[Updated] The REAL Roadblock To MfA
It's wonderful that so many 2020 Democratic candidates are professing support for Medicare for All (MfA). It's a worthy idea that any civilized society should get behind. The problem, though, is that the discussion often centers around funding, i.e. how to pay for it, or on arcane minutiae regarding plans proposed by specific candidates.
What's usually left unaddressed is the REAL roadblock to MfA. It's not funding. It's spending.
I acknowledge that many other nations have government healthcare. In addition, I fully support government funded medical care for everyone in the United States. But think about it. How do those other nations afford it? Simple. Their costs are much lower: The average spending on healthcare among nations comparable to the US is just 50% of what the US spends.
The United Kingdom spends 42% of what the US spends. Canada 47%. Germany 56%. Source: How does health spending in the U.S. compare to other countries?
Okay, then. Easy-peasy. Let's cut our healthcare spending by 50%. Sounds good, but here's just a few of the questions that popped into my head:
- How exactly do we reduce US medical costs by at least 50% to match other developed nations?
- How do nursing assistants, nurses, orderlies, etc. survive on half their current salary?
- How do we compensate workers whose 401K plans include healthcare stocks that suddenly become worthless?
- Who pays off the student loans of doctors and other medical professionals whose earning potential is eviscerated?
[Update -- fixed incorrect spending figure and added source. Rewrote conclusion.]
In addition, as Baby Boomers retire, Federal healthcare spending will triple in the next 8 years with NO other changes from $1.35 trillion to $3 trillion per year (half of total national spending on healthcare). Source: CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures. How do we pay for that natural increase PLUS adding 250 million others to the tab? PLUS adding additional benefits, such as dental and vision, that some MfA proposals call for?
At some point we must address the elephant in the room: Spending. We spend twice as much as other developed countries. I'm hopeful we will have MfA at some point in our future. I just don't see it easily happening with our current out-of-control medical costs. Some form of medical price controls and nationalization of healthcare infrastructure may also be needed. And of course, if we stopped being the world's military bully, we could use that money as well.
[Addendum]
Here's the link to a PDF file from the Centers for Medicare and Medicaid Services (CMS) that breaks down what healthcare dollars are spent on and who is doing the spending: National Health Expenditures 2017 Highlights.
The what is:
- Hospital Care (33 percent share)
- Physician and Clinical Services (20 percent share
- Retail Prescription Drugs (10 percent share)
- Other Health, Residential, and Personal Care Services (5 percent share)
- Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share)
- Dental Services (4 percent share)
- Home Health Care (3 percent share)
- Other Professional Services (3 percent share)
- Other Non-durable Medical Products(2 percent share)
- Durable Medical Equipment(2 percent share)
The who is:
- Private Health Insurance(34 percent share)
- Medicare(20 percent share)
- Medicaid(17 percent share)
- Out-of-Pocket(10percent share)
Comments
The greatest enemy of knowledge
is not ignorance, it is the illusion of knowledge ~ Stephen Hawking
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
?
Perhaps if Medicare
actually negotiated prices from Pharma, et al, instead of paying them what they demand, that would reduce overall spending amounts. From what little I have read on details, I believe even current Medicare does not really negotiate but pays what is demanded by the "market." Without the massive profits our healthcare industry currently rakes in, would we need to spend even what we do now under the current system? Take that big profit away and perhaps there would not be a need to reduce already low salaries of actual healthcare workers but pay them a living wage. If we included funds to train doctors, which we should I believe, then there would not be massive student loan amounts to have to pay off. As for insurance stocks, well, those would undoubtedly tank, so I have no answer there but someone out here smarter than me probably does.
In the meantime, and you'll probably just roll your eyes that I have to bring it up but I do, there's plenty of money for wars and Wall Street, who we are bailing out yet again as we speak to the tune of billions of dollars, and while our MSM etc don't really talk about that, there's always money for it no matter what. And we Americans accept that, tacitly for sure and probably most don't even tacitly as they simply do not know and are not told about that spending.
If we continue to accept their narrative that "we can't afford it" we'll never get it. Personally I highly doubt it happens in my lifetime but at my current premium of $900 per month as a "benefit" from being laid off, I would obviously be very happy to be proven wrong there.
Only a fool lets someone else tell him who his enemy is. Assata Shakur
Profit is part of it.
Health insurance companies average about 5% profit margin. Drug companies are the big winners, averaging 30% profit margin. Source: How Much Profit Are Health Insurance and Drug Companies Making?.
Currently, administration costs for private health insurance run about 15%. That could potentially be cut in half with MfA, although estimates of actual savings vary.
The profit margin
may look modest, a mere 5%, and that sounds reasonable, not excessive. But when the overall pie of profits gets larger from quarter to quarter, year to year, as it has been for the health insurance industry as they and the providers game the system and find creative ways to squeeze more money out of a complicated opaque system, that 5% translates into considerable increased profits going into the pockets of the industry.
If, say, Humana earns $3b in profits in 2017 with its 5% profit margin, that's not bad. But when it takes in $4b in profits the next year at the same 5% margin, that's even better.
Statistics can be misleading. The health insurance industry from what I've read is swimming in profits, their stock up considerably since ACA was implemented.
The best question to ask
folks is - how much money will you SAVE???
Let's get a grip, here. lizzy got it right - there's plenty of money to institute M4A and pay people accordingly if only the oligarchy would let us spend the money on M4A, infrastructure projects, canceling student debt/providing free college, on and on and on - Bernie's platform - instead of spending the money on WAR, WAR, WAR! The MIC is out of control, but those are our unelected rulers.
It's time for a real uprising - a real movement. Sitting around bitching gets us NOTHING. If only Americans had the courage of their convictions. Those of us with such courage are small voices and need the bigger voices with us. The dying empire is worthless while we continue to elect oligarchs to rule us. As we get more and more tyrannical rule, M4A is the least of our worries.
"The “jumpers” reminded us that one day we will all face only one choice and that is how we will die, not how we will live." Chris Hedges on 9/11
True.
The money is there. It's the spending priorities that are screwed up.
anecdote: medical salaries
there's a guy I come in contact with on the internet whose job is basically handing out pills to patients. He often writes things like "thinking about buying a lake house" or "thinking about buying a boat for my lake house" or "should I hold the door open for the person behind me?"
Anyway...some people in the profession might have problem if their salaries go down. Others make way too much money with the extortionary "you like your health, don't you? now pay up!"
People smirk at stories of how doctors used to practice, coming to your house when you were sick, charging $50 for the visit. As if that's so naive and impractical. But what if grocery stores charged like doctors? What if milk was $7000 a carton? Or eggs? And why not? What about water? Nestle would like to control water and charge whatever they want.
Well that's what's happened in the US health care system.
Oh, and by the way (as Bernie might say), if there was less money involved the lower paid workers would not get 50% less while the top earners also get 50% less. In fact it would weed out the top earners because the assistants are more important to delivering health care.
Good points
The greater number of health care providers are not on the higher end of the scale. Hospice workers, home health aides, volunteers, everyday techs & etc. are the muscle behind assisting the ill. Nurses are striking for better working conditions. Perhaps, thinking macro economics, spending is important.
The bigger issue, to me at least, the industry being controlled by profiteers. Buying health care is a poor example of what most healers and helpers provide.
question everything
Oops
meant to say selling health care (not buying).
question everything
Building in niches for as many middlemen as possible
allows all sorts of possibilities for persons who are not actually involved in the process of production or service delivery to “wet their beaks” / get a cut of the action / collect an economic rent.
Middlemen are kind of like ticks. Too many of them in any profession or supply chain, and both producer and end-user can end up looking like a ghost moose.
Yes, and:
I actually don't have as much of a problem with private-practice doctors' rates, given how much they've been gouged on tuition for their medical education. But I do have a problem with hospital administrators who demand their multi-million-dollar compensation packages (some of which are subsidized by hospital-employed physicians and other practitioners, which also contributes to inflated rates) while those same administrators deny the actual care providers decent wages.
Our university hospital here has systematically been eating up all of the smaller, once-independent facilities in order to create a regional
monopolynetwork that -- lo and behold! -- "requires" even more highly compensated administrators to, um, I don't know, run it I guess.We can't fix the problem of health care costs without addressing this admittedly complex but critical issue.
[Edit: billion to million]
Cowboy Economics
Apologies to those who may have posted this previously:
[video:https://www.youtube.com/watch?v=tqfkmBJhUIQ]
edit: spelling
Entertaining and Informative
Interesting that discussions about being able to "afford" another war don't seem to take the trajectory that M4A does. When the government needs money for war, like magic, they issue the money for war. The Cowboy makes a good point about resources and how the focus doesn't seem to be there. Big surprise, eh?
Thanks for posting this!
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
The only REAL roadblock to MFA
is the 546 clowns minus a handful that run our government
EOS
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
True dat. n/t
Healthcare spending is not a roadblock.
It's the reason we need M4A.
That's the whole point of a single-payer system!
Yes, we spend more than the rest of the civilized world, and get less.
Did you know that under Medicare Part D the government is prohibited from using its bargaining power to negotiate lower prices ?
Getting rid of for-profit insurance companies and their million-dollar CEOs is just the first step. Under a single-payer system we will be able negotiate lower prices, and therefore less spending, in every part of our current obscenely expensive system.
We need to change from delivering profits to delivering healthcare.
We wanted decent healthcare, a living wage and free college.
The Democrats gave us Biden and war instead.
@Azazello Great chart. Thanks for
Great chart. Thanks for sharing.
one small correction
it's not "million-dollar CEOs" it's BILLION dollar CEOs.
On to Biden since 1973
I was just checking on a Part D drug plan today
And what found is that I could go online and buy the three prescriptions I am taking for about $60 every three months when a drug insurance plan could cost as much as $300 per month. So no Part D drug plan for me.
Link if anyone is interested using my blood pressure drug Losartin as an example.
https://www.blinkhealth.com/losartan?med_name_id=6381&med_id=150773&quan...{adposition}&g_feeditemid=&g_location=&g_product_id=150773&g_product_partition_id=4579053614726882&msclkid=1d1cc428b6b11456bfec99e9174ed25a
Blink Health
I'm a Blink Health customer myself, and Blink can be a total godsend lifesaver.
"US govt/military = bad. Russian govt/military = bad. Any politician wanting power = bad. Anyone wielding power = bad." --Shahryar
"All power corrupts absolutely!" -- thanatokephaloides
Good comment.
Replacing insurance companies with Federal healthcare would save the 5% profit the insurance companies make. Reduced administrative fees should save another 7 or 8%.
Drug company profits average 30%. Spending on drugs is 10% of total healthcare spending, so cutting profits in half would add 5% more in total savings.
That adds up to about 18% savings. To save more, we'd have to nationalize healthcare facilities and workers, then reduce prices and salaries.
What about the other overinflated expenses?
The $100 charged by hospitals for a bandaid or an aspirin, for instance? $2,000 for a 10-minute ambulance ride? $20,000 for a procedure that in other countries costs 1/10th of that amount?
Seems to me that in order to adequately answer that question, we need to first ask: why are US medical costs so much higher than in other developed nations?
There are big bucks that are being made in the healthcare industry. I'm not talking about the actual people who provide the services, the doctors, nurses, etc.
I'm talking about Wall Street, and about the corporate CEOs who get obscene bonuses for making sure they do whatever is necessary to enhance corporate stock values.
That's where the real, practical answers to your question will be found.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
Actually, according to this pithy article
It apparently isn't a very lucrative business. I guess all that money Pharma and the Insurance business is pouring into lobbying is for, what exactly?
Hmmmm....so who are you going to believe? A media consortium of whack a mole information, or your lying eyes?
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Remember, those are net profits, not gross profits.
Neverminding the myriad ways in which accountants can make a profit look like a loss, the expenses of those companies include:
A. Bloated executive salaries.
B. Ludicrous marketing budgets (including various expenditures for bribing physicians).
C. Astonishing inefficiencies associated with trying to protect "intellectual property" during research and development.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Thank you
Funny how those bloated Exec salaries never made it into the article, eh? I used to work down on Wall Street as a graphic designer putting together pitch books for large IPO's. I saw first hand how bankers fudged the numbers.
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Agreed, but there's so much more to it.
Large for-profit hospital chains are part of the problem.
In many places these corporate hospitals have a monopoly and charge accordingly.
Doctors ? They might have to take a pay cut, but they'll be OK.
Our docs make about twice as much, on average, as those elsewhere.
We wanted decent healthcare, a living wage and free college.
The Democrats gave us Biden and war instead.
Based upon this article
The majority of doctors now either strongly or somewhat support Medicare for All. There is a link in the article to a poll of doctors that support the point that this writer makes.
Do I hear the sound of guillotines being constructed?
“Those who make peaceful revolution impossible will make violent revolution inevitable." ~ President John F. Kennedy
one option to lower spending-
that other countries will do is to pay health care providers in a "block grant" or "lump sum" style. As an example- say there is a small town clinic with two part time doctors, 5 nurses and three treatment rooms. A healthcare administrator can calculate that this size facility can see X amount of patients and provide Y amount of services. The administrator makes a simple calculation as to the value of X and Y and cuts them an annual check. The clinic provides services and does not waste any time on itemized billing. They just serve the clients needs as best as they can. They do the diagnostics that they feel necessary and don't do them if not necessary.
It turns out that there can be huge savings by switching to this payment style. Think about this- why do diagnostics cost so much? Often the machine is just sitting there waiting to be used. Whether it be an Xray machine or whatever, the cost of the machine sitting there is the real cost. It doesn't cost much more to use it or to not use it. So clinics wouldn't do diagnostics to just pad their bills. But there would be no reason to not do them if they thought it necessary.
So, if your question is really serious, then know that there are many many ways that other nations use to keep their costs down. The real question that we are faced with right now is why do we choose to use the most innefficient and costly system imaginable? Why? Thats the real question.
Exactly. That is the real question.
If you're referring to capitation fees and/or global budgeting,
you're basically describing the funding mechanisms of a typical 'managed care' system.
If you're not referring to managed care, would you please clarify. (Especially, since you mention other countries, which might mean that you have in mind something else.)
My problem with the type of funding you describe is that, for the most part, health care providers stay within their lump sum budgets by mostly employing "utilization management." IOW, so-called 'managed care.'
It's my experience that a lot of folks (Mr M and I, included) prefer the autonomy of making their own medical decisions--including, getting second opinions, seeing specialists--without having to obtain a bureaucrats 'approval,' or jumping through a bunch hoops, etc.
IOW, we wouldn't be too keen on the idea of having medical services denied, due to budgeting considerations. So, we'd much rather stay with the FFS-model of provider reimbursement--like our current 1965 Traditional Medicare--not a capitated system.
IMO, vigilant and thorough auditing, along with the imposition of sanctions/penalties on practitioners who abuse the system, should eliminate the misuse of testing, rendering of unnecessary services and procedures, etc. Certainly, we're not in favor of so-called 'gaming the system.'
Thanks.
Mollie
I think dogs are the most amazing creatures; they give unconditional love. For me they are the role model for being alive.
~~Gilda Radner, Comedienne
Gratitude is not only the greatest of virtues, but the parent of all others.
~~Cicero
The obstacle is the path.
~~Zen Proverb
Everyone thinks they have the best dog, and none of them are wrong.
The simplistic 'accounting method' arguments...
against MfA miss a much larger reason that costs are so high: for-profit health systems promote expensive treatment over inexpensive prevention.
In a for-profit system, nobody makes money until somebody gets sick, so preventing illnesses before they develop into full blown medical problems is not good for the bottom line. In order to maximize profits, the system wants people to be more sick, more often. Simply put, all those extra 'costs' of a for-profit system are a feature, not a bug.
Instead of looking for reasons to increase costs, non-profit systems seek to reduce costs by emphasizing illness prevention, which is far less expensive than treatment and includes the added bonus of creating a much healthier populace over time.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
the problem of people not seeking care until their
situation has deteriorated into the "very expensive to treat" category is well-understood, well-documented, and well-ignored.
there are, amongst the worst of the worst, a subset of individuals whose devotion to a weird and ugly concept of virtue is such that they would rather that 100 people go without valid and deserved care, than that one hypochondriac go to the doctor when it isn't necessary. introducing this sort of calvinist moral blather to the formula for deciding how to provide our citizens with decent healthcare is insane.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
An ounce of prevention...
Let's say the average treatment for metastasized cancer costs $150,000 while a cancer screening costs a free clinic maybe $10.
So every cancer the clinic catches before it metastasizes pays for 15,000 more people to also get screenings, which reduces the number of cancer cases that much more, etc. etc.
Of course, all those fancy, private cancer clinics will lose business but isn't that what we want?
Right. It's the same mentality that doesn't want a sick 'illegal' to be able to see a doctor even though he might infect 100 people if he doesn't.
Not only is such an exclusion immoral on its face, it's also extremely short sighted when it comes to actually preventing the knock on costs of a single illness.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
"Short term"
That's pretty much what our system of financialized capitalism is focused on, to the exclusion of everything else. The only thing it considers is what the immediate impact on share values will be.
That's a big reason why our current system is killing us. It's an insane way to live, and it's unsustainable.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
One thing that the ACA was supposed to do
was let people go to the doctor once a year without having to pay an arm and a leg for it. But the insurance companies found a way around that. If a routine mammogram found breast cancer then they could bill it as diagnostic instead. Pretty sure that goes for other ailments.
My bottom line is that we don't have to reinvent the wheel. Just follow other countries that have sane health care plans and go from there. This way people won't have to decide between paying for rent or food and can see a doctor when they need to and have yearly exams.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
moral blather
spelling and capitalization adjusted to pacify autocorrect
It's insane, yes -- and immoral as well!
"US govt/military = bad. Russian govt/military = bad. Any politician wanting power = bad. Anyone wielding power = bad." --Shahryar
"All power corrupts absolutely!" -- thanatokephaloides
probably "moralizing blather" was the form I wanted ...
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Once I required treatment in Norway—point was pressed home to me
when I received a stern lecture from the doctor about the importance of listening to what my body was telling me and how failing to take good care of myself drags down society in general.
That was the same incident where, when it came time to hand me the hospital bill, the staff had to ask around to find someone who had ever prepared a bill. They finally found an improvised form in a drawer, a photocopy of a photocopy. It took only a minute to type up a one-line invoice for one lump sum covering everything, to be sent to my German health insurer. If I had been Norwegian, no billing procedure would have been necessary at all.
okay ... um ... seriously?
the inefficiencies of our "system" of healthcare are well-documented. we spend a half-trillion a year on billing; and that doesn't include the time that doctors spend on the phone "negotiating" with insurance company stooges to win approval for treating their patients according to their medical expertise. I've seen MDs who talk about spending 2 to 4 hours PER DAY on the phone with hacks whose job is to make sure that their own customers -- the policy-holders -- do not get the care that they were supposedly paying for.
your concern for those at the bottom rungs of providing healthcare is well-meant, but irrelevant. we aren't going to cut the cost of healthcare in half by cutting the wages of orderlies and nurses in half, we're going to do it by cutting the bonuses of pharmaceutical marketing douches 100%. and cutting the salaries of health insurance executives 100%. and yes, eliminating the clerical position in every MD's office that is devoted to nothing but navigating the insurance/billing minefield.
look: the bottom line is that we will spend, as a nation, whatever we're going to spend; whether it's the government spending it is immaterial. what is indisputable is that whatever amount we choose to spend, will be better spent -- more efficiently, more effectively, and across a larger swath of the population -- in a single-payer situation, with the government as the single-payer. every alternative -- which is to say, every system in which the people are paid to do absolutely nothing that has anything to do with actually delivering healthcare, while some capitalists somewhere profit, handsomely or otherwise, must be less efficient and less effective. when every medical procedure or process must return a profit to somebody; while at the same time it must impinge on the profits of somebody else; then the system is just one gigantic tug-of-war to provide the least care for the most money.
so i'm not going to get into an exhaustive list of inefficiencies. suffice to say that i'm not the least bit concerned about our national healthcare budget ballooning to 18 trillion dollars ($50k per capita), unless we leave it in the hands of the profiteers, the marketing douchebags, and miscellaneous other useless eaters sucking on the teat of our dire necessity.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
If you'll pardon the pun..
..this is the money quote:
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
This reminds me
I was recently shopping for a Medicare Supplement policy, and called the big insurance company whose name starts with United. At one point while I was making my way through the phone tree, the recorded voice said this: "Remember that having coverage does not guarantee that you will receive benefits."
What a deal, huh. Give us your money, and we may or may not give you anything in return. That sounds like a great kind of business to be in.
(OK, technically I did get something from them in exchange for my $$. They sent me a Certificate of Coverage. Because that's literally what you're buying when you purchase an insurance policy. You're buying "coverage". Which is not the same thing as "benefits".)
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
Bingo!
This is the problem with our health insurance companies. They don't have to pay for your treatment if they can find a way out of it. One part of our insurance scam is worker's compensation insurance. These days if you get injured at work employers can and will send you to their doctors who will do everything they can to keep you from getting treated. Say your arm gets amputated and you're sent to the company's doctor. You might come out with a report saying that you just sprained it. I'm not really exaggerating here. It's this bad. Hint: one way around that is to make sure that you write down that if you get injured at work you have chosen the doctor you want to see. This might protect you from seeing their hack doctor who has no qualms about screwing you. That is why they get paid big bucks. Another way is to not say you were injured at work even if you have to crawl home and go through your regular insurance. I've been in worker's comp hell for over 20 years now and I'm hearing that it has gotten much worse. Mine is bad enough.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
Black Knight Blue Cross
https://duckduckgo.com/?q=monty+python+just+flesh+wound&iax=videos&ia=vi...
“It’s just a flesh wound!”
It really is almost that bad
Tis but a scratch
My MRI and CT scan showed all kinds of pathology in my back, but the doctors I was sent to for some reason couldn't see them.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
The real roadblock to M4A
is thinking that the stated costs for the 'system' now, are bona fide.
Greed seems to be the main driver at present.
Gëzuar!!
from a reasonably stable genius.
This can be fixed
Congress could insist that insurance companies aren't gouging us by raising premiums so that CEOs can get huge bonuses just for denying people care which they do. They can also negotiate for drug prices. There is no way insulin should cost $300 here when it sells for $30 in Canada. There are numerous other drugs that have seen their prices skyrocket for no reason other than drug companies can do so. Epi pens also went sky high for no other reason than a different company bought it.
UR is spot on this.
I worked in ophthalmology and when patients had urgent retinal emergencies first the front desk person had to punch countless buttons to get to the right person who would then ask questions that they had no idea what the answer meant. After being denied the doctor would then have to take over and describe to a lay person what the disease was and why it needed treatment now. One doctor said it's like having a third grader checking a college professors exam. Time away from patients that made the whole day behind therefore running into after hours and paying overtime... and that was in just one office. Multiply that by every specialist in the country... let's do away with all of that..
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
It's "simple" don'tcha know?
We can't implement M4A because our costs are too high. Other countries can afford healthcare because their costs are much lower. Except for the fact that the OP never identifies what is inflating our astronomical costs, thereby identifying the problem, the argument makes complete sense. Amirite?
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Oh, that makes it sound like the OP is asking in bad faith
which I don’t believe is the case.
When the same OP asked whether c99 was becoming like TOP, much discussion ensued, a lot of which turned out to be quite worthwhile. It would be great if the same thing could happen here.
The current system is less concerned with delivering actual healthcare and is more designed to create maximum money flows and “parasitic” jobs that are made to seem important but boil down to maintaining many parallel silos of administration and sales.
Excellent point. Thanks to the OP for presenting an opportunity for it to be brought out.
Not at all
I think the OP believes what he says. I just think he's wrong. As for yesterday's elucidating essay asking if "we were turning into DKos", I frankly thought it was a bogus comparison and an insult to the founders of this site.
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
My perspective may be skewed by having been a mathematics major
I too thought the “Edg-Kos conjecture” was false from the get-go.
But just as in mathematics, a conjecture that proves to be false still can be very valuable to the field as a whole, if it sets a lot of good minds to the task of — each in their own way — clearly demonstrating that the conjecture is false.
And then there was the humor involved in trying to find an element of the c99 set that would be isomorphic to Armando.
Fair enough
Although any reference to Armando, before breakfast, I could do without
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Guess that picture didn't float your boat either?
I'm sorry, but I couldn't resist posting it.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
No, it didn't Snoopy
But this one I'd be ok with...
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Another thing that can be done
is something that Bernie has talked about. He would enforce the federal antitrust laws, to prevent the kind of unfair market rigging that we see Big Pharma, Big Insurance, and to some extent Big Healthcare, doing today.
This includes price-fixing and the creation of de facto monopolies that deprive the public of true choices. As I've mentioned before, Big Insurance is doing it right now with original Medicare. They're attempting to manipulate the healthcare "marketplace" in many geographic areas, to effectively shut out original Medicare so that people have no real choice except to buy their private Medicare Advantage plans.
As Bernie points out, these things are illegal. He says he would use his DoJ to enforce the existing laws. Of course, it would be good to do this along with enacting tough laws specifically dealing with the "healthcare" industry.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
Huh?
https://people.howstuffworks.com/10-questions-in-u-s-health-care-cost-de...
Uh....okay. So you are telling us that big pharma and insurance companies are pouring millions of dollars into lobbying D.C. for a profit margin of 3%? That simply invites more questions than answers. Isolating numbers like this makes me very inquisitive.
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
Accounting magic.
Just like sports teams are always losing money, yet they're worth hundreds of millions of dollars.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Funny thing about numbers
Kinda like polls that leave out an entire demographic and show Hillary is winning!!!
There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier
A few observations
None of this means anything. Or maybe it does...
Back in my grade school days (late 1950's to early 1960's) one of my classmate-friends was the son of the local surgeon. We used to play in their yard. Their home was in a decent, but far from new, section of our midwestern town. Next door to the doctor lived a bulldozer operator. I can no longer remember who lived on the other side of the doctor's house, but as I recall it was the home of a shoe salesman or hardware buyer ... or something similar.
***
I was born in a frat house. Yes, really. Well, okay ... at the time it was a hospital and later the building was used as a fraternity house. Years ago, my parents showed me the hospital bill they had to pay after my birth. Frankly, I don't remember the exact amount, but it was something on the order of $26.82. Yes, that decimal point is in the right place. To get me born-ed, the hospital, doctor, everything, cost less than thirty bucks.
***
These days, I have to frequent doctor's offices more than I would like. With not so much better to do, I often arrive early. So, I observe. One thing that I see constantly, without fail, is certain well-dressed people - men and women - coming up to the front desk and speaking to the receptionist as they hand them a business card. Usually with no wait, that person is buzzed quickly behind the locked entry to the doctors offices and exam rooms. These folks are always carrying rather bulky bags, larger than briefcases; sometimes they have small wheeled luggage thingys they drag along. These peeps are drug sales men and women. While the rest of us wait and wait for our few minutes with a doctor, these stalwarts of the medical industry have the keys to the kingdom. Evidently.
(By the way, there is a website where you can look up what monies have been fronted to your doctor by the various pharmaceutical companies simply for prescribing their drugs. Check it out.)
***
My wife's brother is a very successful (and wealthy) personal injury attorney. Occasionally, he'll talk shop with my wife and myself. Usually just general talk, no names of course. Around two years ago, he mentioned that the doctors he knows have all had to increase their staff to do paperwork and deal with insurance claims since the Affordable Care Act came into existence. They didn't just double the staff. Generally, they quadrupled the staff ... or more. A close doctor friend of his went from four people doing insurance work to nearly 20. My own endocrinologist completely gave up on the paperwork and insurance haggling and now pays a third-party company to manage it. That company is in Maine; we're in Texas.
Your first observation
seems very relevant. In fact, it's something I think about quite a bit.
I was a kid during that same time period. My parents grew up in poor working class families during the Great Depression. Dad was in the Army Air Corps during WWII, then came home and went to college on the GI Bill. My parents were part of the generation that created the American middle class.
In the early 1960s, my parents bought their first house in the suburbs. My experience was much the same as yours. Teachers, doctors, engineers, salespeople, welders at the local shipyard, airline pilots, airline mechanics, hairstylists, office workers, small business owners, even a US Marshal and a priest lived in our neighborhood.
We all lived together comfortably. The parents socialized with each other. The kids went to school together, played together, roamed the streets together (that was back before helicopter parenting). The one thing they all had in common was that they were building a better life for their families. They wanted their kids to have it better than they did. That period of time was optimistic and forward-looking.
Most of their kids did have it better. Then we (collective "we") grew up, took it all for granted, and destroyed the advantages we had been given. We learned to fight amongst ourselves and "look out for number one" rather than work together for the common good.
I saw a comment on social media by someone who identifies as a "liberal" but who doesn't like Bernie Sanders or his democratic socialist ideas.
The person's stated reason? "We don't want to give up our post-war advantages." He was was referring to post-World War II.
Good god, that horse left the barn 40 years ago. Those post-WWII advantages disappeared a long time ago, with Reagan and Clinton.
I get alternately angry and sad when I think of how things could have been, if what got started in the '50s and early '60s had been allowed to continue and develop.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
The peak generation
I believe my parents generation was the peak. They had it easier than their parents and their kids. Then with my generation, it all started going back downhill. I cry when I think about the kind of world my grandkids will know. Instead of thinking they might have it better than I did or my kids did, I just want them to be able to grow up.
children
I have no children, thank God!
"US govt/military = bad. Russian govt/military = bad. Any politician wanting power = bad. Anyone wielding power = bad." --Shahryar
"All power corrupts absolutely!" -- thanatokephaloides
One small thing we can do
is to keep describing for the younger generation what it was like growing up in that world, and when it changed (and if we get a chance, why and how). So many of them believe that this is all life has to offer.
Lurking in the wings is Hillary, like some terrifying bat hanging by her feet in a cavern below the DNC. A bat with theropod instincts. -- Fred Reed https://tinyurl.com/vgvuhcl
Medical sales persons are the bane of health care
We saw them every day waltz into ur offices carrying goodies for the staff and asking sweetly if they could have a moment of the doctor's time which was usually granted. Back then all kinds of incentives were offered to doctors if they would prescribe their medication over ones that had been working well for years. No research into the side effects or why they might be contraindicated..... I dated a sales rep and the amount of money they made, the free cars, fun meetings ect. The amount of money put into selling drugs is another thing that is wrong here. This was supposed to have been fixed, but people are still getting around the rules.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
This too
The number of companies that spend hours each day dealing with the billing has increased big time as have the companies that go after people who owe on their medical bills. The debt collectors can be downright ruthless going after people who can't pay their medical bills. Imagine dealing with a serious health issue and being hounded to death for something you can't do. 500,000 medical bankruptcies in this country each year. Then of course there are the millions of Americans who don't even have access to insurance. Some disorders are very painful and yet those people have to suffer through it just cuz congress gets to decide that no we shouldn't have affordable health care. Less than 600 people keeping us from having what should be rightfully ours.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.
~Hannah Arendt
It sure does, wow.
Wow,
If that doesn’t draw an image of how drastically (for the worse) things (you name it) have changed, I don’t know what could.
Speechless. Shameful.
Meant as a response to travelerxxx n/t
From my experience living in New Zealand,
Lizzyh7’s, and wouldsman’s comments reflect much about the difference in organisation and cost between America’s and other country’s systems.