"Market Based" Healthcare Solutions : A Future of Leech Farms and Barber-Surgeons
Let's be clear about one thing - Obamacare sucks and the Democrats failed on a phenomenal scale when they attempted to modify our "uniquely American" system of keeping for-profit insurers at the center of our healthcare system. Ever wonder why our system is "unique"? Because almost every other sane country in the world has realized that "profit" and "healthcare" cannot co-exist in the same space.
The health insurance industry was obviously already aware of that fact. Why do you suppose they came up with the concepts of "pre-existing conditions" as a barrier to coverage, or "lifetime caps" to limit payouts or "age-rating" to gouge older people who will have predictably rising coverage needs, or "rescission" in order to bump out covert bunion sufferers who later turned up with breast cancer? Because the insurers want premiums but they don't actually want to pay for actual healthcare! Imagine an industry whose sole goal is to limit and hinder access to the product they supposedly are the conduit to. Insurers are the industrious beavers damming up the channels we have to navigate in order to treat our illnesses and hopefully save our lives. Instead of realizing that there is no role for beavers and their dams in a modern national healthcare construct, the Democrats undertook a Save the Beavers campaign.
The Beavers are actually responsible for writing much of Obamacare, through the Senate Finance Committee and Max Baucus with the full approval of the President and his White House minions, who in an early secretive move, killed off the only thing that potentially could have made Obamacare successful - the Public Option which would have acted as a powerful lever of competition to provide an alternative to the for-profit insurers. The Beavers would have been faced with some industry altering choices if they still wanted to stay in the game - like (gasp!) not paying out ginormous, staggering sums to their top tier executives and BODs. Those insane and immoral compensations are based on the relative success of the scheme to kill Americans through Death by Spreadsheet - healthcare denied is healthcare insurance profit earned.
Why is Obamacare so spectacularly unsuccessful? It's a matter of simple math. A person may be able to afford the premium, but then they have to sit around and hope that they never have occasion to actually USE the insurance, because they will be hit with co-pays, deductibles and out-of-pockets that they often will not be able to afford. For 2017 the maximum out of pocket for an individual is $7,150 and for a family it is $14,300. When taking into account that the average American family has savings of less than $1000 it's easy to see that a number of people who desperately need coverage have figured out that they would be forking money over for premiums for coverage they can't affords to actually use. They will be out the premium money and they will still be forced into financial ruin or bankruptcy over medical expenses. And this situation is not limited to those covered by Obamacare, people who have employer coverage face the same dilemma of having insurance but not being able to cover the co-pays and deductibles.
Kaiser recently released a study in conjunction with the New York Times detailing the consequences that start the downward financial spiral when someone is unfortunate enough to get ill or have an accident even when insuredThe Burden of Medical Debt - Section 2: The Role of Health Insurance Major issues cited were the inability to pay their portion of cost-sharing (75%), "surprise billing" from a health provider they were unaware was outside of their network (32%), or having their claim denied by the insurance company (26%)
So here we are folks, in 2016, six years after the passage of the ACA in2010 and 3 years into its implementation. The problems that existed before the ACA still exist even though coverage has increased. The increase in coverage becomes moot when large percentages of the population, whether covered by Obamacare or receiving employer coverage STILL cannot afford to get care as opposed to the illusion of care.
In my opinion the ACA suffered from a fatal flaw at its inception, the tenet that for-profit insurers had to remain at the core of the American healthcare system. The good thing about the ACA is that it can be considered an experiment that failed. The choice is clear - either insurance companies retain profit subsidized by the illness and death of every American, or we finally, finally attempt to implement a single payer system that removes profit from the equation.
We can rely on Republicans to continue spouting useless aphorisms about "market-based" healthcare without understanding that is what we have had and still have - a market created by the greed of both the providers, the drug companies and the insurers. They will also talk about Health Savings Plans, another useless concept for Americans with stagnant wages and no disposable dollars. I have no particular reason to believe that Democrats will rise to the occasion of offering a better alternative to the ACA based on their previous failures of competence and reasoning in implementing it in the first place. The only way that Americans will finally get comprehensive, single-payer healthcare is if we coalesce around this issues and make it a litmus test for any politician who wants to get elected in the future. Bernie Sanders laid some groundwork in this regard. Healthcare was a major impetus for the election of President Obama in 2008. We need to make it the impetus for election in 2018 and beyond. We need to reject candidates who tell us "it will never happen" if we want it to happen. We can make it happen.
I leave you with this article Repealing Obamacare? A Better Idea: Medicare For All written by Rose Ann DeMoro, Executive Directer of National Nurses United.
Medicare remains one of the most popular social reforms in U.S. history. Expanding it to cover everyone is an idea favored by 58 percent of Americans, as a May Gallup poll demonstrated. It’s the real healthcare reform we need.
Imagine that - 58% of Americans are already in favor of Medicare for All right out of the starting gate. Imagine what will happen after we unite and promote and educate. Our leaders apparently don't have the will to do what needs to be done. We will have to "make them" as one of them told us frankly. It's a struggle we can win.
Comments
I should add that there is ONE non-sucky aspect of the ACA
which was the expansion of Medicaid in those states that accepted the expansion - definitely life-saving and which was also the only part of the ACA which could be considered as an expansion of a single-payer system. Hard to believe that Republican Governors who chose to kill their constituents as opposed to accepting the expansion are still in office.
On the other hand their is an additional very sucky aspect to the ACA that I did not address - the gap of uninsured who make too much for Medicaid and too little to receive a subsidy. These people have been in clear view since day one - the uninsured working poor.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
Are you aware of the medicaid clawback?
It's applicable to anyone 55 years or older who is forced on to medicaid in the years before they qualify for medicare.
If the medicaid recipient owns their house, upon their death their state is permitted to clawback the costs of their medical care from their estate by claiming their house. This loophole courtesy of the 1992 democratic congress iir.
The clawback has a horrifyingly sinister meaning when you consider that the medicaid program is not allowed to negotiate the costs of prescription drugs. Big pharma will be paid at the rate they desire, and the heirs be damned.
So if you are lucky enough to have conserved a little bit of your lifetime earnings as a wage slave and you wanna give it to your kids upon your death so they have some resources to tangle with the elite 1%ers in the future, don't get sick. But if you do, die quickly enough to stay off of medicaid.
~annominous
Even if you are on Medicare
a long term nursing home stay will convert to Medicaid. And if your kids put you in the home, they will required (the kids) to repay nursing home costs.
Poor kids get sued, while rich kids get all daddy's money without estate taxes assessed.
We Texans have more laws to protect deer than the sick and elderly.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
Not in Illinois
The Estate is required to pay, but not the children. You are not responsible for your parents debts. Unless you signed a paper agreeing to be responsible.
I've seen lots of changes. What doesn't change is people. Same old hairless apes.
The nursing homes use tons of pressure
to get the person signing the patient in to accept "responsibility", not necessarily making it clear that means financial. If there is no estate, the responsible person gets sued.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
Just don't sign - make the patient sign
Unless they are too far over the bend to read or write. In that case, death is rather near. Might as well die at home, as my Uncle did this October.
I've seen lots of changes. What doesn't change is people. Same old hairless apes.
I am aware of the clawback and have diaried about it at TOP
I didn't address it in my comment simply due to time and space.
The Medicaid expansion which dropped the asset limitation was seen as great because it seemed to understand that people may have accumulated some savings and assets and yet still had reduced income which limited their access to being insured. But then the clawback provision was discovered. And, it only addresses one specific segment of the age demographic. I know people who have qualified for the Medicaid expansion but did not go on it for this very reason - they did not want to dissipate their savings and assets when they might need them to finance their later retirement.
Many people were initially unaware of it when they went on Medicaid as the disclosure was lacking and/or insufficient which I think has been addressed in most states. (By the way, Medicaid does have negotiated drug prices, unlike Medicare, but the clawback is still reprehensible.)
The clawback applies only to people between the ages of 55-65 which is senseless in and of itself. Age 54 and below, no clawback. Hit 55, boom! Clawback. One of the more questionable aspects of the clawback is that in many cases, simply being enrolled in the system, even if you do not need or require care, care trigger "administrative" charges which are not specified. There are so many things wrong with the clawback that I could go on and on, (which I have, previously.)
The clawback triggers once again the question - who writes these rules and laws, and for whose benefit? Certainly not for the citizen/consumer.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
Thanks, I stand corrected. Medicaid can negotiate rx prices.
In my case, it doesn't make a difference. Medicaid is not an option for me. Luckily I'm vested in ongoing health insurance coverage, though affording the premiums may be dicey, once I give up full time employment.
Excellent post btw, thanks for that too.
~annominous
Negotiated prices sound good but don't let this fool you
Many states sharply limit the drugs covered on Medicaid because they cannot find pharmaceutical companies to participate in a market which restricts their profit significantly. What does "significantly" mean? It means whatever the drug company wished it to mean.
Funny how RepublicRATs always railed against the "death squads" when ACA was first promoted but they forgot, those death squads already existed in Pharma boardrooms and the Lord High Executioners were the CFOs and their underling bean-counters. You might liken these underlings to the Albert Speers of the world, who didn't directly kill anybody (other than working a few thousand slave laborers to death). Albert just made sure Himmler, Heidrich, Eichman et al got the proper equipment to do their jobs.
Somebody please tell me how this murder by neglect is any different than starving prisoners of a concentration camp to death.
Good. My mother is 96, and paying to be in a nursing home.
She can afford to live on her savings until she's about 120. Inheritance to her offspring, designated such by her. I can do without, my sister, her former major caregiver, needs those funds more. Family difficulties. Luckily, my mother is unaware. Beware!
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
Medicaid privatization
Medicaid is increasingly privatized as Medicaid managed care. The ACA expanded opportunities to privatize, including moving dual eligible people from Medicare to Medicaid, as on the cusp has posted above; and expanding the extent to which states can privatize. People here will recall in the early days some states resisted the expansion. Additional privatization was a bargaining chip. Insurance companies were eager for the expansion
July 2015 discussion of privatized Medicaid
http://pnhp.org/blog/2015/06/15/privatized-medicaid-managed-care-yet-ano...
2013 overview
http://www.nakedcapitalism.com/2013/03/david-dayen-the-gradual-privatiza...
Medicaid privatization
Deleted duplicate
Thanks for those links!
A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.
My daughter is a BSRN at our local non-profit hospital
which the NLRB (Labor Relations Board) found guilty of impeding unionization of the nurses. When she received her BSRN (after her RN qualifications) she got a later $0.30/hr raise. That's all. Up the interstate, where nurses are unionized, they make more. With similar sick patients, all covered by the same insurance companies.
The sheer fact that a nurses union is in favor of sucking this all away from the clutching hands of insurance companies says much. Like teachers, many nurses are underpaid and have to deal with sicker patients who could not afford health care until Something Really Bad Happened. Stress on the system from all sides. Add in understaffing by RNs on shifts (she does 12 hour shifts, good for patient continuity). The hospital is not a hotel with room service. It's medical service first.
Now add the power-play by the insurance companies withdrawing coverage from states. We are being gamed.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
A grotesquely mercenary practice
There can be few other words to describe the burgeoning commoditization of cancer treatment centers across the country.
They might as well start putting up a billboards on the side of the road that read 1-800-CANCER.
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Don't look at Fertility Centers.
I should have been mercenary enough to go there. Check this out, co$ts are showing.
https://www.cnyfertility.com/
My daughter got superovulated and donated 18 eggs. She walked out with a check for $4K. Profit, profit.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
Egg freezing as low as $1,900
Are they offering coupons too?
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Practically, embryo freezing is more advanced
My daughter's eggs were bought by shopping family, presumably to be inseminated immediately and frozen as the "best candidates" to be implanted some 3 days down the line. The IVF lab had glass windows so I could see setups. Nice scopes.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
Uh...
If you tried to call 1 800 CANCER you wouldn't get through - the phone would wait forever for the last number. Something like if you tried to call a health insurance company and waited for a real person who could say something other than "no".
On to Biden since 1973
Ah, a stickler for detail.
Ok, how about a billboard that reads: Call 1 800 FUCK YOU and we'll tell you all the ways you're gonna die.
I think that has about the right amount of numbers.
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Between having to have "insurance" and the fine
you pay for not playing what the ACA has done is created a tax on health.
I can't imagine what the aliens are thinking when watching the reality series "America Exceptionalism"
I never knew that the term "Never Again" only pertained to
those born Jewish
"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"
Heard from Margaret Kimberley
That's exactly what it is
The ACA exists as a platform for private insurers to force a private sector tax. As far as I'm concerned, it is a violation of the peonage laws under Title 18 U.S.C. I'd be interested in what any attorneys that might visit here may have to say about that.
"I can't understand why people are frightened of new ideas. I'm frightened of the old ones."
John Cage
There isn't any accountability for
people known as corporations, only for people that can't afford to be a corporation.
I never knew that the term "Never Again" only pertained to
those born Jewish
"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"
Heard from Margaret Kimberley
But But--
Corporations are people too!
"I can't understand why people are frightened of new ideas. I'm frightened of the old ones."
John Cage
Calm down there mittens
I never knew that the term "Never Again" only pertained to
those born Jewish
"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"
Heard from Margaret Kimberley
What's wrong with you ? CLM ! CLM !
How rude of you to make mirth, we all know Corporation Lives Matter most! Libtards, they just don't understand the angst and struggle involved!
+100
well done!!!!!!
I never knew that the term "Never Again" only pertained to
those born Jewish
"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"
Heard from Margaret Kimberley
Well done Phoebe!!
Though it wasn't a win, win...we did not elect one politician who said Universal Healthcare was a non-starter...Hillary Clinton. Her comment about that ( from debate with Bernie, if I recall correctly) was the main reason I turned permanently from her as a candidate...then, of course, the corruption of the Primary by the Clinton Campaign, and DNC, sealed the deal.
Unfortunately, now we are left with an executive branch where doctors are running the Dept. of Housing, and Urban Development, Big Oil execs in charge of the EPA, Wealthy, religious, right wing, idealogues seeking to destroy public schools in charge of the Dept. of Education, and the economic attitude of those in charge is completely in the "market based" world.
I guess the good news (or the really, really bad news) is that little has changed...the inmates are still in charge of the asylum!!
Don't give up yet
Trump called in Al Gore to talk about climate change, & it's apparently going to happen again. Maybe he'll surprise us.
Not exactly. Al went in to meet with Ivanka, but
Trump did join later.
A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.
Trumplestiltskin just named a climate change denier
to head up the EPA. No fan of Hillary's, but this is not good.
Would the HRC administration be any better?
Smoother talking I'm sure, but not, in practice, better.
I've seen lots of changes. What doesn't change is people. Same old hairless apes.
"Follow the money"
Anyone have any idea how much the insurance companies and pharmaceutical industry PAY to the members of Congress.
It is astronomical. More lobbyists per member of Congress than we can even imagine.
Why was Lieberman given such a voice - Insurance companies in CT.
Obama should have listened to Rahm on this one issue - do the "economy" before ACA.
But, think Obama was more concerned about his "legacy" even in those very early days than we could have imagined.
We fell for Hope & Change. We lost.
For years I have said to anyone who doubts whether our
politicians are corrupted -
What kind of legislature or country passes a law specifically to prevent itself from negotiating prices in a government funded healthcare program, i.e. Medicare? This is prima facie evidence of deep deep corruption since it entrenches into law that our Congress not fulfill its fiduciary duty to the citizens taxpayers to spend our common wealth as wisely as possible. Instead, this law means that the Congress abetted in a wealth transfer to a specific industry. End of story.
I'd like any Congressperson or Senator to attempt to explain the rationale for this law. They can't. The only explanation is the one they can't offer - we passed this law because we were told to by our corporate funders. Under the Influence
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
Claim of inability to speed read does not work.
And what happened to time frames for a bill to be introduced and studied (at least by aides)?
What a useless bunch, then and now.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
I've commented before about this.
I'm almost two years in to my bad cancer diagnosis. I'm only still here because I've responded so well to several of the new chemo-type targeted treatments that retail for about $100K per year each. My health insuror negotiates those costs down by 75%, hell of a markup.
Each year I've watched the annual out-of-pocket max for my employer-based health insurance increase by over $1K and felt personally responsible. This year I had one medication that suddenly jumped from $400 per month to $600 per month, but I'm supposed to feel no blame cuz that's the cost for the generic! The real deal retails for about $3500 per month! And that's not even one of the miracle chemos! Apparently my insurer has agreed to this price increase, and I'm not even allowed to shop around for a better price.
Lucky for me I've been able to stay employed, trying to hang on to my insurance and succeeding so far (the FMLA helps a lot) but ... think about that. I've had to continue working more or less full time while dealing with metastatic cancer, chemo, surgery, and radiation treatments and their debilitating side effects.
What kind of an exceptional place is this US of A? PEOTUS Trump assures us people won't be dying in the streets after he signs the ACA repeal, and he's probably right. Most of us will prefer to die in the alleys, for the sake of maintaining a semblance of privacy as we face the ultimate destiny.
~annominous
We can *hope* for an "Only Nixon" scenario, but
I wouldn't bet my whole future on it, nor should anyone.
There is no justice. There can be no peace.
ACA =
boondoggle for the insurance industry. Anyone claiming otherwise, is lying.
Recced and shared.
The Four Horsemen of the ACA-Pocalypse.
Insurance Cos, Hospitals, Providers and Pharma, all Charging You The Maximum The Market Will Bear. What will you pay to restore your health. The only answer is anything, everything. And those fuckers know it.
Gee if only we didn't have a FAKE GOVERNMENT. You know, one where congress, the executive branch, and courts were on our side. I know, I know, you can't have your fucking unicorn. Funny how the US is the only industrialized nation that doesn't regulate price controls on healthcare.
I got dumped into Obamacare this year. Still wrestling with the agonizing decision of whether or not to take the no-coverage penalty option.
Donnie The #ShitHole Douchebag. Fake Friend to the Working Class. Real Asshole.
Where do you live?
my county has a program where the uninsured get a 50% discount through a ciinic that provides better, faster care than private practices, but your county will vary. Also, Medicaid eligibility varies state to state.
On to Biden since 1973
In Texas the Future is Now!
Texas releases abortion booklet with debunked cancer link, suicide risk claim
I think we should consider saying goodbye to the whole model.
While the insurance companies are the worst actors in the "healthcare industry," the worst problem is that healing is considered an "industry" rather than a sacred calling. The most disappointing thing to me is how doctors, other than a tiny minority of brave folks, are far more focused on running a business than being healers. They've been obstacles to needed changes going back to the Medicare fight (where they hired Ronnie to do his 20-Mule Team thing).
If that doesn't change--and I don't think it will--then our communities will be required to look into less capital intensive ways to provide effective healthcare to the population as a whole. Cuban doctors have a different focus. Once upon a time, many American doctors did too. It's going to take a rebuild from the foundation on up.
There are a lot of interlocking pieces to this puzzle
America's facing a shortage of primary-care doctors
Years ago I had a good friend in medical school. I have to say that every med student I met at various gatherings seemed to be motivated by future financial prosperity. They all discussed what specialty they wanted to go into and which was the most lucrative. The very few people I met who seemed to be going into medicine for altruistic reasons were women. I'm not generalizing from that, I'm just saying that was my personal experience with one group of people. But aside from that, there aren't enough medical schools to graduate the number of doctors we will need, so I'm sure doctors from other countries will continue to immigrate here for the financial opportunities offered here.
I always thought that implementing single payer healthcare in this country should act as a huge jobs engine. If every single American were entitled to receive government funded healthcare, we should see an explosion in the number of doctors, nurses, therapists, dieticians, radiologists, etc. that would be required. Additionally, these are all higher paying, skilled jobs. The construction trades should also boom due to the need for building new medical schools, clinics and hospitals, and outpatient centers. Then there would be the supplemental and accessory jobs of the restaurants and stores needed to complement the new medical centers. It's such a total win I can't understand how that is not being utilized as one way to market the desirability of single payer. The influx of new jobs and taxes should go a long way to the funding of the healthcare.
Our government always focuses on cutting and reduction as a means to growth - which is simply stupid IMO. Expansion and growth is the means to growth.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
My daughter is continung studies toward a NP
And the economy of the field is stressed. NPs graduate as semi-doctors and can do most of those clinical roles. For about half the price and about half the educational time. Majority-female was last year's graduating class.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
Nurse Practitioners are definitely part of the solution
to the GP doctor shortage. Every one I have ever interacted with has been great and I never missed seeing an actual doctor at all. Your daughter sounds like she she is on the road to a successful, productive and necessary career. Congrats to her.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
Tangental factoid
a friend of mine, who's a chemical engineer, tells me that something like 60% (it was a casual conversation, so I might have the exact number wrong) of engineering graduates are women. Is it possible that women are still looking for "traditional" well paid careers - doctors, engineers (well paid because they are actually worth something) while men go into fields like the finance industry (parasitical) If so, wait a generation, then everyone will be stock brokers and there won't be any doctors at all.
On to Biden since 1973
The financial changeover will occur when the next market bubble
bursts.
When the bubble pops a lot of these non-fiduciary blood suckers will be looking for jobs in the general labor force because there will be less need for them. It would serve them well too find out that they are over-qualified to flip burgers or sell athletic shoes.
There are alternatives to industrial medicine that are effective
Getting Lyme 20-some years ago was very disillusioning about the medical system. Essentially, they are taught to discount what patients say and feel, and only look at numbers on lab reports, even when they don't have good lab tests.
So I started reading medical journal articles, and that was wven worse. My academic training was largely in how to design and analyze research, and an awful lot if what gets published is truly dreadful in terms of methodology. Not to mention that single non-replicated studies are accepted at face value and their (often unsupported even by their own data) recommendations widely implemented.
But there are alternatives, alternative doctors and protocols, nutrition (including probiotics and live fermented foods to keep your critical microbiota happy) and what finally worked for me was an herbal protocol. It took a good year, but after that, this is the best I've felt in 20 years. You can do your own research and adapt what you're doing to how you're responding.
Emergency medicine is necessary, though, and is probably is the best of the medical system.
Right there with you. DH even did stats/research for one
treating physician. But after rounds of abx for both of us, the answer has been herbals, essential oils, diet, and other non traditional treatment. It does work. And we are better without the constant rounds of abx which made us sick as dogs.
We have to be our own doctors, lawyers, and many other "experts" to look after ourselves.
You may choose to look the other way, but you can never say again you did not know. ~ William Wiberforce
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Yes, when one starts to read medical journals carefully,
it is way more frightening, disturbing and depressing than even the mainstream media. I'm talking about conclusions expressed in the abstract that are flat out contradicted in the body of the text. Out and out lies about how good certain prescription drugs are and to the contrary for supplements. Details here: http://caucus99percent.com/content/when-good-doctors-prescribe-bad-medic...
Cuban doctors
I don't think American doctors will take chickens or vegetables in payment.
Many doctors used to adjust their charges to the patient's income back before widespread insurance. Now, I think that is specifically prohibited, although I can't cite when that happened.
I've seen lots of changes. What doesn't change is people. Same old hairless apes.
Fee adjustment is only prohibited if a physician
"accepts assignment" from CMS. That means that the patient's charges, heavily discounted, are paid directly to the patient.
Life and Death are basic human realities, and have nothing
to do with material $$$$profit. "Promote the General Welfare....." Where is "and turn a profit"? It would be funny if it wasn't so damned sickening!! (No pun intended.) Rec'd!!
Inner and Outer Space: the Final Frontiers.
You touched on a really important aspect of our moral devolution
as a country which involves rating every function of government through a business infused perspective of ROI or Return on Investment.
I wrote about that a while ago in this essay When Leaders Reach the Right Conclusions For the Wrong Reasons which I'll just abstract some bits from:
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
P.L., you've made the correct diagnosis and we have plan
Yes, we have a treatment plan already PROVEN. I will spell this out for those of you who may not know: M-E-D-I-C-A-R-E for all.
That "company" (trustee) is the association and collective best interests of its stakeholders (trustors). Who are these? They are us. The government was developed ostensibly to promote health (i.e. welfare), mutual protection and the ability of all to be safe and secure (i.e., welfare again = health).
Trump has been sending out
mixed signals for years... but he has at times, expressed interest in a single payer system. To the horror of his Republican colleagues.
native
Well, he is a businessman and single payer is the most efficient
and cost effective way to achieve universal healthcare. One of the biggest conundrums to me has always been why all American businesses large and small haven't lined up to demand single payer for this country since our industries are at such a competitive disadvantage compared to other countries due to the fact that they have to absorb the cost of employee health insurance in their bottom line.
Granted, some taxes will go up, but as Bernie said, even after a tax increase, there would still be a net gain for both companies and individuals.
This country's leaders have consciously decided that protecting the profits of a few specific industries is more important than saving the lives of its citizens. There's your Democrats and your Republicans. How do they look at themselves in the mirror?
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
Crushing Debt and Healthcare Costs
We all know Healthcare Costs are driven by corporate executive's greed and stock market (id est stockholder's) expectations. A few years ago I attended an open forum on Health Care issues. One of the speakers commented on a "straw poll" he recently conducted at a midwestern medical school. He asked the future doctors what they expected for income in the years following med school. He then asked what they thought would be a reasonable income if their education was free or significantly less expensive. Everyone, everyone, emphatically agreed they had no interest in an exorbitant income.
Sure, maybe they were lying. Maybe peer pressure influenced the conversation. But I wouldn't be so sure. I have known many medical professionals that have made career choices corroborating the speakers thesis. So, I am inclined to think the key to a saner system is fully funded education that would help drive the movment to implement vigorous measures to de-privatize essential services of all types.
Most MDs I have met seem sincerely interested in helping
As you imply, another key is for doctors to be in salaried positions so they do not have to worry about creating a profitable business.
Becoming a doctor is exhorbitantly expensive in the US
I know one person who joined the military as part of some program to defray his med school expenses. I think there are also programs which forgive some costs if the person will go practice in some rural area for a few years.
This all relates back once again to the fact that America crushes its students with debt while Europe supports their professional progress and future with low/no tuition policies. But of course they have government health plans and have figured out that providing healthcare requires medical professionals.
Why are we so far behind the curve? I maintain it is because of our geographical isolation and lack of curiosity about other countries combined with an inborn complacency and hubris that promotes the entire concept of American exceptionalism - we're No 1! Even when the truth is we're No. 37 or something when it comes to healthcare.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
In Nebraska:
There is a similar program for Lawyers. The obligation is for ten years with a loan forgiveness on the order of 50%.
Duplicate - deleted
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
"It's about the economy" ? Healthcare is tied to the economy
Unless one has an employer healthcare benefit with their job, ⅓ of one's income could go to healthcare. If there was a good Federal medicare program in place, the burden would not fall on employers; they would be able to increase their workers' salaries.So Jobs/Economy are intricately tied to healthcare. The USA needs single payer healthcare, there are examples from other countries that prove it is possible and that it will not bankrupt the Federal budget.
Watch the propaganda wording: we should never use the word "entitlements" for Medicare, healthcare, pharmacare- Americans have a right to government funded health care. Medicine should be a "service" not a "business."
It will happen one day but under Trump the prospects are so dim. It doesn't stop people from studying and planning for it in the future. Trump may not even make it through his first term. He's walking right into impeachment territory every day.
To thine own self be true.
Health Insurance Pools Also Float the Markets and Other
investment vehicles. Nothing like a couple trillion dollars flowing directly into markets and investment vehicles to prop up the economy. That's quite a slush fund.
IMO, it's this that is the problem that makes public healthcare a political non-starter.
“Tactics without strategy is the noise before defeat.” ~ Sun Tzu
I've ranted on this before
but how about making all out of pocket medical expenses a refundable tax credit? Like with the ACA, (which calculates your subsidy based on last year's income and pays the insurance provider in advance) your doctor would just send his bill to the IRS in your name. It wouldn't be quite as good as single payer - people would still be adverse to doctor visits, and some doctors and hospitals and definitely nursing homes would try to pad their bills, but it would cost about half what it costs today, and would work better than the system we have.
On to Biden since 1973
Great essay, so glad you took the time to post it here!
No doubt a focus on cost saving would do something about THIS problem, but yeah, with you on our devolution of moral compass on HCR.
OT but your post brought back memories of Grayson putting it to the Republicans back during HIR.
A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.
Insurance companies (of any stripe)
are NOT in the "claims-paying" bidness -- they are in the "premium-collection" bidness.
All clear?
When Cicero had finished speaking, the people said “How well he spoke”.
When Demosthenes had finished speaking, the people said “Let us march”.
We are only three years into the implementation of the ACA
And the flaws within the product have become glaringly obvious although many were predicted right from the getgo once the legislation was revealed.
Recall that this program was designed from the ground up BY DEMOCRATS as the first priority they had once elected and with all three branches of government under their control.
To me, one of the great ironies has always been that President Obama when running for prez in 2008 and a fairly detailed plan for his proposed healthcare plan with 4 major legs to his stool: a public option to drive competition with the for profits, negotiated drugs in Medicare, a fast track to generic drug development and allowing the re-importation of drugs from Canada. The last two were designed to hold down the costs of Pharma. Shockingly, or perhaps not, not one of these fundamentals of his campaign healthcare plan made it into the final legislation. I hold that the reason is that any one of these proposals would have had a a salutary effect in controlling prices and promoting competition, so naturally every one of these planks were removed by the input of industry lobbyists whose input essentially wrote the resulting bill.
What we have right now is insurance that most cannot afford to use. The people who made out the best were the poor (at least income wise) who qualified for Medicaid expansion (albeit with the clawback provision for those between 55-65) and the wealthy for whom the costs of out-of-pockets and deductibles was never a concern in the first place. The vast numbers of working poor and moderate income Americans were tossed into a place where they had coverage as long as they didn't need to use it.
One of the weirder aspects of the ACA is the punitive fashion it takes to so-called "Cadillac plans", more expensive plans, some with great coverage and low deductibles, which it attempts to completely remove from the marketplace with a onerous tax of 40% set to kick-in in 2020. These are/were the kind of benefits that unions fought for and forwent wage increases to get. But the "Cadillac" status is determined solely by the cost of the plan and not by the benefits provided, so some companies with expensive plans as a result of underwriting an older/sicker pool of employees may get caught up and labelled as "Cadillac" and end up with this crazy tax burden which will most likely be passed along to the employees.
Another issue is the "family glitch" where a spouse and family of a worker who has employer provided coverage whose cost for that individual worker is less than 9.5% is deemed ineligible for subsidies and an exchange policy for the family even if the cost of family coverage with the employer is way over 9.5%, which seems to be the majority of family policies compared to family income. If you are unaware of this "glitch" - read here:For Family Trapped In The ACA's Glaring "Glitch", Life Gets Harder and also read the comments. "Glitch" seems such an innocuous and inappropriate word for a bureaucratic snafu, if that's what it is, that consigns many of American families to lack of coverage and financial ruin if a family member falls ill or gets into an accident.
Whenever I bitch about the ACA, I try to remember, that yes it did some good things. Probably the best things it did was establish that trying to eliminate people with pre-existing conditions is a no-go, as is lifetime caps, as is rescission. But the tension between the ACA without those profit protectors for the insurance industry is destined to eventually cause the entire system to blow up because the industry NEEDS those policies to cherry-pick coverees and maintain their profit margins.
The lesson here is you cannot serve two masters. The Democrats had a choice as to whether they would design a working healthcare program that would lower costs and serve the public and provide actual affordable healthcare as touted in the name of the legislation OR they could bow to the will of the united front of healthcare industries (primarily insurance and pharma but some providers as well) whose goal was the direct opposite - maintain their for profit placement as the nexus of the system and eliminate any and all effective price controls. Note here that the Medical Loss Ratio has no effect in controlling actual costs, it actually is a legislated profit ceiling of 20-25% of direct health expenditures but can actually result perversely in encouraging higher costs (i.e. if the insurer is allowed to retain 25% of 100K in expenditures, why should they be motivated to keep expenditures at 50K?).
If one was going to be their most cynical, they could imagine that the ACA, an industry written program, was designed to offer the illusion of coverage and not actual coverage because, at its heart that's exactly what it does. If you can afford your premium and you avoid major illness or catastrophe, you can go about your merry way believing that you have healthcare in the great ole USofA which is unable to separate the profits of the few from the lives of the many.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
This is worth repeating:
This is worth repeating:
"People always have been the foolish victims of deception and self-deception in politics, and they always will be until they have learnt to seek out the interests of some class or other behind all moral, religious, political and social phrases."