Then you could vote the people running the healthcare system out for gross mismanagement. I gave them some cushion. France isn't throwing people out of hospitals spending less so why should we have to throw people out spending more than they do?
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The Heartland Institute’s Very Stupid New Medicare for All Report
- Thread starter ZiprHead
- Start date
Then you could vote the people running the healthcare system out for gross mismanagement. I gave them some cushion. France isn't throwing people out of hospitals spending less so why should we have to throw people out spending more than they do?
Why? Is that how you think of European national healthcare systems? Suppose we set the per capita spending cap at 10% above what France spends now. How can you argue it's not more generous than French healthcare?
It doesn’t matter how much more it is in a general sense if you cut it off for the people who need it the most when they need it the most. The vast majority of people are going to be well below the per capita rate and a few will be well above it.
If a kid is born with a heart defect, he’s going to need a lifetime of medical care and that should be provided on account of his being a citizen with no other considerations. He shouldn’t have his medical treatments cut off and his parents forced to choose between paying their mortgage or having their son die over the concern that some healthy people might also get into an accident and drive the median rate up.
Do you know what the average spending per capita is? You take all the money you spent and divide it by all the people you covered. Nothing prevents you from spending all of the nation's budgeted money on one kid if that's how you prioritize things.
I'm guessing France and other European countries with universal healthcare are dealing with problems like this now. I think they have kids there and everything.
Ah, I misunderstood what you were saying. I thought you meant individual caps. If you have a national cap and you end up spending more, you should probably look into raising the national cap and increasing taxes to cover the extra costs, while not sacrificing anyone's care due to the national cap being hit ... which basically means not having a national cap as anything but a general target. While efficiency of spending is important, it's a secondary concern to providing the care needed to patients.
Maybe helicopter a few soldiers in to shoot up a wedding once or twice instead of dropping missiles on them to cover the costs if it's that important to you.
SimpleDon
Veteran Member
The problem with our health care system isn't how it is structured. It is because it has been increasingly turned over to the profit motive in the last fifty years or so.
The for-profit insurance companies were overpaying medical bills because this was the sure way to increase their profits. The "free market" fable of the insurance companies driving down the medical costs to be able to compete with their rivals would result in no profits for any of them.
Most European health care systems are structured as Bismark-type systems which were first introduced in Germany in the 1870s. They have private insurance companies and employer mandates to pay at least 50% of the cost of the premiums, but most employers pay more. My company paid 100% of my premium. But the health insurance companies are all non-profit community rate based like the Blue Cross-Blue Shield companies of post-world war 2 in the US.
The insurance companies don't negotiate the rates paid to the health care providers. In each lande, roughly like our states, the government sits down with the interested parties and they negotiate the rates for the year for each different service.
The state government has broad control over the number and location of the hospitals and of expensive machines like MRIs. Germany and most European countries are struggling with constraining health care costs. Modern medicine is expensive. And the profit motive is cherry-picking health care services in Europe just like in the US, day surgery-, infusion-, dialysis-, imaging-centers, etc. And like the US there is much more financial capital available than can be invested in traditional industries and in the stock market or real estate so the pressure to privatize things like health care and traditional government services is building, too.
The for-profit insurance companies were overpaying medical bills because this was the sure way to increase their profits. The "free market" fable of the insurance companies driving down the medical costs to be able to compete with their rivals would result in no profits for any of them.
Most European health care systems are structured as Bismark-type systems which were first introduced in Germany in the 1870s. They have private insurance companies and employer mandates to pay at least 50% of the cost of the premiums, but most employers pay more. My company paid 100% of my premium. But the health insurance companies are all non-profit community rate based like the Blue Cross-Blue Shield companies of post-world war 2 in the US.
The insurance companies don't negotiate the rates paid to the health care providers. In each lande, roughly like our states, the government sits down with the interested parties and they negotiate the rates for the year for each different service.
The state government has broad control over the number and location of the hospitals and of expensive machines like MRIs. Germany and most European countries are struggling with constraining health care costs. Modern medicine is expensive. And the profit motive is cherry-picking health care services in Europe just like in the US, day surgery-, infusion-, dialysis-, imaging-centers, etc. And like the US there is much more financial capital available than can be invested in traditional industries and in the stock market or real estate so the pressure to privatize things like health care and traditional government services is building, too.
Do you know what the average spending per capita is? You take all the money you spent and divide it by all the people you covered. Nothing prevents you from spending all of the nation's budgeted money on one kid if that's how you prioritize things.
I'm guessing France and other European countries with universal healthcare are dealing with problems like this now. I think they have kids there and everything.
Ah, I misunderstood what you were saying. I thought you meant individual caps. If you have a national cap and you end up spending more, you should probably look into raising the national cap and increasing taxes to cover the extra costs, while not sacrificing anyone's care due to the national cap being hit ... which basically means not having a national cap as anything but a general target. While efficiency of spending is important, it's a secondary concern to providing the care needed to patients.
Maybe helicopter a few soldiers in to shoot up a wedding once or twice instead of dropping missiles on them to cover the costs if it's that important to you.
Suppose someone comes to your door and says they want to sell you a new European style water heater that will save you 35% on your hot water costs because that's what they are already saving in France.
If you respond, "OK, I'll take one provided you guarantee me in writing I'll save 25%" and they start pitching a fit about how guaranteeing that will cause a very large parade of horribles to occur. Children dying. Widows and orphans starving in the street.
Would you still buy the water heater?
Do you know what the average spending per capita is? You take all the money you spent and divide it by all the people you covered. Nothing prevents you from spending all of the nation's budgeted money on one kid if that's how you prioritize things.
I'm guessing France and other European countries with universal healthcare are dealing with problems like this now. I think they have kids there and everything.
Ah, I misunderstood what you were saying. I thought you meant individual caps. If you have a national cap and you end up spending more, you should probably look into raising the national cap and increasing taxes to cover the extra costs, while not sacrificing anyone's care due to the national cap being hit ... which basically means not having a national cap as anything but a general target. While efficiency of spending is important, it's a secondary concern to providing the care needed to patients.
Maybe helicopter a few soldiers in to shoot up a wedding once or twice instead of dropping missiles on them to cover the costs if it's that important to you.
Suppose someone comes to your door and says they want to sell you a new European style water heater that will save you 35% on your hot water costs because that's what they are already saving in France.
If you respond, "OK, I'll take one provided you guarantee me in writing I'll save 25%" and they start pitching a fit about how guaranteeing that will cause a very large parade of horribles to occur. Children dying. Widows and orphans starving in the street.
Would you still buy the water heater?
When purchasing a water heater, cost effectiveness is a primary concern. When dealing with health care, cost effectiveness is a secondary concern.
If you budget $100 billion for health care in a year and it ends up costing $130 billion, it may be that you have a shitty system with a lot of unecessary expenses and it may be that your budgeting process was shit and you need to look into which. When looking into it, however, you should not be asking yourself "Is there a way I can save $30 billion?", you should be asking yourself "Is there a way I can save $30 billion without compromising the quality of care?". When you just look into the raw amount of the expenses and not the reasoning behind those expenses, you don't get valid results.
Suppose someone comes to your door and says they want to sell you a new European style water heater that will save you 35% on your hot water costs because that's what they are already saving in France.
If you respond, "OK, I'll take one provided you guarantee me in writing I'll save 25%" and they start pitching a fit about how guaranteeing that will cause a very large parade of horribles to occur. Children dying. Widows and orphans starving in the street.
Would you still buy the water heater?
When purchasing a water heater, cost effectiveness is a primary concern. When dealing with health care, cost effectiveness is a secondary concern.
If you budget $100 billion for health care in a year and it ends up costing $130 billion, it may be that you have a shitty system with a lot of unecessary expenses and it may be that your budgeting process was shit and you need to look into which. When looking into it, however, you should not be asking yourself "Is there a way I can save $30 billion?", you should be asking yourself "Is there a way I can save $30 billion without compromising the quality of care?". When you just look into the raw amount of the expenses and not the reasoning behind those expenses, you don't get valid results.
Well then, why is the guy always talking about how much cheaper water heaters are in Europe?
I didn't force him to make that sales pitch.
Suppose someone comes to your door and says they want to sell you a new European style water heater that will save you 35% on your hot water costs because that's what they are already saving in France.
If you respond, "OK, I'll take one provided you guarantee me in writing I'll save 25%" and they start pitching a fit about how guaranteeing that will cause a very large parade of horribles to occur. Children dying. Widows and orphans starving in the street.
Would you still buy the water heater?
When purchasing a water heater, cost effectiveness is a primary concern. When dealing with health care, cost effectiveness is a secondary concern.
If you budget $100 billion for health care in a year and it ends up costing $130 billion, it may be that you have a shitty system with a lot of unecessary expenses and it may be that your budgeting process was shit and you need to look into which. When looking into it, however, you should not be asking yourself "Is there a way I can save $30 billion?", you should be asking yourself "Is there a way I can save $30 billion without compromising the quality of care?". When you just look into the raw amount of the expenses and not the reasoning behind those expenses, you don't get valid results.
Well then, why is the guy always talking about how much cheaper water heaters are in Europe?
I didn't force him to make that sales pitch.
Probably because water heaters are cheaper over there due to way less useless bullshit adding to the price. You do, of course, need to deal with that bullshit, but just slapping a price tag on it and firing people who fail to move units with that price tag is probably the least effective way possible to do about selling a competitively priced water heater.
The first thing you need to do is make sure that you have a comparable product and that all the citizens of your country are getting their water heated to the same levels that people in Europe are. Once you've done that, you can then move on to reigning in the costs of the water heating system. Your ideas seem to prioritize compromising step one in order to move onto step two. Step two should be considered as less important than step one.
Well then, why is the guy always talking about how much cheaper water heaters are in Europe?
I didn't force him to make that sales pitch.
Probably because water heaters are cheaper over there due to way less useless bullshit adding to the price. You do, of course, need to deal with that bullshit, but just slapping a price tag on it and firing people who fail to move units with that price tag is probably the least effective way possible to do about selling a competitively priced water heater.
The first thing you need to do is make sure that you have a comparable product and that all the citizens of your country are getting their water heated to the same levels that people in Europe are. Once you've done that, you can then move on to reigning in the costs of the water heating system. Your ideas seem to prioritize compromising step one in order to move onto step two. Step two should be considered as less important than step one.
What bullshit are you talking about? And if the government taking over makes it go away why doesn't it go away immediately when the government takes over? If it's known to be bullshit why would the government keep it?
How about if I give them a few years of transition period before the cap takes effect? Is 5 years enough?
Well then, why is the guy always talking about how much cheaper water heaters are in Europe?
I didn't force him to make that sales pitch.
Probably because water heaters are cheaper over there due to way less useless bullshit adding to the price. You do, of course, need to deal with that bullshit, but just slapping a price tag on it and firing people who fail to move units with that price tag is probably the least effective way possible to do about selling a competitively priced water heater.
The first thing you need to do is make sure that you have a comparable product and that all the citizens of your country are getting their water heated to the same levels that people in Europe are. Once you've done that, you can then move on to reigning in the costs of the water heating system. Your ideas seem to prioritize compromising step one in order to move onto step two. Step two should be considered as less important than step one.
What bullshit are you talking about? And if the government taking over makes it go away why doesn't it go away immediately when the government takes over? If it's known to be bullshit why would the government keep it?
How about if I give them a few years of transition period before the cap takes effect? Is 5 years enough?
Who fucking cares? If you hit the cap, exceed the cap. It's not a priority.
What bullshit are you talking about? And if the government taking over makes it go away why doesn't it go away immediately when the government takes over? If it's known to be bullshit why would the government keep it?
How about if I give them a few years of transition period before the cap takes effect? Is 5 years enough?
Who fucking cares? If you hit the cap, exceed the cap. It's not a priority.
I think you make the mistake of assuming everyone has the same priorities.
But clearly if its not a priority to cut spending we can be pretty sure it won't be cut, so don't try to tell people it will cut spending. They don't believe you.
What bullshit are you talking about? And if the government taking over makes it go away why doesn't it go away immediately when the government takes over? If it's known to be bullshit why would the government keep it?
How about if I give them a few years of transition period before the cap takes effect? Is 5 years enough?
Who fucking cares? If you hit the cap, exceed the cap. It's not a priority.
I think you make the mistake of assuming everyone has the same priorities.
But clearly if its not a priority to cut spending we can be pretty sure it won't be cut, so don't try to tell people it will cut spending. They don't believe you.
You and I are clearly having two separate and unrelated conversations.
southernhybrid
Contributor
Not because I oppose it in principle, but because I find it very difficult to believe that the US would be able to provide decent care to all Americans if we adopted Medicare for All, I oppose it for practical reasons. No candidate so far seems to even understand the complexity involved in going from where we are now to a single payer system. Nobody has discussed how to deal with all of the fraud and abuse that exists in the current Medicare system. Nobody has discussed how hospitals will survive if they go from receiving the much higher payments that private insurance companies give them, to the much lower Medicare payments. Nobody has discussed where all of the money will come from to support such a system. It's insane to think the wealthy Americans have enough money to pay for it, even if they were taxed at 100 percent. Nobody has said how much more taxes the middle class would have pay to support such a system, or what percengage of doctors would simply become concierge providers. If you're not familiar that means doctors that only take cash for their services and sometimes charge a monthly fee for access. And, nobody had even mentioned that many other countries are having problems supporting their own UHC systems. Plus, nobody has discussed how to mange the insane cost of aggressive end of life care that many people expect and many doctors prescribe. That's just for starters. It's far more complicated than most people think. I did audits for Medicare patients, helped with billing and Medicare reviews etc. when I worked as a QA/UR nurse. It's very easy to abuse Medicare quide lines, by over or under utilizing based on how much profit would be made. I'm against health care for profit, but how the fuck do we get it out, when almost everything from hospice to hospitals, from drugs to long term care are based on profit. And, btw, in case you don't know, Medicare doesn't pay for long term care. There must be a better way to help more people get adequate care without causing chaos.
The following is from an institution in Canada that describes itself as non partisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.
Perhaps, as patients we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.
https://www.fraserinstitute.org/article/canadas-health-care-crisis-is-an-economics-problem-not-a-management-problem
Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist. I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
The following is from an institution in Canada that describes itself as non partisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.
Perhaps, as patients we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.
https://www.fraserinstitute.org/article/canadas-health-care-crisis-is-an-economics-problem-not-a-management-problem
Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care. The president of the Canadian Medical Association recently called on the federal government to become more involved in the management of provincial health systems in order to solve the serious problems plaguing Medicare. Unfortunately, the CMA president seriously misdiagnosed the cause of the health systems ills.
The Canadian health system has been run as a government monopoly since 1970. It doesnt really matter which level of government tries to manage the system, our experience shows that political planning doesnt work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.
The current health system does not have a management problem; it has an economics problem. The looming crisis in our system has three identifiable causes: the governments monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.
Politically managed, 100 per cent redistributive financing produces a pay more, get less result: unsustainable cost growth and rationed access.
According to a recent Fraser Institute study using provincial government data, total government spending on health grew at an average annual rate of 7.5 per cent across all provinces over the period from fiscal years 2000-2001 to 2009-2010. During the same period, total available provincial revenue from all sources, including federal transfers, grew at an average annual rate of only 5.7 per cent. At the same time the economy, measured by gross domestic product (GDP) grew by only 5.2 per cent.
Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist. I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
And what if it reaches the cap? The next people to go to the hospital are to be left to die?
Then you could vote the people running the healthcare system out for gross mismanagement.
Just because it costs a lot doesn't make it gross mismanagement. As I wrote above, what matters is how efficient it is. The health care system your country needs very well may cost a lot.
And what if it reaches the cap? The next people to go to the hospital are to be left to die?
Then you could vote the people running the healthcare system out for gross mismanagement.
Just because it costs a lot doesn't make it gross mismanagement. As I wrote above, what matters is how efficient it is. The health care system your country needs very well may cost a lot.
So then all these people who say that if we adopt European style healthcare we can lower spending to European levels are charlatans?
Well then, why is the guy always talking about how much cheaper water heaters are in Europe?
Because he's constantly being told we can't heat water because it will cost too much. He's answered an economic concern with an economic prediction/claim. that doesn't make this economic prediction/claim drawn out of him his primary reason for wanting water heated. He has other more important reasons. He's only talking about the savings because costs have been declared prohibitively expensive.
Just because it costs a lot doesn't make it gross mismanagement. As I wrote above, what matters is how efficient it is. The health care system your country needs very well may cost a lot.
So then all these people who say that if we adopt European style healthcare we can lower spending to European levels are charlatans?
They are probably right. But why would they hold themselves hostage to this prediction when it is not their only or even primary argument for single payer?
Just because it costs a lot doesn't make it gross mismanagement. As I wrote above, what matters is how efficient it is. The health care system your country needs very well may cost a lot.
So then all these people who say that if we adopt European style healthcare we can lower spending to European levels are charlatans?
They are probably right. But why would they hold themselves hostage to this prediction when it is not their only or even primary argument for single payer?
When in US history has anyone ever been accountable for over spending versus their projected cost of a social program?
The following is from an institution in Canada that describes itself as non partisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.
Ya, viewing the Fraser Institute as non-partisan is like accepting the politically neutral Koch Brother's non-biased assessment about whether or not it's OK for rich people to bribe politicians (spoiler alert - they came to the objective determination that it was fine). They're a bunch of right wing hacks who are paid to come to the correct conclusions, not to make objective assessments.
It's true that health care is expensive and there are a lot of tough decisions which need to be made regarding costs, particularly when it comes to costly (and often futile) things such as end of life care. Adding a free market profit motive into the equation, though, will never be part of an effective solution. You need to deliver the care needed and then worry about the cost of that care and you need to do it in that order without the second compromising the first.
SimpleDon
Veteran Member
I know some costs of the present system that these calculations don't take into account. These are costs borne by all of the health care providers dealing with all of the different insurance companies and with all of the different coverages from the different policies that the insurance companies write. When I was dealing with the health insurance for my company I purchased a study from the management consultant McKinsey & Company out of New York. I think that this was in the middle of the 1990s and at that time McKinsey estimated this cost was 400 billion dollars a year in the US. It has to be much more today, twenty-five years later.
These costs would largely disappear under Medicare for All. Medicare's "deal" with the health care providers has always been we will pay you a little less than the others but in exchange, we will pay you promptly when you bill us and we will not question your professional judgment as so many of the other insurers do.
This has nothing to do with the "doc fix" which is the method by which Congress shakes down the health care providers every year for campaign contributions. This is the biggest problem with MFA, keeping politics out of the rate-setting mechanism.
These costs would largely disappear under Medicare for All. Medicare's "deal" with the health care providers has always been we will pay you a little less than the others but in exchange, we will pay you promptly when you bill us and we will not question your professional judgment as so many of the other insurers do.
This has nothing to do with the "doc fix" which is the method by which Congress shakes down the health care providers every year for campaign contributions. This is the biggest problem with MFA, keeping politics out of the rate-setting mechanism.
And what if it reaches the cap? The next people to go to the hospital are to be left to die?
Nah, the less urgent cases wait. And wait. And wait. Same as UHC everywhere.
Or when the first approach fails they don't try plan B.