U.S. Health Care Ranked Worst in the Developed World (1 Viewer)

[roadkill1292]

Some yes, but I am genuinely trying to explain what's going on in the market.  It's a complicated situation for sure. 

"Acting in the best interests of the country at large" would potentially be a personal opinion, though, right?  Some people could genuinely believe that a Medicare for all system would be best, and others could genuinely believe that some other type of system would be best.

I appreciate this post.

 

[Tau837]

The UK has a fairly substantial population of ethnic minorities, including blacks. Their healthcare is better (and cheaper) too.

UK population by race, per 2011 Census:

• 87.1% White
  
• 6.9% Asian
  
• 3.0% Black
  
• 2.0% Mixed/multiple
  
• 0.9% Other
  

US population by race, per 2010 Census:

• 72.4% White
  
• 12.6% Black
  
• 4.8% Asian
  
• 0.9% Native American
  
• 0.2% Pacific Islander
  
• 2.9% Two or more
  
• 6.2% Other
  
• Also, the US population is 16.3% Hispanic/Latino (across races). I feel confident that is significantly different than in all of the countries compared to the US in the article you cited.
  

The US census is estimated to have undercounted its black populations by 2.1%, its Hispanic/Latino population by 1.5%, its Pacific Islander population by 1.3%, and its population of Native Americans living on reservations by 4.9%. Not sure how comparable this is to the UK census.

Furthermore, I expect the next US Census will show a continuation of the trend in diversification of the US population, i.e., a lower percentage of white and increased percentage of minorities.

Bottom line, I stand by my point about very significant differences in population diversity between the US and all of the countries compared to the US in the article you cited.

Disparity and access to care are absolutely linked to healthcare quality.

I agree and have not posted or implied otherwise.

What makes you think our care is top notch

As I posted earlier in the thread, I think the quality of our healthcare is in the top tier of all countries. My opinion on this is based on two things:

1. The preponderance of information available on the subject. Objective articles and facts.
   
2. Personal experience dealing with my wife's healthcare. She has been disabled since 1998 due to very complex health issues and has had several significant surgeries. She has received healthcare in 5 states during that period from many organizations, including Duke and Johns Hopkins.
   

are you content with maintaining the status quo regarding its implementation/paymement?

I think we should continually seek to improve our healthcare system. However, I am in favor of smaller, incremental change focused on specific problems rather than big, sweeping change such as Obamacare and Medicare for All.

The major healthcare programs that have been managed by the US Government include Medicare, Medicaid, VA, IHS, Obamacare. Based on that generally unimpressive history, if my choice is status quo vs. Government managed healthcare, I choose status quo.

 

[matttyl]

The single biggest thing we need to do is get a handle on costs.  The ACA mandated that carriers spend 80+% of premiums collected on claims in the individual market, and 85+% in the group market.  This wasn’t a huge change because carriers by and large were already spending that or more, on average, in claims.  We should be concentrated in the ~85 cents of every premium dollar being spent on care rather than the ~15 cents being spent on carrier overhead, taxes, outreach, profit, operation costs, and so on.

in one of these healthcare threads I’ve given personal examples from my own family members.  Last year my son likely had a few hundred thousand in claims for a condition that while EXTREMELY rare, shouldn’t have cost nearly what it did to fix.  Why was each MRI (and MRA, and MRV) each like $3k?  Let’s solve that issue, rather than bickering about who should pay for it.  I’d much rather pay (some portion of) $1k for a procedure for someone that might not take great care of themselves than $5k for that same procedure.  

 

[Terminalxylem]

Google it

Im not interested in that debate 

Nice edit. Isn't the quality of US healthcare the topic of this thread ?!?!?

You can't just dogmatically assert our healthcare is great, especially when all evidence points to the contrary.

 

[msommer]

Yeah....even WE don't understand.  I'm trying to figure out why we keep buying all these F35 fighter jets when it's pretty clear the next world war is likely to be of the cyber/technology variety.

Hell, Denmark is apparently buying F35s also  But likely a lot fewer.....

 

[The Commish]

Hell, Denmark is apparently buying F35s also  But likely a lot fewer.....

Don't get me wrong, I see the point in having them to some extent.  Close to 2000?  no.

 

[msommer]

Don't get me wrong, I see the point in having them to some extent.  Close to 2000?  no.

If you bought fewer they would each be more expensive #trumplogic

 

[yak651]

The single biggest thing we need to do is get a handle on costs.  The ACA mandated that carriers spend 80+% of premiums collected on claims in the individual market, and 85+% in the group market.  This wasn’t a huge change because carriers by and large were already spending that or more, on average, in claims.  We should be concentrated in the ~85 cents of every premium dollar being spent on care rather than the ~15 cents being spent on carrier overhead, taxes, outreach, profit, operation costs, and so on.

in one of these healthcare threads I’ve given personal examples from my own family members.  Last year my son likely had a few hundred thousand in claims for a condition that while EXTREMELY rare, shouldn’t have cost nearly what it did to fix.  Why was each MRI (and MRA, and MRV) each like $3k?  Let’s solve that issue, rather than bickering about who should pay for it.  I’d much rather pay (some portion of) $1k for a procedure for someone that might not take great care of themselves than $5k for that same procedure.  

I would get on board with this for a start.

Also, why can't prices of MRI, x-ray, setting a broken bone, etc but at set rates.  Why if my insurance pays for something that cost $5k they are charged $3k, but if I want to pay out of pocket it's $2k more?

 

[matttyl]

I would get on board with this for a start.

Also, why can't prices of MRI, x-ray, setting a broken bone, etc but at set rates.  Why if my insurance pays for something that cost $5k they are charged $3k, but if I want to pay out of pocket it's $2k more?

They are set (between the provider and the insurance carrier).  You'll just never, ever, ever see those rates.

Rephrase that last question, it makes no sense.  If insurance is only charged $3k for a $5k procedure (and they paid $3k)....why do you want to come out of pocket for another additional $2k?  Wasn't the purpose of the insurance to limit your exposure and give you in network rates/discounts?

 

[SoBeDad]

The single biggest thing we need to do is get a handle on costs.  The ACA mandated that carriers spend 80+% of premiums collected on claims in the individual market, and 85+% in the group market.  This wasn’t a huge change because carriers by and large were already spending that or more, on average, in claims.  We should be concentrated in the ~85 cents of every premium dollar being spent on care rather than the ~15 cents being spent on carrier overhead, taxes, outreach, profit, operation costs, and so on.

in one of these healthcare threads I’ve given personal examples from my own family members.  Last year my son likely had a few hundred thousand in claims for a condition that while EXTREMELY rare, shouldn’t have cost nearly what it did to fix.  Why was each MRI (and MRA, and MRV) each like $3k?  Let’s solve that issue, rather than bickering about who should pay for it.  I’d much rather pay (some portion of) $1k for a procedure for someone that might not take great care of themselves than $5k for that same procedure.  

In dementia research, a 45 minute MRI including the radiology read, can be done for $400 or less where i work in Miami. It's an effort to support research and a concession for a large number of clinic referrals paid by insurance. I'm not sure what the real cost is, but there is great variability in imaging costs: https://www.precisemri.com/2017/07/12/hospitals-determine-price-mri-clinics-can-charge-less/

Radiologists get paid alot.

 

[Terminalxylem]

As I posted earlier in the thread, I think the quality of our healthcare is in the top tier of all countries. My opinion on this is based on two things:

1. The preponderance of information available on the subject. Objective articles and facts.
   
2. Personal experience dealing with my wife's healthcare. She has been disabled since 1998 due to very complex health issues and has had several significant surgeries. She has received healthcare in 5 states during that period from many organizations, including Duke and Johns Hopkins.
   

I think we should continually seek to improve our healthcare system. However, I am in favor of smaller, incremental change focused on specific problems rather than big, sweeping change such as Obamacare and Medicare for All.

The major healthcare programs that have been managed by the US Government include Medicare, Medicaid, VA, IHS, Obamacare. Based on that generally unimpressive history, if my choice is status quo vs. Government managed healthcare, I choose status quo.

The preponderance of data suggest US healthcare lags behind other top systems, particularly when access and affordability are considered. This is based on the conclusions of every Commonwealth report and data I've posted in this thread. While I'm glad your wife has received excellent care, Duke and Johns Hopkins are not typical US hospitals.

Agree that our government's provision of healthcare leaves a lot to be desired, but our current system is not financially sustainable. Instead of making excuses why America is different, we should learn from the rest of the world how centralized, single payor care can be effective.

 

[matttyl]

In dementia research, a 45 minute MRI including the radiology read, can be done for $400 or less where i work in Miami. It's an effort to support research and a concession for a large number of clinic referrals paid by insurance. I'm not sure what the real cost is, but there is great variability in imaging costs: https://www.precisemri.com/2017/07/12/hospitals-determine-price-mri-clinics-can-charge-less/

Radiologists get paid alot.

Totally get that.  It was $3k at a children’s hospital (which included a pediatric anesthesiologist )....after insurance discount.  And they were changing them out all day and night there.  I just wish there was more transparency in these costs, but insurance doesn’t really want you to know them, either.

 

[Terminalxylem]

I would get on board with this for a start.

Also, why can't prices of MRI, x-ray, setting a broken bone, etc but at set rates.  Why if my insurance pays for something that cost $5k they are charged $3k, but if I want to pay out of pocket it's $2k more?

That's the free market at work, except prices are set arbitrarily high as the providers know they'll be reimbursed ~half what they ask. And the uninsured individual? If he can't pay out of pocket, he can deal with debt collectors.

 

[yak651]

They are set (between the provider and the insurance carrier).  You'll just never, ever, ever see those rates.

Rephrase that last question, it makes no sense.  If insurance is only charged $3k for a $5k procedure (and they paid $3k)....why do you want to come out of pocket for another additional $2k?  Wasn't the purpose of the insurance to limit your exposure and give you in network rates/discounts?

No I'm saying if I didn't have insurance why would I have to pay $5k for the same procedure/work that the insurance company only pays $3k for.

 

[Tau837]

The preponderance of data suggest US healthcare lags behind other top systems

This is only true absent context. For example, absent consideration of poverty rates, population diversity, and cultural differences in compared countries. (I notice you gave up on the idea that the UK population is similar to the US population.)

While I'm glad your wife has received excellent care, Duke and Johns Hopkins are not typical US hospitals.

Agreed. However, she has received care from dozens of providers in several states. Most were not Duke or Johns Hopkins. Naturally, she has experienced a range of quality of care. That said, I am confident that the quality of her care overall has been superior to that she would have received in other countries. My wife's health situation is an extreme outlier, which is not a situation I expect to be dealt with effectively in a Government controlled/rationed healthcare system.

our current system is not financially sustainable

Responses to this:

1. Why not? I have already posted in the thread that US public sector spending is comparable, and it is private sector spending that is significantly higher in the US... but US households have the highest gross adjusted household disposable income among OECD countries.
   
2. What system are you advocating that will be less expensive? Can you show justification that it will be less expensive? Is it less expensive because less overall healthcare is provided (e.g., through rationing)?
   

 

[Terminalxylem]

This is only true absent context. For example, absent consideration of poverty rates, population diversity, and cultural differences in compared countries. (I notice you gave up on the idea that the UK population is similar to the US population.)

Agreed. However, she has received care from dozens of providers in several states. Most were not Duke or Johns Hopkins. Naturally, she has experienced a range of quality of care. That said, I am confident that the quality of her care overall has been superior to that she would have received in other countries. My wife's health situation is an extreme outlier, which is not a situation I expect to be dealt with effectively in a Government controlled/rationed healthcare system.

Responses to this:

1. Why not? I have already posted in the thread that US public sector spending is comparable, and it is private sector spending that is significantly higher in the US... but US households have the highest gross adjusted household disposable income among OECD countries.
   
2. What system are you advocating that will be less expensive? Can you show justification that it will be less expensive? Is it less expensive because less overall healthcare is provided (e.g., through rationing)?
   

I noticed you failed to comment on healthcare in countries with similar obesity rates as the US, and ignored data which showed the US has worse outcomes in many subspecialty areas compared to other developed countries, with the exception of cancer care...

While context is important, overall quality metrics don’t support superiority of US healthcare. Unfortunately a sizable chunk of our population can not afford/access care in places like Duke or Hopkins. Using your wife’s experience as an “extreme outlier” doesn’t apply to most patients. But you have no idea what quality of care she would have received elsewhere. 

Our healthcare is too expensive, both for individuals and institutions. It is immoral to provide differential care based on one’s ability to pay. We should get on board with centralized, single payer healthcare, like just about everywhere else in the world. It can be cheaper, as evidenced by the %GDP spent on healthcare in every other OECD country.

I know rationing is a buzzword that is invariably used when single-payer, government sponsored care is mentioned, but unless it results in poor outcomes, perhaps it isn’t a problem? On the contrary, maybe we are too quick to order tests, procedures and medications? Not only does that impact medical expenditures, but it can result in more unnecessary testing, side effects and complications. Surely you’re aware that medical errors are a leading cause of death for hospitalized patients? Sometimes, less is more, and waiting may be superior to doing something just because we can.

 

[TripItUp]

This is only true absent context. For example, absent consideration of poverty rates, population diversity, and cultural differences in compared countries. (I notice you gave up on the idea that the UK population is similar to the US population.)

It is shocking how this relatively simple concept is lost on this forum.

Hint:  Quit trying to compare other countries’ healthcare to the US, no other country has our profile

 

[TripItUp]

Nice edit. Isn't the quality of US healthcare the topic of this thread ?!?!?

You can't just dogmatically assert our healthcare is great, especially when all evidence points to the contrary.

The quality of care to those that have it is among the best in the world.  This is undisputed.  Liberal media and liberals in general will argue that care isn’t provided to enough people but that is a separate, but related issue.  Of course, liberals love to combine the issues into a single argument.

 I’m not saying the system can be improved and cost can’t be reduced, I provided several ideas on the first page that would address costs which I believe is the major issue.  Of course the ACA did nothing to address costs, a major failure for Democrats.

 

[yak651]

The quality of care to those that have it is among the best in the world.  This is undisputed.  Liberal media and liberals in general will argue that care isn’t provided to enough people but that is a separate, but related issue.  Of course, liberals love to combine the issues into a single argument.

 I’m not saying the system can be improved and cost can’t be reduced, I provided several ideas on the first page that would address costs which I believe is the major issue.  Of course the ACA did nothing to address costs, a major failure for Democrats.

Well I know this will be addressed soon, it's only been 3 years but Trump said some of the best healthcare is coming to us soon.  Not sure if that's next week, next month, next year, but soon he has a plan that will address all these issues.

 

[The Commish]

Of course the ACA did nothing to address costs, a major failure for Democrats.

Finally something we agree on

This fact makes it all the more amazing the GOP can't get out of their own way to do something better while in control of everything.

 

[Godsbrother]

Well I know this will be addressed soon, it's only been 3 years but Trump said some of the best healthcare is coming to us soon.  Not sure if that's next week, next month, next year, but soon he has a plan that will address all these issues.

It is going to be terrific  

 

[Tau837]

I noticed you failed to comment on healthcare in countries with similar obesity rates as the US, and ignored data which showed the US has worse outcomes in many subspecialty areas compared to other developed countries, with the exception of cancer care...

I did not ignore it. I specifically commented that I think there are many factors that contribute to it, including cultural differences and differences in makeup of populations. It is an apples to oranges comparison wtihout accounting for important contextual factors. Not at all unlike how applying context changes the comparisons of life expectancy and infant mortality.

Using your wife’s experience as an “extreme outlier” doesn’t apply to most patients.

Of course not. By definition, an extreme outlier is not representative of most.

But you have no idea what quality of care she would have received elsewhere.

False. I have a very good idea that many medications and treatments she has received would have been denied under Government managed/rationed healthcare. I recommend that you stop going down this tangent talking about my wife's situation, since you know nothing about it.

We should get on board with centralized, single payer healthcare, like just about everywhere else in the world

"Just about everywhere in the world" does not have centralized, single payer healthcare. There are very few countries that actually have it. There are many systems inaccurately said to have it, when they actually use different and/or hybrid models.

I know rationing is a buzzword that is invariably used when single-payer, government sponsored care is mentioned, but unless it results in poor outcomes, perhaps it isn’t a problem?

Rationing in single payer, Government-sponsored health care is an unavoidable fact. By definition, rationing may eliminate some redundant or wasteful services, but equally by definition it will result in poorer outcomes for some patients. This is not debatable, because Government-sponsored healthcare is tied to a budget.

Surely you’re aware that medical errors are a leading cause of death for hospitalized patients?

Yes, I am. I fail to see any connection to this discussion.

Sometimes, less is more, and waiting may be superior to doing something just because we can.

Less is more when you or your loved one is not among the patients who get less when more would have been helpful to health and quality of life. That's the rub, though... almost all of us eventually reach a point in life where we or our loved ones are in that patient population.

 

[the moops]

Hint:  Quit trying to compare other countries’ healthcare to the US, no other country has our profile

Researchers take these differences into account. Just as they do when comparing our economy or our education or whateve to other countries

 

[Tau837]

Researchers take these differences into account. Just as they do when comparing our economy or our education or whateve to other countries

This is not true, at least not as a sweeping generalization. It is easy to see by looking at the comparisons of life expectancy and infant mortality, since those comparisons showing the US fares poorly can easily be refuted by applying context that is lacking, as linked earlier in the thread.

 

[Terminalxylem]

I did not ignore it. I specifically commented that I think there are many factors that contribute to it, including cultural differences and differences in makeup of populations. It is an apples to oranges comparison wtihout accounting for important contextual factors.

Of course not. By definition, an extreme outlier is not representative of most.

False. I have a very good idea that many medications and treatments she has received would have been denied under Government managed/rationed healthcare. I recommend that you stop going down this tangent talking about my wife's situation, since you know nothing about it.

"Just about everywhere in the world" does not have centralized, single payer healthcare. There are very few countries that actually have it. There are many systems inaccurately said to have it, when they actually use different and/or hybrid models.

Rationing in single payer, Government-sponsored health care is an unavoidable fact. By definition, rationing may eliminate some redundant or wasteful services, but equally by definition it will result in poorer outcomes for some patients. This is not debatable, because Government-sponsored healthcare is tied to a budget.

Yes, I am. I fail to see any connection to this discussion.

Less is more when you or your loved one is not among the patients who get less when more would have been helpful to health and quality of life. That's the rub, though... almost all of us eventually reach a point in life where we or our loved ones are in that patient population.

Well, since no country on earth is identical to the US, this topic isn't worth discussing, is it?

And unless your wife received care in another system, you really don't know how she would have done. I don't need to know specifics to recognize what is obvious.

While you're right most models are hybrids to an extent, pretty much all of the countries in the Commonwealth report have much greater government/less private involvement and near universal healthcare coverage - two things the US should try and emulate.

Rationing is a part of any healthcare plan, as resources are finite. The question is, does rationing lead to worse outcomes on a population level? 

When doctors are incentivized to run tests and perform procedures, sometimes unnecessary stuff is done which may actually cause harm. It's one reason the US has more resistant bacteria and clostridioides difficile than areas which severely restrict antibiotic use, for example. We also have higher radiation exposure from all the frivolous x-rays, CTs and stress tests physicians order.

Rationed care isn't necessarily substandard. The lay public's perception of medical necessity and rapidity of intervention is often off-base - things like MRIs for most back pain, knee arthroscopy, serial stress testing, antibiotics for sinusitis, etc. do nothing to improve health outcomes, but add a lot to our medical expenditures. Read the Choosing Wisely guidelines and go to any ER in this country and watch on-demand, shotgun medical care which violates most professional society recommendations. Sometimes it's best to pump the brakes. 

 

[zoonation]

I don’t need to know a “country’s profile” to know that no one should have to consider bankruptcy as possible sequelae of their medical condition.  

 

[Tau837]

Well, since no country on earth is identical to the US, this topic isn't worth discussing, is it?

It is worth discussing with proper context applied. If you can't see that, I will agree to disagree and end my part of this discussion here.  

And unless your wife received care in another system, you really don't know how she would have done. I don't need to know specifics to recognize what is obvious.

Again, I know more than you about this subject. What you think is obvious is not obvious, and you are wrong. This is not important to the discussion, so I suggest again that you drop it. I only brought it up because you asked about the basis of my opinions.

While you're right most models are hybrids to an extent, pretty much all of the countries in the Commonwealth report have much greater government/less private involvement and near universal healthcare coverage - two things the US should try and emulate.

The bolded is an opinion. Not everyone agrees with it. I don't. At least not until and unless someone presents a detailed plan that addresses all of the important details in a satisfactory manner. Stuff like:

• How would it be implemented and managed? How can we be confident that the Govt can successfully implement and manage a program on that scale?
  
• What would happen to the current healthcare systems (VA, Medicaid, private/employer  insurance, etc.), and over what period of time?
  
• What would be the effect on the current healthcare providers/industry, their roles in associated research and innovation, and the employment of their personnel?
  
• How would the massive cost be covered? Would it simply be additive and impact deficit, would other things be cut (and what, exactly?), would it require new/increased taxes (and how much?), or some combination?
  
• What improvement in healthcare outcomes would be projected? Not just talking more people covered, what are the improved outcomes in terms of better overall health indicators?
  
• What limitations (e.g., wait times, rationing, limitation on providers, etc.), if any, would be imposed?
  

It isn't enough to simply point to other countries that do it, when they have different culture, social structure, taxation, etc. We have to understand in depth if/how it will work here. I have never seen any such plan presented.

Rationing is a part of any healthcare plan, as resources are finite. The question is, does rationing lead to worse outcomes on a population level?

The primary benefit of rationing is to reduce cost, not to improve healthcare outcomes.

Rationing will absolutely lead to worse healthcare outcomes for some. IMO the net result is that it will lead to worse overall population healthcare outcomes (con) but will save money (pro). A person's opinion on whether the tradeoff is appropriate will be largely influenced on whether he and/or his loved ones are in the patient population getting worse healthcare outcomes. And a person may think it is a worthy tradeoff today and realize it isn't at some point in the future when his situation changes.

 

[TripItUp]

Finally something we agree on

This fact makes it all the more amazing the GOP can't get out of their own way to do something better while in control of everything.

Agreed 

 

[KarmaPolice]

I know I am for sure jealous of anybody who thinks that our health care is affordable and/or be good enough to be worth those costs.  

Our family health insurance is about 1150/month, and that is with pretty high deductibles and not great cost for meds.  That is through my wife's work (they do pay for about 40%), and my work's plans are even worse.  Even with her work pitching in, our out of pocket costs are reaching $1K or more depending on how many mental health visits she needs.  That's standard per month.   Recently I got some food stuck in my esophagus and had to go to ER for a scope.  That plus follow up was $2K more.  She recently messed up her knee and had to get a scope to clean that out.  Our bill for that was several Ks.  Needles to say, we are one of those families that are getting cleaned out by health care, and are in constant fear of getting sick or injured.  We barely got done paying off the last wave of med bills before this crap hit, and this is going to suck hard.  

 

[matttyl]

No I'm saying if I didn't have insurance why would I have to pay $5k for the same procedure/work that the insurance company only pays $3k for.

Because the insurance company has the negotiating power (due to having so many individuals insured) to lower the cost the pay.  Think of it like buying in bulk - my company just purchased a few hundred laptops at a per unit price far below what I'd have been charged for one.

Also, the insurance company is good for their $3k (nearly) ever time.  Individuals are hit or miss on the $5k.  Some pay something, some pay nothing, so the providers have to charge more to those who do pay to make up for it.

 

[matttyl]

I know I am for sure jealous of anybody who thinks that our health care is affordable and/or be good enough to be worth those costs.  

Our family health insurance is about 1150/month, and that is with pretty high deductibles and not great cost for meds.  That is through my wife's work (they do pay for about 40%), and my work's plans are even worse.  Even with her work pitching in, our out of pocket costs are reaching $1K or more depending on how many mental health visits she needs.  That's standard per month.   Recently I got some food stuck in my esophagus and had to go to ER for a scope.  That plus follow up was $2K more.  She recently messed up her knee and had to get a scope to clean that out.  Our bill for that was several Ks.  Needles to say, we are one of those families that are getting cleaned out by health care, and are in constant fear of getting sick or injured.  We barely got done paying off the last wave of med bills before this crap hit, and this is going to suck hard.  

At some point, though, your're going to hit your max OOP.  All plans have those.  The ACA mandated that they be no higher than about $8k for an individual, or $16k for a family plan (no matter how large of a family) - inclusive of your deductible.  Last year my son hit his max OOP the very first overnight stay in a hospital...the first night alone.  After that, I really didn't care what anything cost, because it was all being paid by insurance. 

 

[KarmaPolice]

At some point, though, your're going to hit your max OOP.  All plans have those.  The ACA mandated that they be no higher than about $8k for an individual, or $16k for a family plan (no matter how large of a family) - inclusive of your deductible.  Last year my son hit his max OOP the very first overnight stay in a hospital...the first night alone.  After that, I really didn't care what anything cost, because it was all being paid by insurance. 

Sure.  I think we are in the bottom 10% of FBGs for income though, so it's a huge bite in the ### for us (and I get that we are lucky in the overall scheme of things for the country) to shell out 12k a year + get hit with a huge bill like that.  

 

[jonessed]

I go into every year knowing I will hit my max.  $6K in today’s word of healthcare expenses is nothing.

 

[yak651]

I know I am for sure jealous of anybody who thinks that our health care is affordable and/or be good enough to be worth those costs.  

Our family health insurance is about 1150/month, and that is with pretty high deductibles and not great cost for meds.  That is through my wife's work (they do pay for about 40%), and my work's plans are even worse.  Even with her work pitching in, our out of pocket costs are reaching $1K or more depending on how many mental health visits she needs.  That's standard per month.   Recently I got some food stuck in my esophagus and had to go to ER for a scope.  That plus follow up was $2K more.  She recently messed up her knee and had to get a scope to clean that out.  Our bill for that was several Ks.  Needles to say, we are one of those families that are getting cleaned out by health care, and are in constant fear of getting sick or injured.  We barely got done paying off the last wave of med bills before this crap hit, and this is going to suck hard.  

This right here.  It's all those little hits that keep adding up.  My wife and I have "good" insurance, she is a teacher so everyone claims they get the "best" plans that the taxpayers all have to pay for.  We are in good health, but she's had some nagging shoulder pain.  Between Dr visits and a minor surgery we are out $6k this year, not including premiums for healthcare.  We both have decent jobs so we can afford it, but many can't.  I went to the open enrollment meetings for my works insurance.  They raised the deductible to $8k.  There are people that I work with that are unskilled, one of them takes a medication that will require them to be out of pocket (not including the monthly premiums) $8k.  I'm guessing this person makes around $25-30k/year.  Once taxes are taken out, take this $8k out, take out housing, car, car insurance, food, you think these people are able to save anything for retirement?  I know, get a better job, lots of good jobs out there....not everyone has the skill set to get those jobs.  Guess poor luck on their part for not winning the gene lottery.

 

[yak651]

I go into every year knowing I will hit my max.  $6K in today’s word of healthcare expenses is nothing.

I remember when people were mad that co-pays went to $20!  Wouldn't it be great to have those days back.

 

[matttyl]

Sure.  I think we are in the bottom 10% of FBGs for income though, so it's a huge bite in the ### for us (and I get that we are lucky in the overall scheme of things for the country) to shell out 12k a year + get hit with a huge bill like that.  

I totally get that.  I really do.  But how many people need to do just that to offset @Just Win Baby claims?  Or the claims that my 3 year old had last year, completely out of the blue, which I'm sure were well into the multiple hundreds of thousands of dollars when all said and done.  It's just math - which is why I said above that the real answer is lowering the actual cost of care.  If my son's claims were in the hundreds of thousands last year, but rather only a hundred thousand - maybe the insurance company could get away with only charging your family $6k a year rather than $12k (net of employer subsidy). 

 

[Terminalxylem]

It is worth discussing with proper context applied. If you can't see that, I will agree to disagree and end my part of this discussion here.  

Again, I know more than you about this subject. What you think is obvious is not obvious, and you are wrong. This is not important to the discussion, so I suggest again that you drop it. I only brought it up because you asked about the basis of my opinions.

The bolded is an opinion. Not everyone agrees with it. I don't. At least not until and unless someone presents a detailed plan that addresses all of the important details in a satisfactory manner. Stuff like:

• How would it be implemented and managed? How can we be confident that the Govt can successfully implement and manage a program on that scale?
  
• What would happen to the current healthcare systems (VA, Medicaid, private/employer  insurance, etc.), and over what period of time?
  
• What would be the effect on the current healthcare providers/industry, their roles in associated research and innovation, and the employment of their personnel?
  
• How would the massive cost be covered? Would it simply be additive and impact deficit, would other things be cut (and what, exactly?), would it require new/increased taxes (and how much?), or some combination?
  
• What improvement in healthcare outcomes would be projected? Not just talking more people covered, what are the improved outcomes in terms of better overall health indicators?
  
• What limitations (e.g., wait times, rationing, limitation on providers, etc.), if any, would be imposed?
  

It isn't enough to simply point to other countries that do it, when they have different culture, social structure, taxation, etc. We have to understand in depth if/how it will work here. I have never seen any such plan presented.

The primary benefit of rationing is to reduce cost, not to improve healthcare outcomes.

Rationing will absolutely lead to worse healthcare outcomes for some. IMO the net result is that it will lead to worse overall population healthcare outcomes (con) but will save money (pro). A person's opinion on whether the tradeoff is appropriate will be largely influenced on whether he and/or his loved ones are in the patient population getting worse healthcare outcomes. And a person may think it is a worthy tradeoff today and realize it isn't at some point in the future when his situation changes.

We can agree to disagree about dismissing nearly every shortcoming of the US health system to demographics, etc. At some point, the system itself needs to be called into question.

I don't want to get in a pissing match about your wife's care. I'm glad you're pleased with it.

Agree that we need a lot of specifics regarding healthcare overhaul. What we don't need is the status quo. Fundamentally, I don't believe free market economics apply very well to the provision of care, and would prefer we investigate centralized, single(few?) payer healthcare. While there are many barriers to overcome, I think we can reasonably believe it can work in the US, in large part because of the success of systems abroad.

Rationing is  a loaded term. As I've already described, limited resources are always rationed in one way or another; healthcare is no different. I'm referring more to limiting frivolous care, which our system encourages to an extent.

So here are a few suggestions for healthcare reform, borrowed from an old post:

1. Everyone needs to pay into a centralized, government-sponsored insurance. Wealthy people can supplement their care out-of-pocket. If private, "luxury" health insurance evolves, so be it.

2. Insurance should pay for an allocated number of routine visits, important meds (sorry, Viagra and Ambien) + catastrophic care - which kicks in after a certain $ value is exceeded. The rest is out-of-pocket. 

3. Every visit needs a copay. Preventive care visits have reduced fees.

4. One set of rules should eliminate a lot of the coders/billers/admin required by a multifaceted insurance industry. A central EHR should eliminate a lot of the medical records personnel, too.

5. Tort reform to promote less defensive medicine. Should also reduce malpractice premiums, though this hasn't happened when reform has occurred. Establish a central medical panel to review validity of malpractice cases, toss the illegitimate claims early.

6. Somehow limit the "me too" drugs that pharma/device industry devotes too many resources developing, purely for financial reasons. Eliminate drug reps and advertising, too - the use of meds/devices should be based on need and affordability, in that order. (notice this flies in the face of free market economics). Might need to revisit the patent laws as well. 

7. Teach the American public that waiting for noncritical tests/procedures is not tantamount to care rationing any more than basing their availability on ability to pay.

8. Doctors take a pay cut, particularly specialists. We need more primary care and the pay disparity is not justified.

9. Paying for all this can come from income tax, rather than placing the onus on employers. We can cut our military, increase the retirement age for SS and eliminate some foreign aid to help with the bill. Plus up the sin taxes on tobacco, alcohol +/- fast food. And eliminate the Bush tax cuts.

10. Initiate meaningful end-of-life policies which mandate advance care directives and empower physicians in futile situations to stop wasting resources on lost causes.

11. Most importantly promote healthy lifestyle among our lazy, fat, overindulgent society. I don't know how to do this when even those in the healthcare field have horrible habits. 

Medicine is like no other industry. Few people want the product until they are not in position to pay for it. Most diseases are indolent and tangible health detriment isn't evident until potentially irreversible damage has been done. Very little is "quick fix", and almost everything is expensive. Why would anyone think supply/demand would apply to such a market? What incentive do insurers have to provide care for those who cannot afford it - do you let people suffer/die because they lack $ to pay for insurance?

 

[Tau837]

1. Everyone needs to pay into a centralized, government-sponsored insurance. Wealthy people can supplement their care out-of-pocket. If private, "luxury" health insurance evolves, so be it.

We already do this. It's called Medicare.

8. Doctors take a pay cut, particularly specialists. We need more primary care and the pay disparity is not justified.

We already have a doctor shortage. This will only make it worse.

9. Paying for all this can come from income tax, rather than placing the onus on employers. We can cut our military, increase the retirement age for SS and eliminate some foreign aid to help with the bill. Plus up the sin taxes on tobacco, alcohol +/- fast food. And eliminate the Bush tax cuts.

This is too vague and generalized. How much is it going to cost? How are we going to pay for it, specifically?

• If you propose to cut the military, when and by how much? If by a non-trivial amount, how to deal with the ripple effects, e.g., unemployment of people who currently work in that industry?
  
• If you propose to increase SS retirement age, when and by how much?
  
• If you propose to eliminate foreign aid, when and how much?
  
• If you propose to "up" the sin taxes, when and how much?
  
• If you propose to eliminate prior tax cuts, when and which ones?
  

We don't need platitudes, we need details. Medicare for all has been estimated as best case adding $2.5T+ per year to the Federal budget. That is a huge number.

 

[Terminalxylem]

We already do this. It's called Medicare.

We already have a doctor shortage. This will only make it worse.

This is too vague and generalized. How much is it going to cost? How are we going to pay for it, specifically?

• If you propose to cut the military, when and by how much? If by a non-trivial amount, how to deal with the ripple effects, e.g., unemployment of people who currently work in that industry?
  
• If you propose to increase SS retirement age, when and by how much?
  
• If you propose to eliminate foreign aid, when and how much?
  
• If you propose to "up" the sin taxes, when and how much?
  
• If you propose to eliminate prior tax cuts, when and which ones?
  

We don't need platitudes, we need details. Medicare for all has been estimated as best case adding $2.5T+ per year to the Federal budget. That is a huge number.

Sure, but Medicare isn't available to everybody.

The doctor shortage disproportionately affects primary care physicians. Their pay can be raised a bit and concomitantly cut the sub specialist's income by a larger amount. And the roles of PAs and NPs can be expanded. Plus they can open up more medical school and residency spots - there are still plenty of people interested in going into medicine. How do other countries manage to pay physicians so much less?

I'm not an economist. But our military budget is greater than the rest of the top 10 in the world combined. We could easily cut it 25-50% and still be the biggest bully on the block. And like the countless well-paying positions in insurance/billing/coding/medical admin, I have no problem eliminating military jobs which don't provide a meaningful/needed product or service.

Life expectancy has risen about 20 years since the creation of SS. Let’s split the difference and raise retirement age 10 years.

I have no idea how much foreign aid can be reduced, but I definitely think we should get our own house in order before helping the rest of the world.

Cigarettes provide a good model for how much taxes can be increased before behavior is deterred. I'm fine with similar amounts tacked on to alcohol, soft drinks and fast food. Gasoline too.

I'm no tax expert either, but the mortgage interest deduction is high on my list. Frankly I'd like to raze most of the tax code and replace it with a flat income + investment tax, especially for higher earners. And no, I don't care if a few accountants lose their jobs.

Sorry I can't provide a spreadsheet with more specifics, but I've tried to elaborate some of the things I think would help. Of course, the devil is in the details. 

 

[yak651]

We already do this. It's called Medicare.

We already have a doctor shortage. This will only make it worse.

This is too vague and generalized. How much is it going to cost? How are we going to pay for it, specifically?

• If you propose to cut the military, when and by how much? If by a non-trivial amount, how to deal with the ripple effects, e.g., unemployment of people who currently work in that industry?
  
• If you propose to increase SS retirement age, when and by how much?
  
• If you propose to eliminate foreign aid, when and how much?
  
• If you propose to "up" the sin taxes, when and how much?
  
• If you propose to eliminate prior tax cuts, when and which ones?
  

We don't need platitudes, we need details. Medicare for all has been estimated as best case adding $2.5T+ per year to the Federal budget. That is a huge number.

I always love the point that all these doctors are going to quit if Medicare for all is passed.  What are they going to do for a career? 

 

[roadkill1292]

I always love the point that all these doctors are going to quit if Medicare for all is passed.  What are they going to do for a career? 

Revamping our system of training health care practitioners is long overdue, especially if we are losing candidates because of affordability and/or deliberately limiting the numbers of people we elect to train in the first place. Now, the difficulty of becoming a doctor and the ensuing financial rewards are both part of the reason for the quality of our health care in general but going forward there's going to be a huge need for lower levels of health practitioners who deal with the mundane and non-serious and we need to be opening the doors for lots more of those people.

Most modern countries probably have physician shortages. I don't think that has very much to do with how much more effective a socialized system generally is.

 

[sho nuff]

My US healthcare complaint for today.

So I have been having some numbness in my pinky and ring finger...started just there, but have felt it also in my forearm and elbow for a few days.  I do the usual online research to figure out what it could be which leads me to a good guess based on those symptoms.  But I do still call my doctor as it is persisting and not going away.  Here is an issue I have...

Call and talk to triage...describe the symptoms as they are.  I simply get an appointment.  

Go and pay the $25 co pay my insurance requires for a visit outside of my annual physical which I had last month.

Describe symptoms to doctor who quickly thinks its the same as I "self-diagnosed" and then he does the physical examination which confirms what he thought.  And then says he will have a neurologist office call me to test the nerve a bit (Ulnar Nerve Entrapment is the diagnosis) and determine a course of action.  Total time with doctor - 7 minutes.

So, now I have a specialist visit.  $50 copay under our insurance.

I know some insurance companies (and ours may be going to this by the letter I received) have a sort of triage on their own.  A "virtual" doctor where I could have described all of what I just did at the doctor's office and save the first co-pay.  And this used to be much worse with the old HMO model where I was forced to have an actual referral from my PCP before seeing a specialist.  I used to be forced to see my PCP for sinus infections when I knew Id end up at an ENT.  Of course...the insurance company would probably also charge at least $25 for this virtual visit to then refer me to a specialist anyway.  I imagine some of this is what keeps some people from even bringing up some issues to a doctor's attention outside of their annual physical.

 

[Hawkeye21]

Revamping our system of training health care practitioners is long overdue, especially if we are losing candidates because of affordability and/or deliberately limiting the numbers of people we elect to train in the first place. Now, the difficulty of becoming a doctor and the ensuing financial rewards are both part of the reason for the quality of our health care in general but going forward there's going to be a huge need for lower levels of health practitioners who deal with the mundane and non-serious and we need to be opening the doors for lots more of those people.

Most modern countries probably have physician shortages. I don't think that has very much to do with how much more effective a socialized system generally is.

It would be awesome if our country put more resources into our healthcare, education and infrastructure instead of military and a wall.  Don't get me wrong, having a strong military is very important but I think it's a little exorbitant the amount of resources that go into sometimes.

 

[roadkill1292]

It would be awesome if our country put more resources into our healthcare, education and infrastructure instead of military and a wall.  Don't get me wrong, having a strong military is very important but I think it's a little exorbitant the amount of resources that go into sometimes.

I don't know if an American president of any stripe -- and certainly the majority of the American voters -- would ever be willing to give up having the world's biggest club at his or her disposal. In the near future, that is. The rising generations may have a different view about this.

 

[Hawkeye21]

I don't know if an American president of any stripe -- and certainly the majority of the American voters -- would ever be willing to give up having the world's biggest club at his or her disposal. In the near future, that is. The rising generations may have a different view about this.

I think there's a lot of room in that budget to allow lowering it while still being the largest and strongest military in the world by a pretty big margin.

 

[Godsbrother]

Life expectancy has risen about 20 years since the creation of SS. Let’s split the difference and raise retirement age 10 years.

I don't have a problem raising the retirement age but 10 years would put it age at 76, which would mean a lot of old people trying to find job that pays a livable wage.   You also could not implement this overnight -- it would have to be gradually raised over the course of 10 years.

 

[yak651]

I don't have a problem raising the retirement age but 10 years would put it age at 76, which would mean a lot of old people trying to find job that pays a livable wage.   You also could not implement this overnight -- it would have to be gradually raised over the course of 10 years.

Dang, expecting people to work until 76.  What are they going to do, be politicians?

 

[roadkill1292]

I think there's a lot of room in that budget to allow lowering it while still being the largest and strongest military in the world by a pretty big margin.

The current size allows us to project power and influence in almost all of the spheres of potential conflict now. The American people don't have the patience to hear that we don't have immediate striking power in response to whatever dustup arises, wherever. This need is almost never questioned by anyone in government nor by the public at large.

I wish that this reliance on military strength instead of less tangible methods would end but that is a view shared by few over a certain age. And that age isn't a very high one, either.

 

[Terminalxylem]

I always love the point that all these doctors are going to quit if Medicare for all is passed.  What are they going to do for a career? 

Concierge medicine, where members pay an annual fee out of pocket and let patients deal with insurance squabbles if additional testing/referrals are necessary. It’s already happening.

 

[Terminalxylem]

My US healthcare complaint for today.

So I have been having some numbness in my pinky and ring finger...started just there, but have felt it also in my forearm and elbow for a few days.  I do the usual online research to figure out what it could be which leads me to a good guess based on those symptoms.  But I do still call my doctor as it is persisting and not going away.  Here is an issue I have...

Call and talk to triage...describe the symptoms as they are.  I simply get an appointment.  

Go and pay the $25 co pay my insurance requires for a visit outside of my annual physical which I had last month.

Describe symptoms to doctor who quickly thinks its the same as I "self-diagnosed" and then he does the physical examination which confirms what he thought.  And then says he will have a neurologist office call me to test the nerve a bit (Ulnar Nerve Entrapment is the diagnosis) and determine a course of action.  Total time with doctor - 7 minutes.

So, now I have a specialist visit.  $50 copay under our insurance.

I know some insurance companies (and ours may be going to this by the letter I received) have a sort of triage on their own.  A "virtual" doctor where I could have described all of what I just did at the doctor's office and save the first co-pay.  And this used to be much worse with the old HMO model where I was forced to have an actual referral from my PCP before seeing a specialist.  I used to be forced to see my PCP for sinus infections when I knew Id end up at an ENT.  Of course...the insurance company would probably also charge at least $25 for this virtual visit to then refer me to a specialist anyway.  I imagine some of this is what keeps some people from even bringing up some issues to a doctor's attention outside of their annual physical.

You’re gonna be really frustrated after the neurologist confirms the diagnosis, possibly with an expensive test, then just recommends avoidance of certain positions and/or a splint. Unless it’s been going on for months and the symptoms are severe, you could’ve figured all this out and done it yourself.