More of the same from Biden

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by dblack, Jul 15, 2019.

  1. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    I believe the best method for allocating healthcare dollars is by medically necessary costs. The free market should only be used for non-medically necessary cost such as cosmetic surgery.

    For medical necessary healthcare the decisions should be made by the patient assisted by the doctor. Costs should not be a determining factor. Government's role would be the same as it is now, to review treatment costs. Where treatments fall outside medically recommended guidelines or for certain procedure, advance approval would be required. This is exactly what insurance companies, Medicare, and Medicaid do today.
     
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  2. dblack
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    dblack Platinum Member

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    It would indeed be nice if costs weren't a "determining factor" when it comes to health care. But that's denying reality. And you've been denying it for several posts in a row. The point I keep making, and you keep ignoring, is that there is not enough money in the federal budget, not enough money in circulation, to provide everyone with all the health care they need.

    We need some mechanism for figuring out who gets health care and who doesn't. Right now, society makes these decisions via the free market. But you don't like that, so what are you suggesting as an alternative?? You keep focusing on giving doctors the authority to make the call, but they have neither the power nor expertise to do so. It's not a question of determining what is medically necessary. It's a question of how to pay for it.
     
  3. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    I think you're exaggerating the cost of providing enough money to meet demand for healthcare. Of course it's more than we are currently spending. However, it will not bankrupt the nation. People do not have an inexhaustible demand for healthcare. They don't use healthcare simple because it's free.
    If that were true, you would expect a large increase in the number colonoscopies when Medicare, and Medicaid made the procedure completely free. However the fact is their was only a 4% increase. When vaccinations for common diseases such as flu and childhood diseases became free of copays and deductibles, the CDC was expecting a big increase in utilization, but it didn't happen. You would expect Medicaid patient utilization to be huge compared to private insurance with high deductibles and copays, yet utilization is lower, not higher. How can this be if the cost is the determining factor? People would over utilizing free services.

    The reason free healthcare to the patient does not result in high utilization is very easy to understand. People do not like to go to the doctor, dentist, or other healthcare providers. They stick needles in you, drill holes in your teeth, put you on diets that excludes the foods you love, and tell you that you have terrible diseases that require long painful treatment.

    Lowering the cost of healthcare will make it possible for more people to use it but it does not mean people will over utilized. People go to the doctor because they feel they must go, not because they want to. I have never heard anyone say, they had a great time in the hospital. I just can't wait to go back. It was so much fun.
     
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    Last edited: Jul 21, 2019
  4. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    For almost every diagnosis, there are commonly accepted treatments. If a doctor deviates from these, he is going to have to justify to a utilization committee in the clinic or hospital he works and to the insurance company or government agency he is submitting the claims. Fees he receive are limited by medicare, medicaid, and insurance company reimbursement rate.

    For example, a cardiologist in the hospital my wife worked decided that all of his patients should wear heart monitors. The hospital utilization committee require him to submit evidence that this was medical necessary for all patients. He backed off on this immediately.
     
    Last edited: Jul 21, 2019
  5. dblack
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    dblack Platinum Member

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    I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?
     
  6. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

    I have Medicare with a supplement that pays all deductibles and coinsurance. I've been to one doctor this year and haven't been in the hospital or ER in many years.

    First, there is no ten million dollar procedure. Second, all 3 patients will get the life saving procedure if they have government insurance. Even if they have private insurance, they will still get the procedure, but they will have to meet their deductibles and copay. If they have no insurance, they may still get the procedure but will probably be driven into bankruptcy.

    The way insurance works, either goverment or private, the subscribers make up an insurance pool. Actuaries use the demographics and health history of members of the pool to determine yearly budget for healthcare payments. For private insurance this budget plus other expenses and profits is used to calculate premiums. For goverment insurance, it becomes part of the yearly federal or state budget request less any funds paid by subscribers.
     
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    Last edited: Jul 22, 2019
  7. dblack
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    dblack Platinum Member

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    You're so fixated on this over-utilization nonsense you're not listening. I'm not saying people will be going to the doctor just because it's "free". I'm saying that when your life is on the line, your demand for health care is, for all intents and purposes, infinite. But our capacity to pay for health care is not infinite. Someone has to make the call for whether it's worth a life's fortune to keep one person alive. If government is footing the bill, ultimately, government will be making this decision. I don't see how you can continue to deny that.
     
  8. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    Ok, I understand
    Because you may demand medical procedures does not mean you're going to get them. There has to be sound evidence that a treatment will improve your condition or extend your life. For a hospital to ignore this means they will not be paid and may even be sued.

    My experience with family members that are facing death with serious illness absolutely do not want infinite amounts of healthcare. They want relief from pain both physical and mental and just want it all to end.
     
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  9. dblack
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    dblack Platinum Member

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    No, you're still ostriching.
    "evidence that a treatment will improve your condition or extend your life" is irrelevant if there isn't enough money in the bank. You seem committed to the delusion that government can provide everyone with all the health care they "need". I've point out, several times that all of us will face a point where we need more health care than we can afford. Does that just not register with your brain?
     
  10. Flopper
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    Flopper Gold Member Gold Supporting Member Supporting Member

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    I think what you want to discuss is paying for healthcare.

    My plan is relatively simple. Older adults would have the option to join Medicare at an earlier age than 65. For example starting in 2021, adults who qualified for Medicare would have the option of joining at age 64. Each year the minimum age would drop by one year until it reaches age 50. Key benefits are:
    • The more costly people to insure, older adults begin leaving the private insurance pools in employer sponsored health plans and individual insurance reducing costs.
    • For those who get insurance through the exchanges, they will certainly find Medicare a better option at an average premium of $135/mo with a low deductible and a coinsurance about the same as on the exchanges. For those that have high medical costs, they would opt for a Medicare supplement sold by private insurance companies which eliminates all deductibles and coinsurance for about $150/mo additional
    • For those with employee sponsored insurance, Medicare would be a better option for some but not all. It depends on how much the employer subsides the insurance and the benefits.
    • Employers would see their spending on health insurance premiums reduce.
    • Employees could have truly portable insurance with Medicare that they could carry from one employer to the next.
    • Employees would be be able to go to almost any hospital in the US and 98% of all doctors with no concern for referrals or networks.
    • Those with low income would be able to get help paying premiums.
    • For those that are eligible that want to stay on their employer plan, they could assign their Medicare benefits to their employer which would significantly reduce their premium.
    • Unlike many of the healthcare proposals, stopping and modifying the plan is easy without major repercussions. There is little impact on the healthcare industry and there are no new government regulations on the healthcare industry.
    The not so good stuff:
    • The goverment cost of the plan would increase as more people join it. The cost would be payed partially by the subscriber premiums, taxes on employers who benefit from savings of insuring less employees, the medicare trust, and congressional budget appropriations paid by increases in income tax and corporate tax.
    • There is no drug benefit to Medicare so most people would sign up for a drug plan which would likely cost $20 to $60/mo.
    • There is no coverage outside the US so people would have to buy coverage before traveling abroad or select foreign coverage on a Medicare Supplement.
     
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    Last edited: Jul 22, 2019

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