More of the same from Biden

[rightwinger]

Biden’s healthcare proposal seems the most reasonable and executable

We know the Republicans have no plan at all
Medicare for all may be the best option but may be too big a reach

Expanding Medicaid to cover more low income workers (possibly at a small fee) and offering a low cost public option is a good idea

When it comes to changing a healthcare system in a country, it should to be transitional. A republican plan would be Obamacare with a few changes and a new name just like Trump did with NAFTA. Republicans would be less likely to agree on a plan than Democrats.

What really needs to change is higher reimbursement rates for Medicaid expanded Medicaid in all states, single payer, and negotiation of drug prices.

I’d even go with a public option over single payer
If it becomes that popular, it could eventually become single payer

 

[Flopper]

We can lower the cost of healthcare but it will never be affordable for most Americans without a large measure of government support.

How much healthcare should be affordable?

Ideally, all healthcare should be affordable.

Well, ideally we'd all have infinite wealth. But in the real world we don't have infinite wealth, and we can't have infinite health
care.

The only way to make that happen is for it to be free to all patients. However, making healthcare free to all patients can lead to over-utilization and thus rationing of healthcare.

What is "over-utilization" of health care? Can a person have too much health care in your view? How much is too much?

To avoid this, government will have to make the patient responsible for some of the costs. What those costs might be would be a political decision.

You can say that again!

But what if people can't, or don't, pay these costs?

Consider Medicaid. It is free to all that qualify. The funds allocated by government is not near enough to provide the same level of care one get's with either Medicare or private insurance in most states therefore it is rationed by providing low reimbursement rates to healthcare provider who then limit both quality and quantity of healthcare to the poor. This is what most people fear would be the outcome of Medicare for All. Instead of raising the level of healthcare for the poor, the level of healthcare for the middle class and the wealthy would be lowered to that of the poor.

Yep.

Your questions are related so I'll try to answer all them together. There is a point in the use of healthcare where it become over utilized which simply means people are demanding more care than the system can handle. In our healthcare system we seek to control over utilization in two ways:

• Government or the Healthcare provider limits healthcare delivery to match allocated funds and resources.
• Sufficient Cost are passed on to the patient such that the patient will forgo medical care.

I don't believe either of the above is the right way to limit utilization. The medical care should be based on need not the patient's financial resources nor some arbitrary budget decision made by the government. In other words, patients with serious medical conditions should be able to get medical treatments promptly regardless of their ability to pay. Patients seeking medical care such as employment physicals, yearly doctor visits, medical advice, or "doctor, I have terrible cold" or doctor, "I have a backache", etc... should be handle differently.

What many countries are doing and to some extent in the US is to use internet or phone contact to assign a degree of urgency to the problem and determine the next step which might be an office visit, x-ray, or some common treatment for less serious problems. Personnel specifically trained to ask the right questions are used to determine the first step in the care. The advantages of using this type of first contact is it reduces cost, it's less stressful for patient, and it can deliver needed treatment must faster than waiting to see a doctor in the office. However, there are limits. A doctor is able to better diagnose a problem in an office visit. One of the main purposes of the call is determine whether a doctor's visit is needed.

 

[Flopper]

Biden’s healthcare proposal seems the most reasonable and executable

We know the Republicans have no plan at all
Medicare for all may be the best option but may be too big a reach

Expanding Medicaid to cover more low income workers (possibly at a small fee) and offering a low cost public option is a good idea

When it comes to changing a healthcare system in a country, it should to be transitional. A republican plan would be Obamacare with a few changes and a new name just like Trump did with NAFTA. Republicans would be less likely to agree on a plan than Democrats.

What really needs to change is higher reimbursement rates for Medicaid expanded Medicaid in all states, single payer, and negotiation of drug prices.

I’d even go with a public option over single payer
If it becomes that popular, it could eventually become single payer

I think what should happen is any national healthcare system such as Obamacare should be flexible enough to allow changes because the healthcare system is so complex, there is no way of knowing how successful it will be before it's implemented. Whether that should be built into the law or through regulations, there needs to be a way to fine tune the process and eliminate what does not work without waiting for one our political parties to gain full control of government.

 

[dblack]

We can lower the cost of healthcare but it will never be affordable for most Americans without a large measure of government support.

How much healthcare should be affordable?

Ideally, all healthcare should be affordable.

Well, ideally we'd all have infinite wealth. But in the real world we don't have infinite wealth, and we can't have infinite health
care.

The only way to make that happen is for it to be free to all patients. However, making healthcare free to all patients can lead to over-utilization and thus rationing of healthcare.

What is "over-utilization" of health care? Can a person have too much health care in your view? How much is too much?

To avoid this, government will have to make the patient responsible for some of the costs. What those costs might be would be a political decision.

You can say that again!

But what if people can't, or don't, pay these costs?

Consider Medicaid. It is free to all that qualify. The funds allocated by government is not near enough to provide the same level of care one get's with either Medicare or private insurance in most states therefore it is rationed by providing low reimbursement rates to healthcare provider who then limit both quality and quantity of healthcare to the poor. This is what most people fear would be the outcome of Medicare for All. Instead of raising the level of healthcare for the poor, the level of healthcare for the middle class and the wealthy would be lowered to that of the poor.

Yep.

Your questions are related so I'll try to answer all them together. There is a point in the use of healthcare where it become over utilized which simply means people are demanding more care than the system can handle. In our healthcare system we seek to control over utilization in two ways:

• Government or the Healthcare provider limits healthcare delivery to match allocated funds and resources.
• Sufficient Cost are passed on to the patient such that the patient will forgo medical care.

I don't believe either of the above is the right way to limit utilization. The medical care should be based on need not the patient's financial resources nor some arbitrary budget decision made by the government. In other words, patients with serious medical conditions should be able to get medical treatments promptly regardless of their ability to pay. Patients seeking medical care such as employment physicals, yearly doctor visits, medical advice, or "doctor, I have terrible cold" or doctor, "I have a backache", etc... should be handle differently.

What many countries are doing and to some extent in the US is to use internet or phone contact to assign a degree of urgency to the problem and determine the next step which might be an office visit, x-ray, or some common treatment for less serious problems. Personnel specifically trained to ask the right questions are used to determine the first step in the care. The advantages of using this type of first contact is it reduces cost, it's less stressful for patient, and it can deliver needed treatment must faster than waiting to see a doctor in the office. However, there are limits. A doctor is able to better diagnose a problem in an office visit. One of the main purposes of the call is determine whether a doctor's visit is needed.

Sorry. This all smacks of another extended euphemism to me. The whole "over-utilization" excuse is just a reluctant recognition of the fact that, despite government declarations to the contrary, health care would not be free. Unless you plan on enslaving doctors and nurses, health care is a service that people, for the most part, won't do unless they're paid. All the cost shifting schemes don't make health care more affordable. They just socialize it.

 

[rightwinger]

We can lower the cost of healthcare but it will never be affordable for most Americans without a large measure of government support.

How much healthcare should be affordable?

Ideally, all healthcare should be affordable.

Well, ideally we'd all have infinite wealth. But in the real world we don't have infinite wealth, and we can't have infinite health
care.

The only way to make that happen is for it to be free to all patients. However, making healthcare free to all patients can lead to over-utilization and thus rationing of healthcare.

What is "over-utilization" of health care? Can a person have too much health care in your view? How much is too much?

To avoid this, government will have to make the patient responsible for some of the costs. What those costs might be would be a political decision.

You can say that again!

But what if people can't, or don't, pay these costs?

Consider Medicaid. It is free to all that qualify. The funds allocated by government is not near enough to provide the same level of care one get's with either Medicare or private insurance in most states therefore it is rationed by providing low reimbursement rates to healthcare provider who then limit both quality and quantity of healthcare to the poor. This is what most people fear would be the outcome of Medicare for All. Instead of raising the level of healthcare for the poor, the level of healthcare for the middle class and the wealthy would be lowered to that of the poor.

Yep.

Your questions are related so I'll try to answer all them together. There is a point in the use of healthcare where it become over utilized which simply means people are demanding more care than the system can handle. In our healthcare system we seek to control over utilization in two ways:

• Government or the Healthcare provider limits healthcare delivery to match allocated funds and resources.
• Sufficient Cost are passed on to the patient such that the patient will forgo medical care.

I don't believe either of the above is the right way to limit utilization. The medical care should be based on need not the patient's financial resources nor some arbitrary budget decision made by the government. In other words, patients with serious medical conditions should be able to get medical treatments promptly regardless of their ability to pay. Patients seeking medical care such as employment physicals, yearly doctor visits, medical advice, or "doctor, I have terrible cold" or doctor, "I have a backache", etc... should be handle differently.

What many countries are doing and to some extent in the US is to use internet or phone contact to assign a degree of urgency to the problem and determine the next step which might be an office visit, x-ray, or some common treatment for less serious problems. Personnel specifically trained to ask the right questions are used to determine the first step in the care. The advantages of using this type of first contact is it reduces cost, it's less stressful for patient, and it can deliver needed treatment must faster than waiting to see a doctor in the office. However, there are limits. A doctor is able to better diagnose a problem in an office visit. One of the main purposes of the call is determine whether a doctor's visit is needed.

Sorry. This all smacks of another extended euphemism to me. The whole "over-utilization" excuse is just a reluctant recognition of the fact that, despite government declarations to the contrary, health care would not be free. Unless you plan on enslaving doctors and nurses, health care is a service that people, for the most part, won't do unless they're paid. All the cost shifting schemes don't make health care more affordable. They just socialize it.

Doctors need to be able to shift their effort from placating insurance companies to serving their patients

 

[Flopper]

We can lower the cost of healthcare but it will never be affordable for most Americans without a large measure of government support.

How much healthcare should be affordable?

Ideally, all healthcare should be affordable.

Well, ideally we'd all have infinite wealth. But in the real world we don't have infinite wealth, and we can't have infinite health
care.

The only way to make that happen is for it to be free to all patients. However, making healthcare free to all patients can lead to over-utilization and thus rationing of healthcare.

What is "over-utilization" of health care? Can a person have too much health care in your view? How much is too much?

To avoid this, government will have to make the patient responsible for some of the costs. What those costs might be would be a political decision.

You can say that again!

But what if people can't, or don't, pay these costs?

Consider Medicaid. It is free to all that qualify. The funds allocated by government is not near enough to provide the same level of care one get's with either Medicare or private insurance in most states therefore it is rationed by providing low reimbursement rates to healthcare provider who then limit both quality and quantity of healthcare to the poor. This is what most people fear would be the outcome of Medicare for All. Instead of raising the level of healthcare for the poor, the level of healthcare for the middle class and the wealthy would be lowered to that of the poor.

Yep.

Your questions are related so I'll try to answer all them together. There is a point in the use of healthcare where it become over utilized which simply means people are demanding more care than the system can handle. In our healthcare system we seek to control over utilization in two ways:

• Government or the Healthcare provider limits healthcare delivery to match allocated funds and resources.
• Sufficient Cost are passed on to the patient such that the patient will forgo medical care.

I don't believe either of the above is the right way to limit utilization. The medical care should be based on need not the patient's financial resources nor some arbitrary budget decision made by the government. In other words, patients with serious medical conditions should be able to get medical treatments promptly regardless of their ability to pay. Patients seeking medical care such as employment physicals, yearly doctor visits, medical advice, or "doctor, I have terrible cold" or doctor, "I have a backache", etc... should be handle differently.

What many countries are doing and to some extent in the US is to use internet or phone contact to assign a degree of urgency to the problem and determine the next step which might be an office visit, x-ray, or some common treatment for less serious problems. Personnel specifically trained to ask the right questions are used to determine the first step in the care. The advantages of using this type of first contact is it reduces cost, it's less stressful for patient, and it can deliver needed treatment must faster than waiting to see a doctor in the office. However, there are limits. A doctor is able to better diagnose a problem in an office visit. One of the main purposes of the call is determine whether a doctor's visit is needed.

Sorry. This all smacks of another extended euphemism to me. The whole "over-utilization" excuse is just a reluctant recognition of the fact that, despite government declarations to the contrary, health care would not be free. Unless you plan on enslaving doctors and nurses, health care is a service that people, for the most part, won't do unless they're paid. All the cost shifting schemes don't make health care more affordable. They just socialize it.

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

 

[dblack]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

 

[Flopper]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

No, I did not say that nor do I believe it. Nor do I believe the free market should determine who get's healthcare and who doesn't.

 

[dblack]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

No, I did not say that nor do I believe it. Nor do I believe the free market should determine who get's healthcare and who doesn't.

So, if not the government, and if not the free market - what? God?

 

[rightwinger]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

We want the market to tell people they can’t afford healthcare?

 

[dblack]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

We want the market to tell people they can’t afford healthcare?

"The market" is just society, freely collaborating. So, yes. It's a much better mechanism that government mandate.

 

[Flopper]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

No, I did not say that nor do I believe it. Nor do I believe the free market should determine who get's healthcare and who doesn't.

So, if not the government, and if not the free market - what? God?

The people that are best equipped to determined the need for healthcare services, healthcare professionals and the patient should be first point of contact for patient.

By making a patients first contact a medical profession by phone or Internet, instead of the a receptionist that schedules appointments, we could establish a priority for service and actually handle a number of medical problems without an office visit.

 

[dblack]

The people that are best equipped to determine the need for healthcare services, healthcare professionals and the patient should be first point of contact for patient.

They're not at all equipped to solve the actual problem, which isn't assessing the needs of an individual - it's balancing the needs of an individual patient with the needs of all the other patients (ie rationing).

 

[rightwinger]

Biden has a healthcare plan

Where is Trumps?

 

[Flopper]

The people that are best equipped to determine the need for healthcare services, healthcare professionals and the patient should be first point of contact for patient.

They're not at all equipped to solve the actual problem, which isn't assessing the needs of an individual - it's balancing the needs of an individual patient with the needs of all the other patients (ie rationing).

The healthcare providers I'm speaking of are doctors and physicians assistants who are certainly equipped to act as triage before making any office appointments. Even today, millions of people every year run to their doctor with nothing but a common cold, an employment physical, backache from to much exercise, advice on common medical problems and thousand of other rather trivial medical problems. Also, many other people that should be seen by a doctor or ER failed to do so due to cost but also due to the problem of getting to the doctor. If you're very ill just getting out of bed and going to a doctor can be a monumental task.

By use of technology and the internet physicians are able to do much of the same thing on line that they do in the office at a much lower costs to the patient.

Depending on the situation they can schedule the patient to see a specialist or have diagnostic test done or possibly just call in a prescription.

 

[Flopper]

The people that are best equipped to determine the need for healthcare services, healthcare professionals and the patient should be first point of contact for patient.

They're not at all equipped to solve the actual problem, which isn't assessing the needs of an individual - it's balancing the needs of an individual patient with the needs of all the other patients (ie rationing).

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

 

[dblack]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

 

[Flopper]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

 

[Flopper]

I never suggested doctors and nurses should be under paid.

The fact is healthcare is something we all need during our lies. And like anything that is in universal demand with limited supply, it has to rationed in one or another. In the US, healthcare has been rationed based one's ability to pay. Other countries have solved the problem by rationing out healthcare based on the government's ability to pay. IMHO, healthcare should be made available based primarily on the patient's need, not the size of a patient's bank account nor the allocation of government funds.

Right. You're saying government should decide who gets health care and how much, rather than the market. That's exactly what I'm opposed to. I don't want my health care to depend on the good intentions of the next Donald Trump.

We want the market to tell people they can’t afford healthcare?

"The market" is just society, freely collaborating. So, yes. It's a much better mechanism that government mandate.

Neither works very well and probably the best situation is a combination of the free market and government.

In a free market system, the prices for services such as healthcare would be determined by who will pay most for services with no regard for who needs the most. In such system the best healthcare goes to wealthiest, the least healthcare goes to poorest, and no healthcare goes to those who can pay nothing. Such as system is of course unworkable for many reasons.

The government system can't respond properly to demand and supply and thus will over allocate and under allocate resources. Worst yet, a government healthcare system provides little financial incentive for healthcare providers to excel. The demand for protection of taxpayer funds and unbiased allocation of resources guarantee a large cumbersome bureaucracy.

Thus we are left with a combination of the above for both practical and political reasons. IMHO, all delivery of healthcare should be done by private enterprise. The payment system should be a single payer system with yearly deductibles and co-insurance. Private healthcare supplemental insurance would be available. Premiums would be adjusted by income.

 

[dblack]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.