Pgh Public Schools to lay off a lot of people. Wow (Harrisburg: credit card, how much)

[BrianTH]

Originally Posted by stburr91

So, people want a single payer system, well, how do you convince the insurance companies to walk away from an industry wroth billions?

Why do you need to convince them? You just pass the relevant laws to create single-payer, and then insurance companies will have to offer a different product.

There are also at least three more gradual paths to adoption of single-payer in the United States. One would be for individual states to start creating single-payer systems. A second would be to start extending downward the eligibility age for Medicare. And the third would be to give people an option to buy into either Medicare, or another similar program.

[squarian]

Of course, there is the possibility that the political structure is so hopelessly corrupt that those insurance billions can simply buy immunity and preserve a system which benefits no one but themselves.

In that dire case, there aren't really many alternatives: either revolution or slow decline and eventual collapse seem the likeliest.

[Bong477]

I dont want to get into semantics over cause and effect or how my post was worded because that is missing the point. Brian, great graph, but Medicare, as I pointed out, pays less to hospitals and doctors than private insurance does. Often around 20% less, sometimes more sometimes less. Medicare often barely covers expenses or sometimes doesn't even do that. Saying medicare costs less is disingenuous because private insurance effectively is cost sharing what the government isn't paying and keeping your doctor in business. Primary care is not sustainable accepting just medicare. Many offices dont accept medicare patients (you dont see this as much in Pittsburgh since most offices are owned by a health system but its common elsewhere). Some specialities still would be profitable (albeit significantly less so), again due to convulted government designed system that rewards doctors and hospitals for doing procedures and tests, not neccessarily doing what is right.

I don't think the current form of health insurance is a good solution, Highmark, whatever... don't think they are any less culpable for the current mess of affairs. They arent your friend or your doctors friend either. And yes, there needs to be some standards so not every company has all their own rules. The current system, again a result of medicare, makes no sense though.

I'm more familiar with the pros and cons of government run healthcare than you might imagine, I've worked at different VA hospitals and outpatient clinics for 8 of the last 9 years. The truth is some things actually run pretty well particularly at the better VAs (Pittsburgh is one of the better ones if anyone. Is wondering) but there are a lot of massive problems with doing anything that requires limited resources (MRI for example can take weeks to get scheduled) or if you want to do something that administration has decided you shouldn't be able to do for cost savings or "safety" issues.

My summary is healthcare is a mess and a complex problem, the government is partially responsible for the mess, its hard for me to imagine that the US government is capable of solving this problem via more regulation and involvement (or complete takeover) given its track record with complex problems like 1) healthcare thus far 2) education 3) poverty 4) drugs 5) crime 6) their own spending 7) do I need to go on? Im glad you have faith (because thats what it is, there is no evidence that this is actually the case) that we can fix these things via government based solutions, not that long ago I would have agreed with you but I've opened my eyes to how things actually work not how I wish they did.

[MeinGlanzendMotorrad]

I think the parents of every child should be responsible for paying to keep the schools open. Take the number of students per school, divide the total amount needed for the budget by that, send a bill to each parent at the start of the school year. Stop taxing people without children.

Don't like it? Vasectomies are about $4-600, one time fee. Planned Parenthood does abortions Tuesdays and Saturdays.

[stburr91]

Originally Posted by BrianTH

Why do you need to convince them? You just pass the relevant laws to create single-payer, and then insurance companies will have to offer a different product.

There are also at least three more gradual paths to adoption of single-payer in the United States. One would be for individual states to start creating single-payer systems. A second would be to start extending downward the eligibility age for Medicare. And the third would be to give people an option to buy into either Medicare, or another similar program.

Brain, if you think the insurance companies would sit by and let that happen, then you and I see the world much differently.

Originally Posted by squarian

Of course, there is the possibility that the political structure is so hopelessly corrupt that those insurance billions can simply buy immunity and preserve a system which benefits no one but themselves.

In that dire case, there aren't really many alternatives: either revolution or slow decline and eventual collapse seem the likeliest.

I don't think it's a possibility, I think it's already a reality.

[BrianTH]

Originally Posted by Bong477

Brian, great graph, but Medicare, as I pointed out, pays less to hospitals and doctors than private insurance does. Often around 20% less, sometimes more sometimes less.

It is true that one of the ways in which single-payer systems keep down costs is simply by getting better prices from providers. But this is a feature, not a bug. In the United States we are paying way more for many basic procedures (and drugs) than other countries. Rather than view this as an immutable fact--that we in the United States will be charged more for the same procedures and drugs--we have to close that gap significantly if we want to control health care costs.

Some specialities still would be profitable (albeit significantly less so), again due to convulted government designed system that rewards doctors and hospitals for doing procedures and tests, not neccessarily doing what is right.

It is true that one of the other things we need to do is reform Medicare to decrease the incentives to use specialists, and generally we need to reform the system to pay more for results, and not procedures regardless of results. And any universal single-care system would have to incorporate the same reforms.

The truth is some things actually run pretty well particularly at the better VAs (Pittsburgh is one of the better ones if anyone. Is wondering) but there are a lot of massive problems with doing anything that requires limited resources (MRI for example can take weeks to get scheduled) or if you want to do something that administration has decided you shouldn't be able to do for cost savings or "safety" issues.

There always has to be someone who can say no for cost reasons--if it isn't the hospital administration, and it isn't a single-payer agency, it is going to be your insurance company. The question is which of those models ultimately works best, but you can't escape the basic fact that someone has to be able to say no.

Im glad you have faith (because thats what it is, there is no evidence that this is actually the case)

That's just silly. We have a bunch of different health care models actually functioning in the world to look at. We know what other systems are working better in other countries. We know which parts of our system are working better. The fact is that all that evidence demonstrates the same thing: single-payer is much more efficient (getting equivalent or better outcomes at a lower cost), and "socialized medicine" is even more efficient.

What actually takes "faith" (an ideology that depends not on evidence, and indeed defies the available evidence) is your view, that somehow despite all the evidence available both inside and outside the United States, these alternative models will not work if adopted on a universal basis in the United States.

[BrianTH]

Originally Posted by MeinGlanzendMotorrad

Stop taxing people without children.

The benefits of an educated citizenry and labor force are not restricted to parents. So basically, you are arguing that people without children should be free-riders--they should get to benefit from having an educated citizenry and labor force without sharing in the costs.

[BrianTH]

Originally Posted by stburr91

Brain, if you think the insurance companies would sit by and let that happen, then you and I see the world much differently.

They don't have armies. In other words, I'm not sure what you are imagining they could do about it if the relevant laws are passed.

And the fact is that big industries sometimes--indeed often--lose political battles. Of course they can't lose a battle if it is never fought first, which is why a lot of their lobbying efforts are devoted to trying to keep reform processes from even starting.

Finally, the status quo approach is literally unsustainable--it is not possible for health care costs to keep growing at this rate. And the only known cost-control mechanisms involve these measures. So it really isn't a question of whether they will eventually lose this battle, it is just a question of when.

[gg]

Originally Posted by hey man_its me

If teachers want to be paid salaries similar to other white collar workers (which I argue in many districts, they already get, especially if you pro-rate their salary over a full working year), then they should pony up and also pay a similar amount towards their healthcare premiums to ease the burden on the taxpayers.

This is a great point that to be quite honest with you, I was unaware of. I have never read ALL the fine print, but this makes my arguments even easier. Thanks. The madness does need to stop. Look at the mess we have in our area if state funding stops or slows way down. If teacher pay was more in line with our areas private sector if compared by hours put in, we would be in a lot better shape. Also, if teachers had to pay into their healthcare like everyone else we wouldn't have such a huge tax burden. I like the ring to that.

[gg]

Originally Posted by FrannyBear

But I am sure it is ALL George Bush's fault.

I think you need to take a hard look at the cost of that war of his and divide that cost by the number of people in the US and think about if he would have given that kind of money to each person, what the economy would be like. I am not saying it is a good idea to give money to people in that way, but is shows the actual amounts and imagine what kind of infrastructure the US would have had if they used money like that to make us more streamlined. I really don't know how ANYONE can defend that guy, but people somehow can overlook that mess he made. It changed all our lives forever on so many levels.