Healthcare

[MDlaxfan76]

I have NO idea how anyone looks at that chart and thinks "problem with the American Health Care system? What Problem?

I guess everyone on this board thinks it makes sense to pay twice the going rate, and to hand it to middle men who do NOTHING to keep you or your family healthy.

Ah....the middle man. why the F does a non-profit have almost TWO BILLION dollars in assets/savings/investments?

and this is just Blue cross/Blue Shield of Massachusettes.

http://990s.foundationcenter.org/990_pd ... 2_990O.pdf

I never get any responses to my non profit posts, why am I surprised the average American gives a turd about the cartel business practices that go on with our nations insurance companies, when the well meaning posters on here won't engage.

5 of the BC staff make well over a million dollars. Top guy, Andrew Dreyfus, makes almost $4 million
______________________________________________
NON-Profit Health Insurance Companies. Highest assets, per state. Includes highest paid executive and number making 7 figures.
This includes savings, bonds, stocks, etc.

Maryland- Medstar $2.713 BILLION . 7 execs make over a million. Top person, Ken Samet, makes $5.1 million
http://990s.foundationcenter.org/990_pd ... 06_990.pdf

New York- pretend liberal land Columbia/Mailman school of health $16.6 BILLION.
8 execs make at least $3 million per year. Top person, Pete Holland, makes $6.6 million

http://990s.foundationcenter.org/990_pd ... 06_990.pdf

California- Kaiser Foundation $20 billion. 33 execs make over a million. Yes, 33. Top exec, Bernard Tyson, makes $10 million.
http://990s.foundationcenter.org/990_pd ... 12_990.pdf


Just a small sample. Of course, these NON-profits lobbied for obamacare to pass. Gee.....wonder why.

Salaries aside, What the heck is a non-profit doing with billions upon billion in investments?

I agree with you on your critique of not for profit healthcare co's, especially the insurance co's, and exec salaries.

Why did they lobby for Obamacare? Because it maintained the private health insurance system, indeed increased their customer base, and reduced uncompensated care.

Scared to death of single-payor or even public option.

No question the insurance companies made out and that is Obama's fault. He should have gone straight for single payer, medicare for all, would have been less expensive and the roll out would have been a non-event. Easier to scale something already working well, rather than build something new and not use existing parts that worked. This is what comes from trying to compromise, sending a conciliatory signal to the republicans (using a republican game plan). Not listening to Pelosi and company.

I have to laugh(along with afan) every time one of the Trumpnista fools calls Obama a socialist, a left wing extremist.

I'll cut Obama some slack.
I don't think he'd have passed single payor. I think he'd have lost some Dems at that point.
Perfect the enemy of the good.

So, time has passed, some aspects of accountable care are indeed bearing fruit in the health system culture, though we could and should do so much more.

My own view would be to let Medicare-for-all (Basic Care) compete with private insurance. Private insurance would likely evolve to something akin to Medicare Advantage and leave the rest.

Want concierge care, extra care? pay up.
But all basic services, and most especially wellness services, through a single system, designed for efficiency, quality at a long term low net cost (to the taxpayer).

[MDlaxfan76]

On pharma, I think we need to be careful not to throw the baby out with the bath water. We want innovation.

However, I think we should stop subsidizing the rest of the developed world.

Seems to me that the prices paid by the US health care system should not ever be higher than the prices paid by systems in developed countries with smaller markets than the US.

Maybe, just maybe, I can see a discount available to the least developed countries, those where the need to address health may be most acute... and with global ramifications.

I think we'd see other developed counties paying more, the US less, with Pharma just as well rewarded for successful innovation.

There may be some nuances, but directionally that's where I think we need to go.

[jhu72]

Medicare option under ACA and stop the government subsidies for all other plans is the obvious next step. Require all health insurance sold in the US to be placed on the ACA schedule (Exchanges) where it is easily compared against every other plan (this is good for the consumer). If insurance companies want to compete - MAKE THEM COMPETE. The pure insurance companies don't want to compete. The only types of plans that can really compete with Medicare (and make money) are HMO like organizations who provide both the insurance and the healthcare delivery. I guess it might be possible to make a business of concierge healthcare (Concierge HMO), small market.

[a fan]

On pharma, I think we need to be careful not to throw the baby out with the bath water. We want innovation.

How much are the pharma companies innovating, and how many are taking Federal grants for the innovations?

[MDlaxfan76]

Medicare option under ACA and stop the government subsidies for all other plans is the obvious next step. Require all health insurance sold in the US to be placed on the ACA schedule (Exchanges) where it is easily compared against every other plan (this is good for the consumer). If insurance companies want to compete - MAKE THEM COMPETE. The pure insurance companies don't want to compete. The only types of plans that can really compete with Medicare (and make money) are HMO like organizations who provide both the insurance and the healthcare delivery. I guess it might be possible to make a business of concierge healthcare (Concierge HMO), small market.

Yup, there could be concierge care insurance, stepped up access to top docs, special procedures not generally adopted yet, etc.

I think entry to the public option though should require an advanced directive. We waste enormous money on end of life care when no advanced directive. Really stupid waste.

Want to buy up for premium end of life care? ok, private insurance.

Yes, HMO-like co's could survive and certainly the healthcare delivery system would adapt the ACA actually did a good job getting that underway).

[MDlaxfan76]

On pharma, I think we need to be careful not to throw the baby out with the bath water. We want innovation.

How much are the pharma companies innovating, and how many are taking Federal grants for the innovations?

They do both.
I'm not suggesting that all the incentives are properly allocated, but yes, Pharma does a lot of innovation, at least in the biggest disease state issues...and consumer 'want's ala sexual health. Size of market.

Orphan drugs (small market) get some extra patent protection to provide incentives.

What we spend way, way too little on is preventive medicine, nutrition particularly. Really dumb public policy in that arena...which I happen to know a bit about!

Instead we 'fix' issues with another pill.

[runrussellrun]

On pharma, I think we need to be careful not to throw the baby out with the bath water. We want innovation.

However, I think we should stop subsidizing the rest of the developed world.

Seems to me that the prices paid by the US health care system should not ever be higher than the prices paid by systems in developed countries with smaller markets than the US.

Maybe, just maybe, I can see a discount available to the least developed countries, those where the need to address health may be most acute... and with global ramifications.

I think we'd see other developed counties paying more, the US less, with Pharma just as well rewarded for successful innovation.

There may be some nuances, but directionally that's where I think we need to go.

Or we could just repeal the Bayh-Dole act. AOC is going to propose it.....I just can FEEL that she will

Here is a nicely written article. Almost 20 years old now.

https://www.latimes.com/archives/la-xpm ... story.html

The root of the corruption of the NIH -- and "corruption" is the appropriate word -- is the Bayh-Dole Act. That 1980 law, ferociously backed by drug makers, let federally funded researchers take out patents and otherwise work closely with "commercial concerns" to profit from their research. The law created technology-transfer offices not only at the NIH but in universities throughout the country whose job was to license their scientists' inventions to whatever company they thought was best able to get them swiftly to the marketplace. It gave agencies such as the NIH the mandate of a for-profit institution, contradicting their original missions. Finally, it gave Harold Varmus, the NIH's director through most of the '90s, the license to demolish private-public firewalls that had served the agency well. In one 1995 memo uncovered by Willman, Varmus ordered all institute and center directors to rescind a policy that had barred them from accepting consulting fees and stock payments from companies.

Rescind.....that means, like, yeah. like....to take away? Get rid of? When it affects friends and family..........gotta be quite. Uncle's New Shoreham house was paid for by such things....so who's complaining

[HooDat]

I'll cut Obama some slack.
I don't think he'd have passed single payor. I think he'd have lost some Dems at that point.
Perfect the enemy of the good.

all true.

I would add, that there is a part of me that believes he saw Obama care as the first required step toward single payor. He may have even known Obama care would blow up, and force the realization.

[MDlaxfan76]

I'll cut Obama some slack.
I don't think he'd have passed single payor. I think he'd have lost some Dems at that point.
Perfect the enemy of the good.

all true.

I would add, that there is a part of me that believes he saw Obama care as the first required step toward single payor. He may have even known Obama care would blow up, and force the realization.

Not sure that most people would agree that Obamacare has 'blown up'.

The ACA is about at it's all-time high favorability gap. Back in 2014 and earlier, more people viewed the ACA unfavorable than favorable but that reversed and the gap is now quite strong to the positive.

The gap is highest among lower income voters, solid gap at middle income, only the highest income view more unfavorable than favorable. Women find it much more favorable than do men, people of color more so than whites.

There's been a lot of polling over the years, the Kaiser Family Foundation has some good tools to dig into who likes and who dislikes the law.

And there really are some good things happening with how incentives are structured in healthcare delivery...but so, so much more can and should be done to bring more efficiency with better outcomes.

[get it to x]

I'll cut Obama some slack.
I don't think he'd have passed single payor. I think he'd have lost some Dems at that point.
Perfect the enemy of the good.

all true.

I would add, that there is a part of me that believes he saw Obama care as the first required step toward single payor. He may have even known Obama care would blow up, and force the realization.

Not sure that most people would agree that Obamacare has 'blown up'.

The ACA is about at it's all-time high favorability gap. Back in 2014 and earlier, more people viewed the ACA unfavorable than favorable but that reversed and the gap is now quite strong to the positive.

The gap is highest among lower income voters, solid gap at middle income, only the highest income view more unfavorable than favorable. Women find it much more favorable than do men, people of color more so than whites.

There's been a lot of polling over the years, the Kaiser Family Foundation has some good tools to dig into who likes and who dislikes the law.

And there really are some good things happening with how incentives are structured in healthcare delivery...but so, so much more can and should be done to bring more efficiency with better outcomes.

You can't call any of this insurance, whether it's BC/BS, United Healthcare or Medicaid Part B. It's just a transfer. When you pay first dollar benefits with no price transparency for routine care like office visits its like pre-paid oil changes.

We need everyone at a minimum to be responsible for the first $2500 of their annual medical expenses and make providers advertise prices. I'd be fine with means testing and raising the deductible as income goes up. You could then buy a major medical policy for catastrophic events.

As for pre-existing conditions, if you are able to afford insurance but elect not to purchase it then you should go to the high risk pool, with possibly a higher deductible.

The entitlement mentality must be divorced from insurance. Hospitals can't turn you away, so nobody goes without urgent care.

[MDlaxfan76]

I'll cut Obama some slack.
I don't think he'd have passed single payor. I think he'd have lost some Dems at that point.
Perfect the enemy of the good.

all true.

I would add, that there is a part of me that believes he saw Obama care as the first required step toward single payor. He may have even known Obama care would blow up, and force the realization.

Not sure that most people would agree that Obamacare has 'blown up'.

The ACA is about at it's all-time high favorability gap. Back in 2014 and earlier, more people viewed the ACA unfavorable than favorable but that reversed and the gap is now quite strong to the positive.

The gap is highest among lower income voters, solid gap at middle income, only the highest income view more unfavorable than favorable. Women find it much more favorable than do men, people of color more so than whites.

There's been a lot of polling over the years, the Kaiser Family Foundation has some good tools to dig into who likes and who dislikes the law.

And there really are some good things happening with how incentives are structured in healthcare delivery...but so, so much more can and should be done to bring more efficiency with better outcomes.

You can't call any of this insurance, whether it's BC/BS, United Healthcare or Medicaid Part B. It's just a transfer. When you pay first dollar benefits with no price transparency for routine care like office visits its like pre-paid oil changes.

We need everyone at a minimum to be responsible for the first $2500 of their annual medical expenses and make providers advertise prices. I'd be fine with means testing and raising the deductible as income goes up. You could then buy a major medical policy for catastrophic events.

As for pre-existing conditions, if you are able to afford insurance but elect not to purchase it then you should go to the high risk pool, with possibly a higher deductible.

The entitlement mentality must be divorced from insurance. Hospitals can't turn you away, so nobody goes without urgent care.

I understand the notion that having folks pay the first dollars out would help decisions be better. It would seem like that would encourage people to use health care intelligently.

Unfortunately, that's not what behavioral science shows.

Instead, people choose not to get the preventive care that would avoid far greater cost. They make the bet that the issues that result from such avoidance will happen to the other guy, not them. And they may well be right, individually. (or not). The aggregation of these individuals' choices leads to more expensive outcomes, on average.

We may wish that people would, in aggregate, choose differently, but they don't.

Likewise, we make horribly expensive decisions at the end of life, when we don't have an advanced directive, haven't already made these choices. Even worse are the decisions we become unable to make for ourselves, with family and doctors way overspending at this stage relative to continued quality of life.

[jhu72]

Candida auris.

[RedFromMI]

Candida auris.

Note that there is some thinking that this fungus (antifungal resistant) might have gotten its resistance due to the heavy use of fungicides on crops. And because fungi are genitically a little bit closer to animals than bacteria, often antifungals for human treatment are more dangerous in their side effects...

[6ftstick]

Well bust my buttons! When an aging filthy rich British rocker needs cardiac surgery doess he que up and wait in long lines at home to be covered by the British governments healthcare system.

Nope he comes here for the worst of all healthcare according to liberal progressives.

[CU77]

US health care is the best in the world for the wealthy. There is absolutely no one who thinks otherwise, left or right.

[HooDat]

I understand the notion that having folks pay the first dollars out would help decisions be better. It would seem like that would encourage people to use health care intelligently.

Unfortunately, that's not what behavioral science shows.

Instead, people choose not to get the preventive care that would avoid far greater cost. They make the bet that the issues that result from such avoidance will happen to the other guy, not them. And they may well be right, individually. (or not). The aggregation of these individuals' choices leads to more expensive outcomes, on average.

We may wish that people would, in aggregate, choose differently, but they don't.

Likewise, we make horribly expensive decisions at the end of life, when we don't have an advanced directive, haven't already made these choices. Even worse are the decisions we become unable to make for ourselves, with family and doctors way overspending at this stage relative to continued quality of life.

this in an nutshell is 90% of the problem with the healthcare issue. The last 10% is the opacity of pricing and the pricing bureaucracy that supports/creates/feeds off of it.

[MDlaxfan76]

I understand the notion that having folks pay the first dollars out would help decisions be better. It would seem like that would encourage people to use health care intelligently.

Unfortunately, that's not what behavioral science shows.

Instead, people choose not to get the preventive care that would avoid far greater cost. They make the bet that the issues that result from such avoidance will happen to the other guy, not them. And they may well be right, individually. (or not). The aggregation of these individuals' choices leads to more expensive outcomes, on average.

We may wish that people would, in aggregate, choose differently, but they don't.

Likewise, we make horribly expensive decisions at the end of life, when we don't have an advanced directive, haven't already made these choices. Even worse are the decisions we become unable to make for ourselves, with family and doctors way overspending at this stage relative to continued quality of life.

this in an nutshell is 90% of the problem with the healthcare issue. The last 10% is the opacity of pricing and the pricing bureaucracy that supports/creates/feeds off of it.

Yes, that's indeed a factor too.
So, too is transparency of quality of care.
I'd put that in the 'pricing' bucket.

[MDlaxfan76]

US health care is the best in the world for the wealthy. There is absolutely no one who thinks otherwise, left or right.

Unfortunately, the right wing media and incumbent healthcare lobby tell 6ft and other perfectly intelligent and otherwise rational folks that they're better off here than in more efficiently run systems.

And they buy it.

The wealthy and well connected, in dire need, yes.

This really is all about the Benjamins.

But here is why I think the left blows the argument: When they argue that 'healthcare is a human right, not a privilege.'

That blows the minds of folks who value earning what they receive. (often hypocritically, but it's a philosophical POV).

I'm not arguing one way or the other re 'human right', just that the argument is off-putting, needlessly IMO.
It makes these voters/consumers susceptible to the propaganda of those with an economic interest in the status quo.

The far better argument is about efficiency and quality of outcomes.
Conservatives can find a path to intellectually supporting the most fiscally responsible model.
That's what gets me there.

As a taxpayer and payor of insurance, I'm already paying for others' care.
So, I want the most efficient way to achieve the best outcomes for my dollar.

[CU77]

But here is why I think the left blows the argument: When they argue that 'healthcare is a human right, not a privilege.' That blows the minds of folks who value earning what they receive. (often hypocritically, but it's a philosophical POV).

I completely agree. Too many on the left have seemingly given up on the notion of bringing more people over to their point of view, and hence winning more elections.

But the hypocrisy on the right is also high. I have not been able to find any one who will say, yes, we must let people die in the street if they can't pay for their health care. But that's the actual alternative to health care not being a "right". We, as a society, are not willing to tolerate that, so we pass laws like Ronniecare (EMTALA) that force private-sector entities to work for free to provide (emergency) health care to all. Of course these entities don't really do it for free; they pass the costs on to the rest of us in the form of higher insurance premiums and out-of-pocket expenses.

[HooDat]

But here is why I think the left blows the argument: When they argue that 'healthcare is a human right, not a privilege.' That blows the minds of folks who value earning what they receive. (often hypocritically, but it's a philosophical POV).

I completely agree. Too many on the left have seemingly given up on the notion of bringing more people over to their point of view, and hence winning more elections.

But the hypocrisy on the right is also high. I have not been able to find any one who will say, yes, we must let people die in the street if they can't pay for their health care. But that's the actual alternative to health care not being a "right". We, as a society, are not willing to tolerate that, so we pass laws like Ronniecare (EMTALA) that force private-sector entities to work for free to provide (emergency) health care to all. Of course these entities don't really do it for free; they pass the costs on to the rest of us in the form of higher insurance premiums and out-of-pocket expenses.

this conservative would argue that health care is not a "human right", but it is a civil right. Communities owe each other the promise of taking care of one another when injured or sick.