans would not listen to complaints from Democrats, but heeded Trump.

Kellyanne Conway NBC Interview - https://www.youtube.com/watch?v=Usa2MiccuA8



Take a look at what Ford is doing with the Auto Plant in Mexico, all due to the new policies coming out from the President Elect. The threat of the 35 percent tariff is getting results with more U.S. Jobs and not even the President yet! The power of the Trump Tweet and the stock market.

Oh and watch for the WikiLeaks Founder interview that Trump was hinting tonight on Fox concerning the supposed Russian hack.

One of the major problems I see is how we treat insurance in the first place. It should really only be for catastrophic care, not for routine care.

I think this hits the nail on the head. Look at every other kind of insurance we have:

Car insurance
Homeowners insurance
Mortgage insurance

All of these are to insure against something catastrophic happening. Geico doesn't pay for me changing my oil or getting my 30k maintenance done. Even Life Insurance is you insuring against you dying early. The fact that medical insurance is paying for stuff like physicals and small stuff is the real problem, as it's driving up costs across the board.

Good idea Sarge and great analogy Mr Popo! Regulate price caps on the pharmaceuticals and regular visits, U.S. Health care is way too costly!

[marurun]

If you look at the payout for Medicare and Medicaid, it's gotten to the point that some doctors won't even take those patients because they lose money on them.

https://www.bloomberg.com/news/articles ... h-medicaid

That's not so much a management issue, IMO. In terms of actually reimbursing and processing paperwork and mechanical function of that sort, Medicare and Medicaid are relatively efficient. As for the amount of reimbursement, I've done some reading on this... Medicaid particularly does reimburse a little low compared to expenses for many facilities, but Medicaid rates are set based on a relatively straight-forward formula that needs only minor adjustments (assuming adequate funding is provided by state and federal governments) to properly reimburse. Further, many insurance companies reimburse less than Medicaid or Medicare and peg their reimbursement rates to Medicaid rates. And those large private insurers have hospitals and providers over a barrel in a way even the Federal government doesn't. Blue Cross Blue Shield has far more power over current billing rates than Medicaid or Medicare. And if you look at what hospitals charge, you will find a shifting morass. Chargemaster rates (the official "on the books" prices) of procedures vary insanely between facilities are are almost never what a patient pays, unless, of course, the patient is uninsured and therefore has no ability to negotiate those costs.

https://www.washingtonpost.com/news/won ... her-38000/

Furthermore, look at how the VA is managed. In most cases, care there is absolutely hideous.

I will agree, there, but I think the VA is a unique case (for health care, not for government) where bureaucracy and military intersect. And the VA has access to some cost-cutting measures Medicare and Medicaid should have (like negotiating drug costs).

The point about insurance is that we have to ask ourselves why we can't afford routine care. Since consumers use insurance for pretty much everything now, the hospitals know they can charge higher rates for services and get away with it, because the customer isn't paying, the insurance is. Of course, the insurance isn't going to eat the cost, so it gets passed on in the form of higher premiums and deductibles to the consumer. It's currently a market that is pretty much completely devoid of market forces, and thus operates more like a monopoly. Return insurance to its original intent, and you'll see routine services become cheaper as individuals start paying attention to what they're shelling out during a visit to the doc.

I think we could already pay more attention to what we're shelling out if medical facilities were required to set procedure costs and stick to them. And really, the hospital market is a mess. There are a few profitable systems that snap up surrounding facilities in mergers and a lot of smaller or public systems that are constantly on the edge of going broke, but despite these they face a lot of the same issues. Eliminating a profit motive from standard health care would ameliorate most of these issues. Doctors should indeed be compensated, as should other medical professionals, but right now it is largely the upper administrators and supply and drug companies making the profit. GPs are already getting the short end of the stick, and as long as they are beholden to large for-profit entities, they will continue to.

I think you'd see a drop in quality in the general medical populace, and the best doctors would operate in a more mercenary fashion, perhaps even returning to the days where only the rich had their own private doctors and we just have to make do.

How many other nations with better base-level health care than the US does it take to convince you otherwise?

I don't think the current situation is tenable at all, but I also don't think single-payer will work, either. I think we have to completely rethink how we treat health care, because the way it is right now, I'm not sure there is a solution.

There's no pie-in-the-sky perfect solution, but other nations are finding ways to manage their health care costs, and the US stubbornly refuses to try these tested and effective models. How can we claim to be a leader when we consistently fail to learn from the successes of others?