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Universal Health Care - Let's make this happen (1 Viewer)

Sabertooth said:
Why are people so adamant about keeping insurance companies in the mix? 
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Practicality and to allow for competition in my case.

I don't think it's realistic that such a large part of our economy can be eliminated. Even if it's phased out I think it would need to happen over a decade or more.

Also I think it's generally a good thing for consumers/citizens to have options. 

 
msudaisy26 said:
Make marijuana legal tax it like hotel rooms and use the taxes to fund single payer.  It might not fund it all, but it would fund a major part of it, right?
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No, it wouldn't even come close unless the entire population was high 24/7.

 
Bottomfeeder Sports said:
Ops I missed ths,,,

From 2016

And an article on the study.
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The RAND study is loaded with problems, many of which are highlighted here: http://www.disabledveterans.org/2016/07/19/new-rand-study-va-health-care-bait-switch-sham/ 

Suffice to say that it primarily uses old data, narrow criteria  predetermined by the VHA itself to make itself look good, and generally uses date against Medicare and not vs private insurance. This was a propaganda piece created to help the VAs image during Obama's presidency when veterans were literally dying on wait lists. The VA can do a good job of proposing certain things, but it doesn't do well actually implementing them due to bureaucracy, its bloated size, red tape, and struggles with specialized care. 

When I was a resident, VA patients at our facility had a greater than one year wait for screening colonoscopies that were recommended care. Patients with possible coronary artery disease could only have an angiogram, but could not have stents placed if needed because our facility did not have cardiac bypass capability. And if they did need bypass, they were sent to a bigger VA facility six HOURS away for it. (Thankfully this practice has ended, but it gives you insight into the workings of the VA.)  

 
Ketamine Dreams said:
The RAND study is loaded with problems, many of which are highlighted here: http://www.disabledveterans.org/2016/07/19/new-rand-study-va-health-care-bait-switch-sham/ 

Suffice to say that it primarily uses old data, narrow criteria  predetermined by the VHA itself to make itself look good, and generally uses date against Medicare and not vs private insurance. This was a propaganda piece created to help the VAs image during Obama's presidency when veterans were literally dying on wait lists. The VA can do a good job of proposing certain things, but it doesn't do well actually implementing them due to bureaucracy, its bloated size, red tape, and struggles with specialized care. 

When I was a resident, VA patients at our facility had a greater than one year wait for screening colonoscopies that were recommended care. Patients with possible coronary artery disease could only have an angiogram, but could not have stents placed if needed because our facility did not have cardiac bypass capability. And if they did need bypass, they were sent to a bigger VA facility six HOURS away for it. (Thankfully this practice has ended, but it gives you insight into the workings of the VA.)  
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Maybe sometime in the near future more recent and/or more comprehensive data will be available that changes things, but as of now even your rebuttal "bait and switch" article doesn't  present such data.   Sure it cherry picks items (one of which I included) to attack the study, but it doesn't present any better information to offer an alternative view.  Thankfully collecting the kind of performance data that the VA pioneered is becoming more standard both with Medicare and with the private sector so better data should be coming.  

 
Arsenal of Doom said:
Practicality and to allow for competition in my case.

I don't think it's realistic that such a large part of our economy can be eliminated. Even if it's phased out I think it would need to happen over a decade or more.

Also I think it's generally a good thing for consumers/citizens to have options. 
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How many people do insurance companies employ?  What are we going to do with all them?

 
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Politician Spock said:
The government will need to hire a lot of people to do what insurance companies are doing. The government however won't be profiting from it. 
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Will it be like other government agencies where many of their employees are useless (but can't be fired) and they pay outrageous contracts to company's to do the work for them?

 
Politician Spock said:
If you're trying to make a point, I'm not seeing it. 
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There's a ####load of waste in every government agency I've been involved with, or had friends involved with.  Letting the government run healthcare all of a sudden isn't some magical solution.  Is the government going to tell pharma companies and doctors and hospitals what they are allowed to charge?  Are the savings from killing off every insurance company offset by the eventual government waste with their employees that do nothing and their ridiculous contract rates?

 
Ramblin Wreck said:
There's a ####load of waste in every government agency I've been involved with, or had friends involved with.  Letting the government run healthcare all of a sudden isn't some magical solution.  Is the government going to tell pharma companies and doctors and hospitals what they are allowed to charge?  Are the savings from killing off every insurance company offset by the eventual government waste with their employees that do nothing and their ridiculous contract rates?
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That isn't a government problem, that is a problem throughout our country with almost everything,

 
Ramblin Wreck said:
There's a ####load of waste in every government agency I've been involved with, or had friends involved with.  Letting the government run healthcare all of a sudden isn't some magical solution. 
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There's a ####load of waste in every private corporation too. People aren't perfect. Corporations and government are run by people. 

Ramblin Wreck said:
Is the government going to tell pharma companies and doctors and hospitals what they are allowed to charge?  
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You mean like how insurance companies do that today? Probably. Health care providers can't just charge whatever they want. 

Ramblin Wreck said:
Are the savings from killing off every insurance company offset by the eventual government waste with their employees that do nothing and their ridiculous contract rates?
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You're really hung up on this waste thing aren't you? Are we really choosing to let people go without healthcare so as to avoid P&L report waste?

 
jonessed said:
Companies that fail to run efficiently go out of business.
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If this were true, every company should be out of business today. 

A more accurate statement would be the worst efficient companies go out of business. 

No company is absolutely efficient. They all have waste. 

 
jonessed said:
Companies that fail to run efficiently go out of business.
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They'd all be more efficient if they spent the human resources they spend now on providing insurance coverage to their employees on their actual business activities.  Granted they will lose the ability to shift some cost into their ESI tax writeoffs, but I think most would take the trade off.

 
Politician Spock said:
If this were true, every company should be out of business today. 

A more accurate statement would be the worst efficient companies go out of business. 

No company is absolutely efficient. They all have waste. 
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If what were true?  Running efficiently doesn't mean 100% efficiency.  That's unachievable.  Competition drives companies to be more efficient.

 
Bottomfeeder Sports said:
Maybe sometime in the near future more recent and/or more comprehensive data will be available that changes things, but as of now even your rebuttal "bait and switch" article doesn't  present such data.   Sure it cherry picks items (one of which I included) to attack the study, but it doesn't present any better information to offer an alternative view.  Thankfully collecting the kind of performance data that the VA pioneered is becoming more standard both with Medicare and with the private sector so better data should be coming.  
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They talk about safety and effectiveness of care, but what is that really measuring? It seems to be a vague way of looking at health care. Is effectiveness equal to outcomes? Why didn't they just say outcomes? And they talk about patient-centeredness and equity, and although they didn't seem to have enough data to judge; those are truly areas that the VA is going to have a distinct advantage.

One area the VA is pretty good at is being able to mine data because the government implemented a decent computer system years ago. It is hard to compare very different systems but perhaps as more EMRs gain the data history to compare care in the US we will get better data. I can say that taking care of veterans is a truly awesome experience. I still see quite a few veterans in my current practice. But it honestly bothered me to see how poorly the system operated at the VA. Those vets were so trusting and put total faith in the VA system. I just felt that the VA was always letting them down in some way. (Which is why I don't let my dad use the VA for 100% of his care.)

 
Politician Spock said:
I would agree with you if thousands of cashiers had been saying "do you want Twinkies with that" for decades.

If everyone had eaten a twinkie instead of fries and soda with their hamburger that would have reduced their sugar, fat and caloric intake significantly. 

Again, I'm not going to say Twinkies are healthy. But when asked for an example of an unhealthy food, there were far better examples. 
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:lmao:

 
Ketamine Dreams said:
They talk about safety and effectiveness of care, but what is that really measuring?
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The Six Domains of Health Care Quality


  • Safe: Avoiding harm to patients from the care that is intended to help them.
  • Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).
  • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.   (My addition - Contrary to what it means to GOP legislatures where it means have the patients have more "skin in the game" when it comes to paying for services so they are better consumers.)
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.
  • Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.
  • Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
From the perspective of the VA this 2013 report list some of the measures that they were using.   If your practice is part of a large integrated system (i.e. hospital system) then I would think at least some of these would be familiar to you.  

Ketamine Dreams said:
One area the VA is pretty good at is being able to mine data because the government implemented a decent computer system years ago. It is hard to compare very different systems but perhaps as more EMRs gain the data history to compare care in the US we will get better data.
Click to expand...
Private side still pulls much of this kind of data not out of EMRs, but out of billing data.  Of course many private systems are finishing the process of installing their second or even third EMR/EHR in the past decade or so trying to find the promised savings of that other RAND report.

 
Ketamine Dreams said:
They talk about safety and effectiveness of care, but what is that really measuring? It seems to be a vague way of looking at health care. Is effectiveness equal to outcomes? Why didn't they just say outcomes? And they talk about patient-centeredness and equity, and although they didn't seem to have enough data to judge; those are truly areas that the VA is going to have a distinct advantage.

One area the VA is pretty good at is being able to mine data because the government implemented a decent computer system years ago. It is hard to compare very different systems but perhaps as more EMRs gain the data history to compare care in the US we will get better data. I can say that taking care of veterans is a truly awesome experience. I still see quite a few veterans in my current practice. But it honestly bothered me to see how poorly the system operated at the VA. Those vets were so trusting and put total faith in the VA system. I just felt that the VA was always letting them down in some way. (Which is why I don't let my dad use the VA for 100% of his care.)
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Are you a pain doc.. or anesthesia?

 
Bottomfeeder Sports said:
The Six Domains of Health Care Quality


  • Safe: Avoiding harm to patients from the care that is intended to help them.
  • Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).
  • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.   (My addition - Contrary to what it means to GOP legislatures where it means have the patients have more "skin in the game" when it comes to paying for services so they are better consumers.)
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.
  • Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.
  • Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
From the perspective of the VA this 2013 report list some of the measures that they were using.   If your practice is part of a large integrated system (i.e. hospital system) then I would think at least some of these would be familiar to you.  

Private side still pulls much of this kind of data not out of EMRs, but out of billing data.  Of course many private systems are finishing the process of installing their second or even third EMR/EHR in the past decade or so trying to find the promised savings of that other RAND report.
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Again, it's still not outcomes. 

 
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