francoHFW
Diamond Member
GD Pub dupes. France NHC is rated#1, costs about 10% of GDP. Ours is #38, costs 18% and skyrocketing, 45k deaths, 750k bankruptcies. Absolute idiocy.
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...Socialized medicine at some point is going to have to butt heads with individual liberty and that's going to be tough for a country like ours who prides itself on individual liberty. If state run, they will have to control costs. Which means they will have to at some point essentially tell people what they can and can't do as it effects the cost of paying for people's health care. If you're going to insist that government needs to administer this, by way of funding through ME, the taxpayer. Then you better be damn sure I'm going to want a say in how you live your life. What a person most certainly doesn't have a right to do is waste someone elses money. I have tried to ask those in favor of government single payer if they are okay with giving the rest of society the right to dictate how they live. As you can imagine it's been rather quiet.
You're forgetting the cost to provide medical treatment to those who can't pay for treatment, those who choose not to or are not permitted to buy health insurance (pre-existing condition) and those who must sell their home to pay for care. You also ignore the loss of productivity, the higher cost of delay and the ability of Universal Preventable Health Care can slow down a pandemic or the transmission of communicable disease.
No I'm not forgetting about it at all. I'm trying to bring those costs down. One of the best ways to do that is for the consumer to get involved with the product they're consuming. Let's take each of the groups you mention one at a time:
Those that can't pay for it: Expand medicare to this group of people.
Those who choose not to: if you choose not to engage in preventative care for yourself, J. Q. Taxpayer certainly shouldn't be on the hook for the consequences of that. We need to get away from this overly romanticized idea that all life is sacred and that it's cruel to allow others to suffer. A brutal reality of our world is that it's probably over populated and is getting even more so. Let's not waste time and other people's money trying save those who appear to not be interested in saving themselves.
Those who have to sell their house:? That's a little confusing. One shouldn't have to sell their house to pay for preventative care. It doesn't cost that much.
Lost productivity? I'm not sure what you mean by that. Who is going to be less productive?
Let's skip the metaphors and deal with real world facts. There is no reason a private provider can't offer a no frills policy, I never said they could not. A public option in my example provides medical insurance at public hospitals, provided by employees of county or state government. Generally no private rooms, no fancy art, no piano in the lobby. No frills; simply good basic medical treatment.
"Liberal Fascism" is absolute drivel- The Economist...You are a brainwashed Beckbot. LOL!!
Let's skip the metaphors and deal with real world facts. There is no reason a private provider can't offer a no frills policy, I never said they could not. A public option in my example provides medical insurance at public hospitals, provided by employees of county or state government. Generally no private rooms, no fancy art, no piano in the lobby. No frills; simply good basic medical treatment.
Actually it has been my experience that it's the state funded hospitals that have the extra frills. It should intuitively makes sense that is the case since the consumer of the product is so far removed from the costs of services at hospitals funded that way. But you do essentially admit there is a demand for more basic care and facilities?
Let's answer that by looking at the purpose of a private business. To make money right? Of course. HOW does a private business make money? By doing what their customer's want. That's business at the most basic level. That's the only way the relationship between consumer and service provider survives over time. The consumer get's what they want and compensate the provider for providing it. Private employees are incentivized to provide what people want. State employees are not. Private employees are incentivized to deliver quality to retain customers. State employees are not. I don't know how more basic to make it. The private sector is better suited for meeting people's needs because it's in their financial best interest to do so. That isn't true of state employees. Since a customer isn't going to take their money elsewhere they have less incentive to maintain quality. So why wouldn't a hospital jump at the chance to not waste money on all those extras if there's not demand for it? Answer: Because the consumer isn't paying for them. Insurance companies are paying for them or tax payers are indirectly paying for them. Or in some cases because those aesthetics are in fact demanded by the consumer. Many patients associate a utilitarian look with unfriendliness or uncleanliness.
Sorry, sometime when I try to be brief I make leaps. My point is there is no safety net for the responsible citizen hit with a catestropic illness/injury when his/her policy has reached it's limit. I see two necessary solutions: 1) Universal Preventative Health Care; 2) a no frills public option with services provided by state/county hospitals & clinics.
We are less productive when employees and managers, etc. miss work as a result of illness whatever the etiology.
Let's skip the metaphors and deal with real world facts. There is no reason a private provider can't offer a no frills policy, I never said they could not. A public option in my example provides medical insurance at public hospitals, provided by employees of county or state government. Generally no private rooms, no fancy art, no piano in the lobby. No frills; simply good basic medical treatment.
Actually it has been my experience that it's the state funded hospitals that have the extra frills. It should intuitively makes sense that is the case since the consumer of the product is so far removed from the costs of services at hospitals funded that way. But you do essentially admit there is a demand for more basic care and facilities?
Let's answer that by looking at the purpose of a private business. To make money right? Of course. HOW does a private business make money? By doing what their customer's want. That's business at the most basic level. That's the only way the relationship between consumer and service provider survives over time. The consumer get's what they want and compensate the provider for providing it. Private employees are incentivized to provide what people want. State employees are not. Private employees are incentivized to deliver quality to retain customers. State employees are not. I don't know how more basic to make it. The private sector is better suited for meeting people's needs because it's in their financial best interest to do so. That isn't true of state employees. Since a customer isn't going to take their money elsewhere they have less incentive to maintain quality. So why wouldn't a hospital jump at the chance to not waste money on all those extras if there's not demand for it? Answer: Because the consumer isn't paying for them. Insurance companies are paying for them or tax payers are indirectly paying for them. Or in some cases because those aesthetics are in fact demanded by the consumer. Many patients associate a utilitarian look with unfriendliness or uncleanliness.
I could not disagree more with your comments I highlighted. This is pure bias not based on any data and likely used by you (and demagogues everywhere) as an issue to inflame those who were annoyed by their treatment at the Motor Vehicles Department or the wages and benefits of others. You continue the Right Wing efforts (no matter what you claim) of pitting citizen against citizen, an infamous and outrageous example of what's really wrong with American political discourse today.
State ran health care. From top to bottom. State ran hospitals, clinics and so on. State paid doctors, nurses and everything else. Mandatory waivers of the right to sue. On the job training for as many positions as possible to hold costs low. Every patient and every treatment needs to be looked at from a 'remaining contribution to society/cost of treatment' perspective.
Private healthcare firms can continue to compete as they see fit.
The answers are out there people, we are the last industrialized nation to figure this out. We dont have healthcare because to many shitbags are making huge profits from the existing failed system.
This is pretty extreme. We're going to decide to treat people based on their "remaining contribution to society"? I find that repulsive. What about those born disabled? They'll have to forfeit healthcare from the beginning? The elderly will have used up their allotment? Who get's to decide someone's remaining contribution to society? And what if they do not live up to expectations? Do we go back and remove the liver we transplanted into them and give it to someone else? Who gets to decide what cost is worth how much "contribution"?
Obama's bill was horrible and is largely unpopular. Yet the fact still remains that something needs to be done. So what are the suggestions? How to we improve the health care situation in our country?
The biggest problem we have is that there are serious structural problems with our system as it current functions. You'll sometimes encounter the adage that "Every system is perfectly designed to get the results it gets," which fits well with the important insight that the system we've got is not designed to get the results we want. Given what we spend on it, a system that doesn't give us the outcomes we want is unacceptably low-value (value being the cost to quality ratio).
The Institute of Medicine has been beating this drum for well over a decade and if you're really interested in what a better functioning health care system might look like, it's worth closely reading this article: A Users Manual For The IOMs Quality Chasm Report
To add to/build on/complement that article, I'd copy here a few items from a short wishlist for improving value in health care I laid out in another thread the other day:
- More emphasis on primary care and prevention, particularly through various advanced models of primary care that are gaining steam
- A more holistic philosophy of systems-minded, patient-centered care instead of the disjointed, impersonal mess (and all the havoc it wreaks) we have today
- Better use of ...
...
Free-market....As with auto insurance, no mandates, select what you wish to be covered for, sell across state lines, and ..
Every state has minimum coverage requirements for auto insurance, and mandates every driver to have it. While I also disagree with mandates, I think comparing health care to auto insurance to maintain that position is flawed.
I think we discussed this in another thread. The real fire behind "defensive" medicine is the provider's interest in driving up the costs on the patient, and patient ignorance. Provider's cannot order any procedure that the patient does not consent to. The doctor can advise the patient submit to a test, but the patient can refuse. The doctor cannot force it on the patient. And once the doctor has advised the patient in a reasonable manner, he is no longer at risk for a malpractice claim.... Tort Reform:
While malpractice litigation accounts for only about 0.6 percent of U.S. health care costs, the fear of being sued causes U.S. doctors to order more tests than their Canadian counterparts. So-called defensive medicine increases health care costs by up to 9 percent, Medicare's administrator told Congress in 2005. "
Canada keeps malpractice cost in check - St. Petersburg Times
So, the excuse that the medical business gives of defensive medicine is just that, an excuse. In truth, the medical business is in the habit of constantly upselling their customers, in order to increase revenues. Since patients are often either ignorant of their rights, swayed by fear, and/or ignorant about their general health, most patients scarcely put up resistance when the doctor says "we should do tests x, y, and z."
I suppose you realize this, but this approach it is antithetical to free markets. [...]
The problems we face with health care are precisely because we've indulged the desire for centralized 'system'-ization.
System (from Latin systēma, in turn from Greek σύστημα systēma, "whole compounded of several parts or members, system", literary "composition"[1]) is a set of interacting or interdependent components forming an integrated whole.
A system is a set of elements (often called 'components' instead) and relationships which are different from relationships of the set or its elements to other elements or sets.
A market system is any systematic process enabling many market players to bid and ask: helping bidders and sellers interact and make deals. It is not just the price mechanism but the entire system of regulation, qualification, credentials, reputations and clearing that surrounds that mechanism and makes it operate in a social context.
The concept of interlocking elements forming a well-functioning system is not antithetical to markets...
I dont think its that extreme. I am just dealing in something called REALITY. You know where just because we have the ability to do a 300k heart transplant doesnt mean that everyone should get one.
You want to outlive your usefullness to society?
Then I suggest you get off your ass and make something of yourself so you can pay for private health care.
With regard to your pity on the disabled, disabled people can still contribute to society. If they cannot then it is unfortunate but everyone dies. Why would we spend unlimited amounts of dollars on an investment that will yeild zero results?
At some point we all need to put on our big boy pants and realize that everyone will die. That we cannot spend unlimited amounts of goods and services from society on investments that will never pay off. Its harsh, but it is REALITY. And you need a good strong dose of it.
The concept of interlocking elements forming a well-functioning system is not antithetical to markets...
The kind of 'system' that would be required to dictate the reforms you suggest would be, however. It's that urge to over-control things which has painted us into this corner in the first place.
The concept of interlocking elements forming a well-functioning system is not antithetical to markets...
The kind of 'system' that would be required to dictate the reforms you suggest would be, however. It's that urge to over-control things which has painted us into this corner in the first place.
I think you might be misunderstanding Greenbeard. From what I gather he's saying that the industry itself needs to reform with a different philosophical approach to health care. The points he raises are actually very good ones, and are areas where the health care industry could certainly grow in order to provide a better product.
Aligning Financial Incentives
Quality improvement is innately a preventive strategy. It achieves most of its cost savings by improving care “upstream,” thereby avoiding “downstream” failures and their associated recovery costs. Most clinical savings stem from reduced hospitalizations, reduced emergency department visits, and reduced resource consumption within care delivery episodes. David Clark and coauthors provide specific examples of the cost savings that resulted from clinical improvement efforts at Intermountain.18 Such savings extend well beyond savings from administrative improvements.
Unfortunately, health care providers today are paid for precisely those care delivery episodes that quality improvement seeks to reduce. As Intermountain teams implemented clinical management, clinical outcomes improved and costs fell. However, our payments also fell—often even further than our operating costs. For example, although improvement in Intermountain’s appropriate elective induction rates saved the citizens of Utah more than $50 million per year through reduced payments, Intermountain’s costs fell by only about $41 million. Intermountain thus lost more than $9 million per year in operating margins. Implementing better care required us to invest in education, work-flow redesign, and new data systems. As we improved, the resources to drive further change disappeared. [...]
All of the [Affordable Care] act’s major initiatives to reform the care system—such as accountable care organizations and patient-centered medical homes—are intended to “bend the cost curve.” They reflect sophisticated forms of provider cost sharing, an approach that differs from the health maintenance organization in three major ways.
First, in the past twenty years we have seen great improvement in the science of clinical risk adjustment and quality measurement. Well-organized care delivery groups can apply that science to generate and use robust measures that lead to effective care management. Second, the groups charged with managing the care are clinical teams at the bedside, not distant health insurance companies. The third difference between the new organizational structures proposed in the Affordable Care Act and health maintenance organizations is a major advantage for the former: When a care delivery group reduces health care costs by improving clinical outcomes, some of those savings will flow back to the clinical teams that delivered better care. This aligns financial incentives with efforts to improve clinical quality.
Taken together, these policy changes are crucial. Truly “managed care” means “organized care”—care whose hallmarks include rich clinical and financial data that inform the decisions of clinical teams at the bedside; and clinical teams that employ patient-centered care processes leading to improved population health. Researchers must partner with practitioners to evaluate and demonstrate innovative financial alignment models. A central challenge for policy makers now is to align financial incentives and drive the transition to organized care systems that can provide “the best clinical result at the lowest necessary cost.”