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Old 05-05-2016, 01:44 AM
 
93 posts, read 53,185 times
Reputation: 92

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"It is that question that we must ask and answer in the US - what are people willing to give up to get a single payor system, because we will have to give up things. We might be willing to do it, but let's not pretend that we can simply institute a single payor system and keep all the benefits we currently enjoy in our current system."

I apologize here, but only have a short time and cannot answer all of your post. When I have more of the luxury called "a few moments" I will get back to it.

I heartily disagree with this argument. For one, we spend the most of any nation on this planet for health care. In 2014, our total tab was about $3 trillion dollars. How much of this is wasted on needed administration costs, for example? And then there are the $30 million in salaries and more taken home by the health insurance CEO's. These dollars do not go to health care; they are, in fact, taken out of the health system to go to these superfluous costs. We have more than enough to ensure that all of our citizens can get quality health care if we as a nation chose to do this. So far, we would rather see CEO's compensated like this than insuring all Americans.

More later.


FastStats - Health Expenditures

Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program
Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program

 
Old 05-05-2016, 07:06 AM
 
1,246 posts, read 919,712 times
Reputation: 1433
Quote:
Originally Posted by asusual View Post
"It is that question that we must ask and answer in the US - what are people willing to give up to get a single payor system, because we will have to give up things. We might be willing to do it, but let's not pretend that we can simply institute a single payor system and keep all the benefits we currently enjoy in our current system."

I apologize here, but only have a short time and cannot answer all of your post. When I have more of the luxury called "a few moments" I will get back to it.

I heartily disagree with this argument. For one, we spend the most of any nation on this planet for health care. In 2014, our total tab was about $3 trillion dollars. How much of this is wasted on needed administration costs, for example? And then there are the $30 million in salaries and more taken home by the health insurance CEO's. These dollars do not go to health care; they are, in fact, taken out of the health system to go to these superfluous costs. We have more than enough to ensure that all of our citizens can get quality health care if we as a nation chose to do this. So far, we would rather see CEO's compensated like this than insuring all Americans.

More later.


FastStats - Health Expenditures

Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program
Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program


Because the Gov't is excellent at cost control, all of their programs are run so efficient they serve as a model for the private sector! The same waste you say goes to admin costs will still be tied up in the layers of bureaucracy. Only difference is in the private sector if someone messes up, they can get cut. In the federal system you dream of you get a crappy person running the system you're stuck with them.
 
Old 05-05-2016, 08:11 AM
 
285 posts, read 272,507 times
Reputation: 286
Quote:
Originally Posted by asusual View Post
I heartily disagree with this argument. For one, we spend the most of any nation on this planet for health care. In 2014, our total tab was about $3 trillion dollars. How much of this is wasted on needed administration costs, for example? And then there are the $30 million in salaries and more taken home by the health insurance CEO's. These dollars do not go to health care; they are, in fact, taken out of the health system to go to these superfluous costs. We have more than enough to ensure that all of our citizens can get quality health care if we as a nation chose to do this. So far, we would rather see CEO's compensated like this than insuring all Americans.
read what I said again, all of it. I fully admitted early benefits in the form of (relative) cost savings as you cut out some redundant administration. Yes, if we magically changed over to a single payor system tomorrow, and took all the money we spend today, and plunked it into a single payor system tomorrow, then yes, more dollars would go towards patient care as you eliminate admin overhead/bureaucracy amongst various private insurance companies and redirected the profits away from shareholders and back into patient care. That's a single event in time, though.

I am talking long term. Look at the NHS - they have a (relatively) streamlined system in terms of the bureaucracy. They're still having cost containment issues. Even if you were to take all the profits from private for profit insurance companies and plow them immediately back into care, that is a one time cash infusion. That is NOT a long term solution to the larger questions I posed.

Current expectations in US society revolve around getting the best of care for most/all, at least so goes a version of the single payor argument. That is NOT sustainable long term. Any number of of nationalized health systems around the world prove that. Eventually, someone (or a group of someones) has to make decisions on where to cap health care expenditures (transplants? ECMO? dialysis? end of life care? total days on a ventilator in a lifetime? other things?), and that means that will affect real people with real diseases/conditions that might need medical intervention. Again, see the example of the NHS and chronic hemodialysis (https://ndt.oxfordjournals.org/content/15/10/1647.full). Even the NHS' own people admit there was/is implicit rationing due to a number of factors, not the least of which was the very structure of the NHS.

Quote:
Originally Posted by philberf View Post
You've made a number of assumptions that not all would agree with. A single payor system does not necessarily drive down costs unless you limit expenditures by limiting coverage. The same problem of increased utilization leading to increased costs will exist in a single payor system as in our existing system, unless we cap expenditures (like the NHS does). to be fair, it may initially drop costs as we get rid of a lot of administrative bloat (to start), but that's likely temporary, unless society has a fundamental reorientation towards how we use health care.

Again, it does matter how you define what health care is, because if you claim it to be for the good of the public, you have to define what "good" means and who the "public" are.

Is the "good" all possible interventions? why or why not? last ditch chemotherapy? homeopathy? naturopathy? reiki? anointing with oil? ayurvedic medicine? Someone still has to make these decisions and defend them in the public sphere. And again, for the record, I'm not fundamentally opposed to doing this in our country/state. I am bothered by the unwillingness to face up to the real questions that would help us figure this out.

If we want a single payor system, we need to admit that costs will go up if we don't cap what we do for people, and we have to figure out how to morally/ethically justify capping it in whatever way we end up deciding. As I mentioned before, the NHS decided there are certain things older patients just don't get. things that our older patients here in the US generally DO get. That's one way to control costs. But it requires more than simple legal decree or de facto administrative refusals to morally and ethically justify such decisions.

Lots of things are NOT on the table in Cuba. That doesn't mean it's automatically worse - it just means we really need to be clear about what is offered and to whom. Additionally, because different people have differing notions about what "good" is in general in their life, there are many people who are willing to give up the single payor system in cuba because of the other limitations on the "good life" placed on them in Cuba. Again, that makes the point that health care, even in a single payor system, may not be desirable depending on what other sacrifices/requirements are placed on the people in that society.

It is that question that we must ask and answer in the US - what are people willing to give up to get a single payor system, because we will have to give up things. We might be willing to do it, but let's not pretend that we can simply institute a single payor system and keep all the benefits we currently enjoy in our current system.
 
Old 05-05-2016, 08:31 AM
 
Location: Foot of the Rockies
86,889 posts, read 102,319,187 times
Reputation: 32951
Quote:
Originally Posted by asusual View Post
"You do realize a major reason why hospitals bill so much is because people actually use ER's for primary care physicians?"

Surprisingly, I do understand this and it speaks loudly to why we need a single-payer type system. They use the ER for their primary care physician because they cannot afford to go to a primary care physician. In nations with single-payer systems, they do not have to use the ER for their primary care physicians.

"People literally think the ER is for common ailments like fevers, flu, sprained ankle......Why do you think 24 hr health clinics are popping up everywhere? They're cash cows and people are too stupid to realize they charge a 5x premium of their services."

You're right that these clinics are cash cows for those who run them and profit off of them. I am not sure if the people who go to them are too stupid or too desperate, but I also suspect you are right in that they do not know how much these clinics are ripping them off.

"You reference a Michael Moore movie which all are largely fiction. Using his movie which promotes Cuba of all places to make your point is hilarious. Yes Cuba where their health care is so great thousands of people every year literally try to float their way through shark infested waters for the horrible system the US has."

Well, for one, if thousands of people are fleeing Cuba every year, are they fleeing just for the health care in the USA. I would like to see the basis for that. And Mike Moore's film was not fiction. In fact, health insurance companies were deathly afraid of that movie because it told the truth and did what they could do to discredit it. The fiction you say that it is, is a result of that campaign. Here is a former CEO of an insurance company apologizing to Michael Moore for his role in trying to damage Moore and his movie.


https://www.youtube.com/watch?v=6xlpcDnr7eM
Supposedly, the ACA was going to cut down on ER use because people would have a primary doc and go to him/her instead of the ER. Didn't work that way. In fact, even before the ACA, studies showed that most people in the ER had insurance. I have family members who didn't have primaries, just went to the ER. One now has a goiter, from an inactive thyroid gland. It was never picked up in the ER. Her spouse even said, "The ER doc just treats the symptom you came in for, doesn't put it all together." I wanted to say, "Yep". These people are now on Medicare, and had fabulous insurance through a major employer before that. 24 hour clinics are not for the uninsured who don't have much money. They want to be paid on the spot if you don't have insurance. Some few take Medicaid.

Everything in Michael Moore's movie was technically true, but it's all in the presentation.

Quote:
Originally Posted by asusual View Post
"It is that question that we must ask and answer in the US - what are people willing to give up to get a single payor system, because we will have to give up things. We might be willing to do it, but let's not pretend that we can simply institute a single payor system and keep all the benefits we currently enjoy in our current system."

I apologize here, but only have a short time and cannot answer all of your post. When I have more of the luxury called "a few moments" I will get back to it.

I heartily disagree with this argument. For one, we spend the most of any nation on this planet for health care. In 2014, our total tab was about $3 trillion dollars. How much of this is wasted on needed administration costs, for example? And then there are the $30 million in salaries and more taken home by the health insurance CEO's. These dollars do not go to health care; they are, in fact, taken out of the health system to go to these superfluous costs. We have more than enough to ensure that all of our citizens can get quality health care if we as a nation chose to do this. So far, we would rather see CEO's compensated like this than insuring all Americans.

More later.


FastStats - Health Expenditures

Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program
Skyrocketing salaries for health insurance CEOs | Physicians for a National Health Program
Someone will have to administer a single-payer system as well. It's not going to run itself. The government does not have the greatest track record for efficiency.

Quote:
Originally Posted by philberf View Post
read what I said again, all of it. I fully admitted early benefits in the form of (relative) cost savings as you cut out some redundant administration. Yes, if we magically changed over to a single payor system tomorrow, and took all the money we spend today, and plunked it into a single payor system tomorrow, then yes, more dollars would go towards patient care as you eliminate admin overhead/bureaucracy amongst various private insurance companies and redirected the profits away from shareholders and back into patient care. That's a single event in time, though.

I am talking long term. Look at the NHS - they have a (relatively) streamlined system in terms of the bureaucracy. They're still having cost containment issues. Even if you were to take all the profits from private for profit insurance companies and plow them immediately back into care, that is a one time cash infusion. That is NOT a long term solution to the larger questions I posed.

Current expectations in US society revolve around getting the best of care for most/all, at least so goes a version of the single payor argument. That is NOT sustainable long term. Any number of of nationalized health systems around the world prove that. Eventually, someone (or a group of someones) has to make decisions on where to cap health care expenditures (transplants? ECMO? dialysis? end of life care? total days on a ventilator in a lifetime? other things?), and that means that will affect real people with real diseases/conditions that might need medical intervention. Again, see the example of the NHS and chronic hemodialysis (https://ndt.oxfordjournals.org/content/15/10/1647.full). Even the NHS' own people admit there was/is implicit rationing due to a number of factors, not the least of which was the very structure of the NHS.
 
Old 05-05-2016, 08:44 AM
 
1,246 posts, read 919,712 times
Reputation: 1433
^Studies even show most that are uninsured can afford it, they just choose not to. Why have insurance when you can have a iPad?
 
Old 05-07-2016, 12:35 AM
 
93 posts, read 53,185 times
Reputation: 92
"Because the Gov't is excellent at cost control, all of their programs are run so efficient they serve as a model for the private sector! The same waste you say goes to admin costs will still be tied up in the layers of bureaucracy. Only difference is in the private sector if someone messes up, they can get cut. In the federal system you dream of you get a crappy person running the system you're stuck with them."

"Only difference is in the private sector if someone messes up, they can get cut. "

I would love to see some stats on this, on how many who "mess up," in private insurance get cut. I suspect that it is more their insurees who get cut rather than the employees or the CEO's of the private insurance company.

"The same waste you say goes to admin costs will still be tied up in the layers of bureaucracy."


If this were true, then why are the Medicare admin costs consistently lower than private insurance. Medicare is a single-payer health program for senior citizens. If this is as you say, then why are nations with single-payer health systems consistently less expensive while covering all their citizens, not piecemeal like us.


Medicare Is More Efficient Than Private Insuranc
Medicare Is More Efficient Than Private Insurance

"Because the Gov't is excellent at cost control, all of their programs are run so efficient they serve as a model for the private sector!"

I am not sure what you are trying to get at here, whether parody or actually suggesting that this is what really goes on, or whether you are parodying Obamacare, but if the private sector did model their vast numbers of plans on private insurance maybe there would be some sense to them.

" In the federal system you dream of you get a crappy person running the system you're stuck with them."

Well, there is such a thing as the vote.
 
Old 05-07-2016, 12:40 AM
 
93 posts, read 53,185 times
Reputation: 92
[COLOR="rgb(0, 100, 0)"]"^Studies even show most that are uninsured can afford it, they just choose not to. Why have insurance when you can have a iPad?"[/color]

Again, please prove it with the data to show this. I am sure that you will find that the uninsured are not exactly choosing iPads over health insurance, but lack health insurance because they simply cannot afford its huge costs.
 
Old 05-07-2016, 01:17 AM
 
93 posts, read 53,185 times
Reputation: 92
I am talking long term. Look at the NHS - they have a (relatively) streamlined system in terms of the bureaucracy. They're still having cost containment issues. Even if you were to take all the profits from private for profit insurance companies and plow them immediately back into care, that is a one time cash infusion. That is NOT a long term solution to the larger questions I posed."

I think the problem with this argument is that the NHS once was a streamlined system in terms of how it function and its bureaucracy. Conservative governments in Great Britain have been secretly nibbling away at it to hand over the NHS in bits and pieces to private insurance. The current government of David Cameron is trying to do this as best as it can without getting caught at it. This is creating huge problems with "cost containment issues," not to mention access problems as well. As the GOP here well knows, if you want to privatize a public service or a public benefit, like Medicare for instance, you first talk up dire warnings how much it is in the red and can only be saved from bankruptcy by selling it off to private insurance.

"Eight reasons you really can't trust the Tories with the NHS | openDemocracy
https://www.opendemocracy.net/ournhs/caroline-molloy/eight-reasons-you-really-can't-trust-tories-with-nhs"

"Current expectations in US society revolve around getting the best of care for most/all, at least so goes a version of the single payor argument. That is NOT sustainable long term. Any number of of nationalized health systems around the world prove that."
Eventually, someone (or a group of someones) has to make decisions on where to cap health care expenditures (transplants? ECMO? dialysis? end of life care? total days on a ventilator in a lifetime? other things?), and that means that will affect real people with real diseases/conditions that might need medical intervention."

I am not sure what you mean by this. Does this mean that in single-payer systems every person who needs a transplant is judged on whether they meet certain criteria before they can get the transplant? Are they a smoker? Drinker? Are they too old? If you are ninety-five and need a kidney transplant do you get one? If you're fifty and get cancer do you get the chemo? We have the same kinds of decisions here, only they are ruled by the profit motive. Are you a drinker? The insurer will not pay for the liver transplant. Do you need a hip transplant, but cannot afford the supplemental medicare insurance? Well, you're going to keep your old hip. And if the insurer feels that your illness threatens the bottom line, they will deny the claim and force you to pay for it. Or they seek what is called "prior authorizations," for every procedure.

When you say that "Current expectations in US society revolve around getting the best of care for most/all," is "Not sustainable long term" are you saying that some should get the best care and others should not, or get none at all, and that this is the only way to keep a health care system sustainable? Maybe I missed something here, but I think we could make it sustainable in the long term if we wanted to do it.












Again, see the example of the NHS and chronic hemodialysis (https://ndt.oxfordjournals.org/content/15/10/1647.full). Even the NHS' own people admit there was/is implicit rationing due to a number of factors, not the least of which was the very structure of the NHS.
 
Old 05-07-2016, 08:46 AM
 
285 posts, read 272,507 times
Reputation: 286
Quote:
Originally Posted by asusual View Post
I think the problem with this argument is that the NHS once was a streamlined system in terms of how it function and its bureaucracy. Conservative governments in Great Britain have been secretly nibbling away at it to hand over the NHS in bits and pieces to private insurance. The current government of David Cameron is trying to do this as best as it can without getting caught at it. This is creating huge problems with "cost containment issues," not to mention access problems as well. As the GOP here well knows, if you want to privatize a public service or a public benefit, like Medicare for instance, you first talk up dire warnings how much it is in the red and can only be saved from bankruptcy by selling it off to private insurance.

"Eight reasons you really can't trust the Tories with the NHS | openDemocracy
https://www.opendemocracy.net/ournhs/caroline-molloy/eight-reasons-you-really-can't-trust-tories-with-nhs"
I am looking at data/studies from LONG before the current government. The example of the herceptin question was with Labour in power. The study I cited was from 1999. It is inherent to the structure of any single payor system that unless you have strong caps on expenditures SOMEWHERE, demand will go up as new technologies/medicines arrive on the scene. The question then becomes one of how to integrate new technologies, when, and how do you do the cost-benefit analysis. Those ethical and moral considerations are rarely seriously discussed in pluralistic societies. They're usually handed down (see Oregon plan).


Quote:
I am not sure what you mean by this. Does this mean that in single-payer systems every person who needs a transplant is judged on whether they meet certain criteria before they can get the transplant? Are they a smoker? Drinker? Are they too old? If you are ninety-five and need a kidney transplant do you get one? If you're fifty and get cancer do you get the chemo? We have the same kinds of decisions here, only they are ruled by the profit motive. Are you a drinker? The insurer will not pay for the liver transplant. Do you need a hip transplant, but cannot afford the supplemental medicare insurance? Well, you're going to keep your old hip. And if the insurer feels that your illness threatens the bottom line, they will deny the claim and force you to pay for it. Or they seek what is called "prior authorizations," for every procedure.

When you say that "Current expectations in US society revolve around getting the best of care for most/all," is "Not sustainable long term" are you saying that some should get the best care and others should not, or get none at all, and that this is the only way to keep a health care system sustainable? Maybe I missed something here, but I think we could make it sustainable in the long term if we wanted to do it.
I mean that single payor systems have to decide what they will pay for ahead of time. You can't just have an open ended single payor system. No single payor system in the world is open-ended that way. That could consume an entire country's GDP. There are going to be allocation of resource questions in a single payor system, just like ANY healthcare system.

I am fully aware of, and have admitted that we currently ration care based on who can pay. That's not a debate. I'm not trying to defend it. I'm saying that a single payor system will have to answer the same questions and make the moral and ethical case that the limitations in their system are somehow preferable to the present one, and justify the moral authority for those limitations. The patients with breast cancer in the NHS between 1999 and 2006 simply did not have access to herceptin, because of administrative decree. Is that morally justifiable to keep that new medicine from them when it could have benefited them? why or why not? How would one determine the answer to the same question (new medicine X) and when it would be covered in a single payor system in CO or the US? I don't see any discussion of that around amendment 69.

I haven't said anything about what should be. I am simply pointing out that it is not possible to provide the best of care for all people at a low cost. We might all be willing to pay lots of taxes to allow all people to get the best care. We might not. But we haven't had the robust, meaningful, civil conversation among a pluralistic electorate to really know one way or the other. I think you overestimate just how much agreement exists in CO around taxation, the good life, and how taxation and health care services are conceived of in helping people have the good life. We're a morally and ethically diverse country and state. We HAVE to own up to that and have meaningful, difficult, and civil discussions about how to proceed with that diversity.

How do you propose that we make a system that provides the best care for all people? First, what is best and who is all?
 
Old 05-07-2016, 11:57 AM
 
902 posts, read 522,529 times
Reputation: 3628
Quote:
Originally Posted by philberf View Post

Current expectations in US society revolve around getting the best of care for most/all, at least so goes a version of the single payor argument. That is NOT sustainable long term. Any number of of nationalized health systems around the world prove that. Eventually, someone (or a group of someones) has to make decisions on where to cap health care expenditures (transplants? ECMO? dialysis? end of life care? total days on a ventilator in a lifetime? other things?), and that means that will affect real people with real diseases/conditions that might need medical intervention. Again, see the example of the NHS and chronic hemodialysis (https://ndt.oxfordjournals.org/content/15/10/1647.full). Even the NHS' own people admit there was/is implicit rationing due to a number of factors, not the least of which was the very structure of the NHS.
This is what many Americans do not understand will happen with a single-payer system. I have relatives in other countries who have been denied care because they are too old, in fact they came here and paid their own money to be treated. If I go through the list of older people I know I can count dozens of expensive procedures and surgeries that are considered routine--heart stents, heart valve replacement surgeries, knee replacements, rotator cuff surgeries, diabetes treatments, kidney dialysis,kidney transplant, cancer treatments etc, plus the physical therapies and MRI's, CAT scans that go along with all of those. In a single payer system an uncle who was diagnosed with stage 3 cancer was denied immediate treatment because of his age. Also, with obesity rates skyrocketing I wonder if care will also be rationed along lines of personal-responsibility. Should we pay hundreds of thousands of dollar for surgeries and medications for someone who doesn't exercise and overeats to a point where they are 300 pounds? Will a slim person who exercises and eats right get preferential cancer treatment over another less fit person?Everyone wants these benefits and maybe in theory would be ok with rations until it affected them or someone they loved.
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