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CaptFingers and Poppysead, you recall how Mircea gave us a lot of grief about universal healthcare and how it cannot work and is not successful.
Look at his post on VA Healthcare:
Quote:
Originally Posted by jasper12 Just interested, if you are a veteran do you utilize services at the VA?
Hell yeah. I would never go to a civilian doctor. I go to the Cincinnati VAMC and it's one of the best medical facilities I've ever been in. I have to say that the quality of care has improved to be even better since I started going there in '91.
Now, I was also at that same facility in the 1960s and 1970s when my grandfather was there, and it was dump. My grandfather would never go back. Even later, when he was in Florida near Bay Pines and the one in Tampa, he wouldn't go, in spite of my trying to convince him that the care was much better (I'd also been to the Tampa VAMC --- Halifax or Halley or something like that).
I would have to say that as a veteran and a tax-payer, I'm very happy with the care and services.
Seems that what is good for the goose isn't good for us ganders. And the VA system is 100% run by and funded by----our government!
I've never been convinced that universal health care would not work. As Bill Clinton so eloquently put it, it's arithmetic.
The VAMC Mircea used may well be the best medical facility he's ever used.
There's a brand-new VA Hospital near where I live and my wife (who uses it) is very happy with it.
One of the reasons it's so popular is that it hasn't been open for long and it's not overloaded. - Yet.
She has used other VAMC'S where the waiting time to be seen was 5 hours. Not because the staff were lazy, but because the demands placed on the staff (demands as in patient numbers) mandated strict triage and if the case wasn't an emergency (and hers was not - she was ill, but the illness was not life-threatening) then the less-critically ill patients slipped further and further back down the queue.
The VA is run by the government - but it isn't funded entirely by the government. If my wife uses the VA for treatment of a service-related illness or injury, then that treatment is approved treatment and is paid for by the government. Government funding there.
If she uses it for treatment of an illness or injury which is non-service related, then she gets a bill (which goes to the Insurance company.)
The VA behaves just like any other hospital.
The question which nobody seems to be willing to answer is: Who should be running the hospitals?
In the UK, most of the hospitals are run by the NHS (Government run.)
In the US, most hospitals are run by commercial enterprises which run hospitals - with the exception of, amongst a fairly short list, VA Hospitals which are run by the government.
In Germany, hospitals tend to be run by companies which run hospitals. The state doesn't run hospitals - but it does set the rates which each hospital can charge for each procedure. If you are a hospital and you want to be paid by the state, then you have to accept the amount that the state will pay. If, of course, the amount the state was willing to pay was so low that no hospitals were prepared to carry out a given procedure, then the state would have to find an answer.
I get my health insurance through the US Government. Where possible, I use military medical facilities.
Where I can't do that, I go to a provider authorised by the insurer. That provider is (or hopes to be) a 'for-profit' organisation, but (s)he can't get away with over-charging. - The government auditors act just like any other insurance company you're familiar with, - They treat every penny they have to pay out as if it's coming out of their own pockets.
Then there's another factor which seems conveniently to be overlooked.
24 years ago I lived in New Mexico which, AFAIR; had a population of about 2 million people most of whom lived in larger towns or cities.
The area of New Mexico is 121700 Sq miles, population (then) 2 million. Overall population density 16.4 people per square mile.
The area of England is 50350 Sq miles, population (then) 57.5 million. Overall population density 1142 people per square mile.
England is 0.4 the size of NM and had a population density nearly 70 times as large.
If you were a 25 year-old pregnant female living in a town or city in New Mexico and you wanted an OB/Gyn doctor - not really a problem.
If you were that same 25 year old living in Harding County (total population 663, land area 2125 Sq miles, population density 0.3 people per sq mile) and you wanted an Ob/gyn doctor, don't hold your breath.
Do the people in Harding County have no access to an Ob/Gyn doctor because they are poor or do they have no access to an Ob/Gyn doctor because there are only 663 people in the whole county, most of whom are not female not of child-bearing age and not pregnant?
If you were an OB/Gyn doctor do you think you could run a practice with only a dozen or so patients per year? - You wouldn't even make enough to cover your malpractice insurance, let alone make enough money to keep from starving. You'd put a few miles on your car, too.
There are many problems with the US Healthcare system - but you can't make direct comparisons between sparsely-populated deserts and crowded English cities.
Last edited by Manuel de Vol; 01-10-2013 at 11:13 PM..
Reason: typo
The VAMC Mircea used may well be the best medical facility he's ever used.
There's a brand-new VA Hospital near where I live and my wife (who uses it) is very happy with it.
One of the reasons it's so popular is that it hasn't been open for long and it's not overloaded. - Yet.
She has used other VAMC'S where the waiting time to be seen was 5 hours. Not because the staff were lazy, but because the demands placed on the staff (demands as in patient numbers) mandated strict triage and if the case wasn't an emergency (and hers was not - she was ill, but the illness was not life-threatening) then the less-critically ill patients slipped further and further back down the queue.
The VA is run by the government - but it isn't funded entirely by the government. If my wife uses the VA for treatment of a service-related illness or injury, then that treatment is approved treatment and is paid for by the government. Government funding there.
If she uses it for treatment of an illness or injury which is non-service related, then she gets a bill (which goes to the Insurance company.)
The VA behaves just like any other hospital.
The question which nobody seems to be willing to answer is: Who should be running the hospitals?
In the UK, most of the hospitals are run by the NHS (Government run.)
In the US, most hospitals are run by commercial enterprises which run hospitals - with the exception of, amongst a fairly short list, VA Hospitals which are run by the government.
In Germany, hospitals tend to be run by companies which run hospitals. The state doesn't run hospitals - but it does set the rates which each hospital can charge for each procedure. If you are a hospital and you want to be paid by the state, then you have to accept the amount that the state will pay. If, of course, the amount the state was willing to pay was so low that no hospitals were prepared to carry out a given procedure, then the state would have to find an answer.
I get my health insurance through the US Government. Where possible, I use military medical facilities.
Where I can't do that, I go to a provider authorised by the insurer. That provider is (or hopes to be) a 'for-profit' organisation, but (s)he can't get away with over-charging. - The government auditors act just like any other insurance company you're familiar with, - They treat every penny they have to pay out as if it's coming out of their own pockets.
Then there's another factor which seems conveniently to be overlooked.
24 years ago I lived in New Mexico which, AFAIR; had a population of about 2 million people most of whom lived in larger towns or cities.
The area of New Mexico is 121700 Sq miles, population (then) 2 million. Overall population density 16.4 people per square mile.
The area of England is 50350 Sq miles, population (then) 57.5 million. Overall population density 1142 people per square mile.
England is 0.4 the size of NM and had a population density nearly 70 times as large.
If you were a 25 year-old pregnant female living in a town or city in New Mexico and you wanted an OB/Gyn doctor - not really a problem.
If you were that same 25 year old living in Harding County (total population 663, land area 2125 Sq miles, population density 0.3 people per sq mile) and you wanted an Ob/gyn doctor, don't hold your breath.
Do the people in Harding County have no access to an Ob/Gyn doctor because they are poor or do they have no access to an Ob/Gyn doctor because there are only 663 people in the whole county, most of whom are not female not of child-bearing age and not pregnant?
If you were an OB/Gyn doctor do you think you could run a practice with only a dozen or so patients per year? - You wouldn't even make enough to cover your malpractice insurance, let alone make enough money to keep from starving. You'd put a few miles on your car, too.
There are many problems with the US Healthcare system - but you can't make direct comparisons between sparsely-populated deserts and crowded English cities.
Those are really good points and I think the U.S. needs to develop their own system because of points like yours. Other countries can serve as models of similar scale but we are on or own for the most part. Since we do pay for more research here and have the technology and intelligence if we cut out the "for profit" aspect we should be able to come up with a system of great improvement are far as cost and performance goes, it could be a truly unique system.
If we stay "for profit" I'm afraid we just can't come up with anything that will work for the majority that will fit the "for profit" ideal. I don't think it's possible. IMO.
The US Doesn't (IMO) have to abandon the 'for profit' ideal. Nobody can afford to work for nothing. 'The labourer is worthy of his hire' etc, but - although this bit might well [initially] be anathemic in the US, the State (as in the Federal Government) could set the pay rates it pays to contractors.
Were I to work for the Federal Government as a GS/SES employee, I would work at a fixed and known rate of pay.
Were I to work for the Federal Government as a Contractor, I would work at an agreed 'rate of pay' (I probably wouldn't be hired as the direct contractor, but would rather be employed by a contractor.) I could - if they wanted me that badly - negotiate my own terms.
In Germany, the Federal Government sets the charges for every medical procedure/medication/safety pin.
"Oh, but in America, you can't tell people how much they can charge!" Really? - If you get a job working as a contractor for the DOD (for instance) do you really think you are going to dictate absolutely to them how much they are going to pay you?
Everything is negotiable and the bigger you are, the more clout you have when you're at the negotiating table.
If you were sitting at the table and you had the authority to negotiate for healthcare provision for, say, 250 million people, I suspect that those who wanted a 'piece of the action' as sub-contractors would be quite attentive.
US Medical research is second to none, but that research doesn't come free and, as I'm sure you will agree, the universities, medical facilities, pharmacological companies and other 'interested' people have to spend mind-boggling sums to keep at the head of the field.
I suggest that a 'one size fits all' approach is totally impracticable in the US. In some areas (notably the South West, the Appalachians, much of West Virginia, the population density is so low that even if money was no object (and doctors do have to live) it would be very difficult to provide adequate service. Something like 'Médecins Sans Frontières' would work as a band-aid, but it's not a permanent fix.
When I was a kid, I used to watch TV shows and read stories about Australian 'Flying Doctors'. Perhaps some sort of 'Flying Doctor' scheme might help provision in rural areas?
You'd have to rein-in the lawsuits, though. (Says this retired lawyer.) I can list - in great detail - all the reasons 'for' controlling doctors through tort law (and I can also argue the other side to the same depth.)
Unfortunately, rural America (particularly those areas in which the population density is low and wages are also low) can't afford to pay enough to cover the malpractice premiums, so the lawsuits have to go out of the window first.
What! Everybody in the US has the right to sue to recover damages for torts committed against them!
Errr ... actually, that's not so. Under the Feres Doctrine, claims against the federal government by members of the armed forces and their families for injuries arising from or in the course of activity incident to military service are disbarred.
It's not fair!
The law does not have to be fair. It's pragmatic and it's a good idea to have pragmatic laws.
There's no reason why Congress couldn't say: "We're going to pass this law which will provide healthcare and to keep the costs down you can't sue the providers."
Nobody would be obliged to be treated under the scheme, either. Everybody would be fully entitled to hire their own doctors and nurses.
The US Doesn't (IMO) have to abandon the 'for profit' ideal. Nobody can afford to work for nothing. 'The labourer is worthy of his hire' etc, but - although this bit might well [initially] be anathemic in the US, the State (as in the Federal Government) could set the pay rates it pays to contractors.
Were I to work for the Federal Government as a GS/SES employee, I would work at a fixed and known rate of pay.
Were I to work for the Federal Government as a Contractor, I would work at an agreed 'rate of pay' (I probably wouldn't be hired as the direct contractor, but would rather be employed by a contractor.) I could - if they wanted me that badly - negotiate my own terms.
In Germany, the Federal Government sets the charges for every medical procedure/medication/safety pin.
"Oh, but in America, you can't tell people how much they can charge!" Really? - If you get a job working as a contractor for the DOD (for instance) do you really think you are going to dictate absolutely to them how much they are going to pay you?
Everything is negotiable and the bigger you are, the more clout you have when you're at the negotiating table.
If you were sitting at the table and you had the authority to negotiate for healthcare provision for, say, 250 million people, I suspect that those who wanted a 'piece of the action' as sub-contractors would be quite attentive.
US Medical research is second to none, but that research doesn't come free and, as I'm sure you will agree, the universities, medical facilities, pharmacological companies and other 'interested' people have to spend mind-boggling sums to keep at the head of the field.
I suggest that a 'one size fits all' approach is totally impracticable in the US. In some areas (notably the South West, the Appalachians, much of West Virginia, the population density is so low that even if money was no object (and doctors do have to live) it would be very difficult to provide adequate service. Something like 'Médecins Sans Frontières' would work as a band-aid, but it's not a permanent fix.
When I was a kid, I used to watch TV shows and read stories about Australian 'Flying Doctors'. Perhaps some sort of 'Flying Doctor' scheme might help provision in rural areas?
You'd have to rein-in the lawsuits, though. (Says this retired lawyer.) I can list - in great detail - all the reasons 'for' controlling doctors through tort law (and I can also argue the other side to the same depth.)
Unfortunately, rural America (particularly those areas in which the population density is low and wages are also low) can't afford to pay enough to cover the malpractice premiums, so the lawsuits have to go out of the window first.
What! Everybody in the US has the right to sue to recover damages for torts committed against them!
Errr ... actually, that's not so. Under the Feres Doctrine, claims against the federal government by members of the armed forces and their families for injuries arising from or in the course of activity incident to military service are disbarred.
It's not fair!
The law does not have to be fair. It's pragmatic and it's a good idea to have pragmatic laws.
There's no reason why Congress couldn't say: "We're going to pass this law which will provide healthcare and to keep the costs down you can't sue the providers."
Nobody would be obliged to be treated under the scheme, either. Everybody would be fully entitled to hire their own doctors and nurses.
Very legitimate points, and all worth discussing in detail - hopefully in a place where a difference can be made, like Congress?...
I'll keep this response short and just point out that one big reason nothing is happening is that the primary objectives are not shared by the people and our elected officials. I'm convinced that Congress doesn't so much want to provide decent affordable healthcare as they want to enrich the healthcare industry every which way, and guarantee themselves a lobbying job after they leave elected office.
Thus we can argue till we're blue in the face, we can present all kinds of reasonable alternatives till the cows come home - but the bottom line is, "we" and the government are not trying to accomplish the same goals.
The US Doesn't (IMO) have to abandon the 'for profit' ideal. Nobody can afford to work for nothing. 'The labourer is worthy of his hire' etc, but - although this bit might well [initially] be anathemic in the US, the State (as in the Federal Government) could set the pay rates it pays to contractors.
Were I to work for the Federal Government as a GS/SES employee, I would work at a fixed and known rate of pay.
Were I to work for the Federal Government as a Contractor, I would work at an agreed 'rate of pay' (I probably wouldn't be hired as the direct contractor, but would rather be employed by a contractor.) I could - if they wanted me that badly - negotiate my own terms.
In Germany, the Federal Government sets the charges for every medical procedure/medication/safety pin.
"Oh, but in America, you can't tell people how much they can charge!" Really? - If you get a job working as a contractor for the DOD (for instance) do you really think you are going to dictate absolutely to them how much they are going to pay you?
Everything is negotiable and the bigger you are, the more clout you have when you're at the negotiating table.
If you were sitting at the table and you had the authority to negotiate for healthcare provision for, say, 250 million people, I suspect that those who wanted a 'piece of the action' as sub-contractors would be quite attentive.
US Medical research is second to none, but that research doesn't come free and, as I'm sure you will agree, the universities, medical facilities, pharmacological companies and other 'interested' people have to spend mind-boggling sums to keep at the head of the field.
I suggest that a 'one size fits all' approach is totally impracticable in the US. In some areas (notably the South West, the Appalachians, much of West Virginia, the population density is so low that even if money was no object (and doctors do have to live) it would be very difficult to provide adequate service. Something like 'Médecins Sans Frontières' would work as a band-aid, but it's not a permanent fix.
When I was a kid, I used to watch TV shows and read stories about Australian 'Flying Doctors'. Perhaps some sort of 'Flying Doctor' scheme might help provision in rural areas?
You'd have to rein-in the lawsuits, though. (Says this retired lawyer.) I can list - in great detail - all the reasons 'for' controlling doctors through tort law (and I can also argue the other side to the same depth.)
Unfortunately, rural America (particularly those areas in which the population density is low and wages are also low) can't afford to pay enough to cover the malpractice premiums, so the lawsuits have to go out of the window first.
What! Everybody in the US has the right to sue to recover damages for torts committed against them!
Errr ... actually, that's not so. Under the Feres Doctrine, claims against the federal government by members of the armed forces and their families for injuries arising from or in the course of activity incident to military service are disbarred.
It's not fair!
The law does not have to be fair. It's pragmatic and it's a good idea to have pragmatic laws.
There's no reason why Congress couldn't say: "We're going to pass this law which will provide healthcare and to keep the costs down you can't sue the providers."
Nobody would be obliged to be treated under the scheme, either. Everybody would be fully entitled to hire their own doctors and nurses.
I agree, set pricing would be a decent choice. Like Germany or Japan. That's what I mean though, they are both "non profit" health care systems. The U.S. is the only "for profit" system in the top developed countries. Regardless of public options or set pricing, taking big profits out would be necessary to manage costs. Also, regulating tests. We waste a lot of money on testing that's not needed, doesn't do any good and sometimes becomes harmful. Studying the effectiveness would help. They haven't yet studied the effect of all our testing, but on a few they have, like they've started doing with mammograms. When studied, they found out women were actually being caused more harm than good getting them every year at 40. It was hurting more than it was helping. So, they took the recommendation away. Now at 40 you don't automatically get a script for a test because of your age. We need studies done to see what testing is necessary. We hurt ourselves getting tested all the time and it's heavy on the wallet. What ever is found to not work, or actually be causing more harm than good, then, we can cut that cost.
I put a good link to "money and medicine," a documentary done on this by PBS.
We have unregulated healthcare pricing, it's left to the market. We get monopolized. We are at the mercy of competition but the product "want" is inevitably a need. This puts us, the consumer, at a disadvantage which is why other countries set limits and are non profit. They see the discrepancy. Everything we do as consumers of healthcare makes someone a profit, they don't want to let go of it. I can understand how hard that would be but we are now in a bit of a mess with affordability. This slowly creates a 3rd world country. IMO.
America see's the discrepancy but are tied by capitalism. It's tricky to say the least.
I think your idea's would work if we decided to take healthcare out of our capitalist model, saying it's a need, not a want, therefore the rules of capitalism don't apply. Until then, I'm afraid we can't regulate effectively. The market is powerful, it has a hand in our government and they are reliant on it.
Lawsuits, I'm not a retired lawyer (lol), so not my strong point I admit. I do agree that we need to address this area but am at a loss on how to do it fairly. Maybe if we had more regulation in place? I'm not sure.
Next time you whisper to a Gila Monster, please thank him/her for the venom.
(I use synthetic, but it works just as well as the 'real' stuff.
I do find myself drooling occasionally when I see small birds ..)
(LMAO)
LOL, there is actually a long story to my nickname. I received it for a thread I posted on the Arizona forum. It came after some well deserved harassment from my peers for my fear of the little creatures. Hense, I became the "Gila Monster whisper" around my home thread. P.S. Hasn't helped my fear but at least I appear brave and understanding.
Very legitimate points, and all worth discussing in detail - hopefully in a place where a difference can be made, like Congress?...
I'll keep this response short and just point out that one big reason nothing is happening is that the primary objectives are not shared by the people and our elected officials. I'm convinced that Congress doesn't so much want to provide decent affordable healthcare as they want to enrich the healthcare industry every which way, and guarantee themselves a lobbying job after they leave elected office.
Thus we can argue till we're blue in the face, we can present all kinds of reasonable alternatives till the cows come home - but the bottom line is, "we" and the government are not trying to accomplish the same goals.
I agree and I'll go a step further. I'm not sure they can get out of what they owe the industry right now in promises. I think I'll dig a bit deeper on the subject though. I'd like to see what favors are actually owed and who has their hand in the gold pot.
Campaign reform might help, regulation on lobbyist. It's going to take a lot more to unravel the mess, there are always "reasons" like dominos they fall, when it comes to Washington. IMO.
Man, oh, man, I tossed out the bait and you took it hook, line and sinker (just like I knew you would).
The problem with people who are clueless, is they just talk and talk and talk themselves into circles and then they step all over it.
Didn’t realize you were being set up for failure, did you?
Nah, you didn’t see this coming at all. You'll be like a deer in the headlights....of a train.
Did I mention I was a cop in another life?
I really enjoyed interrogating suspects. Sorry, I’ll undertake my best efforts concerning full-disclosure in the future.
Quote:
Originally Posted by Wardendresden
You are stuck with singularly outmoded sources of information,….
Uh-huh, the European Commission, the GAO, the CBO, the Veteran's Administration, the CDC, the European Observatory on Health Systems and Policies, the Dutch Ministry of Health, the German Ministry of Health, the IEA Health and Welfare Unit and the Wirtschafts- und Sozialwissenschaftliches Institut (WSI) are just so “outmoded.”
They obviously do not meet the high standards of YahooAnswers! and the New York Times.
Quote:
Originally Posted by Wardendresden
… and you are unable or unwilling to learn.
Yes, all three of my undergraduate degrees, my Master’s and PhD were just handed to me.
Quote:
Originally Posted by Wardendresden
You cling so blindly to your political view…
And what exactly is my political view?
Are you aware that I’m a registered Democrat? I guess not, but others on C-D are.
Quote:
Originally Posted by Wardendresden
… that it clouds your ability to see the fact that healthcare in the U.S. is crumbling--as physicians state, as many politicians state,….
Wrong again as usual.
I clearly see problems in the health care system. I’ve been commenting on such problems for years and years now, since 2007 here on C-D.
The reason I see problems is not so much due to the fact that I have a BA in Economics, rather it’s because I spent quite some time researching how the US health care system evolved to be in its present state.
Quote:
Originally Posted by Wardendresden
…. as your own MITT ROMNEY…
Uh, wut?
No doubt you do so much like making things up as you go along.
I voted for Gary Johnson, just like I so stated I would here on C-D prior to the Election.
I am a republican only in the Platonian sense republics (as a political and governmental structure), but I am not a Republican. They are far too liberal for me. I am a registered Democrat, but I’m not a Democrat. I normally vote for Independents, Constitution Party candidates, and occasionally Socialist Party candidates.
Wow, don’t you look really stupid.
If I would be you be, I'd quit before you end up looking like a double-dumb-ass.
Let’s look at this……
Quote:
Originally Posted by Wardendresden
It's a cost per patient that's measured, whether it's out of taxes or out of insurance or out of pocket. What is the average cost PER PATIENT.
The VA is better.
Let's use Mircea's numbers which he provided and I quoted in my post (303, I think)
Your stats, Mircea:
Figure 5 VA’s Expenditures on Health Care Services per Enrollee, by Priority Group, 2008
P1 $9,000
P2 $3,900
P3 $3,100
P4 $15,000
P5 $5,200
P6 $1,900
P7/8 $2,200
----------------
$5,757 = average cost per year (in 2010 US Dollars).
Average cost for ALL Americans in 2010:
"Combined public and private spending on health care in the U.S. came to $8,233 per person in 2010, more than twice as much as relatively rich European countries such as France, Sweden and Britain that provide universal health care.
So if the average cost per person is $5757 for the VA system, and ALL combined public and private spending on U.S. healthcare averages $8,233, if you took the VA system out of the latter numbers, the total spending in the U.S. would be even HIGHER than 8,233 on the average for those left.
….and view it in light of these comments you made….
Quote:
Originally Posted by Wardendresden
So, Mircea, you are not well-informed.
Quote:
Originally Posted by Wardendresden
You are stuck with singularly outmoded sources of information,….
I gave the average cost per year for Health Care Services per Enrollee, as reported by Heidi L. W. Golding before the Senate Committee on Veterans’ Affairs July 27, 2011.
Oooooops.
It's not my fault you have no idea what you're talking about.
I'd venture to guess that it never donned on you that just because someone is enrolled in the VA medical system, it does not logically follow that they were treated at the VA medical system during the year.
Get it?
No, you didn't get it.
Now for the coup de grace….
The following is from one of those, um, you know, “singularly outmoded sources of information” you accused me of using.
This is Document GAO-12-908, otherwise known as the VETERANS’ HEALTH CARE BUDGET United States Government Accountability Office Report to Congressional Committees, dated September 2012.
I direct your attention to Page 3 of that document, which states the following….
A variety of activities are funded through VHA’s three appropriations accounts for medical care:
• The Medical Services account includes funds for health care services provided to eligible veterans and beneficiaries in VA’s medical centers, outpatient clinic facilities, contract hospitals, state homes, and outpatient programs on a fee basis. For fiscal year 2012, VA received more than $39.6 billion in the Medical Services account.
• The Medical Support and Compliance account includes funds for the management and administration of the VA health care system, including financial management, human resources, and logistics. For fiscal year 2012, VA received more than $5.5 billion in the Medical Support and Compliance account.
• The Medical Facilities account includes funds for the operation and maintenance of the VA health care system’s capital infrastructure, such as costs associated with nonrecurring maintenance, utilities, facility repair, laundry services, and grounds keeping. For fiscal year 2012, VA received more than $5.4 billion in the Medical Facilities account.
Let’s add that up….
$39,600,000,000
$5,500,000,000
$5,400,000,000
-------------------
$50,500,000,000 spent on health care in 2012.
I now direct your attention to Page 2 of the same report which states….
In fiscal year 2011, approximately 6.2 million patients received health care from VA. In providing that care, VA operates 152 hospitals, 133 nursing homes, 824 community-based outpatient clinics, and other facilities through 21 regional health care networks.
$50.5 Billion spent for 6.2 Million veterans.
Would you like a sedative before I do the math?
$50,500,000,000 / 6,200,000 = $8,145.16 per veteran.
Sucker.
I just played you.
Oh, man, were you ever so easy.
Lest I forget….
“In addition to new appropriations that VA receives during the annual appropriations process, funding may also be available from unobligated balances of multiyear appropriations, which remain available for a fixed period of time in excess of 1 fiscal year. For example, VA’s fiscal year 2011 appropriations provided that $1.2 billion be available for 2 fiscal years.”
To clarify, in addition to the $50.5 Billion the VA gets in its annual budget, Congress often appropriates additional funding throughout the year.
Continuing…
“VA’s other sources of funding include collections and reimbursements. VA’s collections include third-party payments from veterans’ private health care insurance for the treatment of non-service-connected conditions and veterans’ copayments for outpatient medications. VA’s reimbursements include amounts VA receives for services provided under service agreements with the Department of Defense.
See GAO, Veterans’ Health Care Budget: Transparency and Reliability of Some Estimates Supporting President’s Request Could Be Improved, GAO-12-689 (Washington, D.C.: June 11, 2012).”
In addition to its annual budget, plus other appropriations throughout the year, the VA gets additional monies for the sources stated.
That means this figure…
$8,145.16 per veteran
…is actually too low. With co-payments, reimbursements from Medicare, and private insurance, the actual amount would be 15%-25% higher.
Finally….
“This account does not include funding for major or minor construction or for information technology because separate appropriations provide funds for these purposes.”
…which is in reference to the Medical Facilities Account for purposes of clarification.
Switching gears from the, um, you know, "singularly outmoded" (your words) CBO report from 2011 and looking at the, uh, well, "singularly outmoded" (your words) GAO report from 4 months ago....
“In 2010, VHA spent $1.9 billion to treat 400,000 OCO patients. VHA obligated $4,800 per OCO patient, on average, compared with an average of $8,800 per patient for veterans from all eras who were being treated at VHA [emphasis added] --- an obligation is a commitment that creates a legal liability on the part of the government to pay for goods and services ordered or received. Such payments may be made immediately or in the future. OCO veterans are typically younger and healthier than the average VHA patient and as a result are less expensive to treat; indeed, the amount of resources devoted to the average OCO veteran is similar to that devoted to the average non-OCO veteran under the age of 45. Thus, although OCO patients made up 7 percent of the veterans VHA treated in 2010, they were responsible for only 4 percent of the total amount that VHA obligated for medical care and research.”
Statement of Heidi L. W. Golding Principal Analyst for Military and Veterans’ Compensation before the Committee on Veterans’ Affairs United States Senate July 27, 2011, Congressional Budget Office.
I mention that, because you need to view it context with this….
"In the past 20 years, our overriding philosophy has been that the health system cannot spend more than its income." -- Franz Knieps German Minister of Health (2009)
....and that proves the point I've been making all along: Other countries spend less on health care, because they budget less.
The point being that what the VA spends on health care is dependent on what Congress appropriates for spending --- which is nearly identical to how it works in Europe...they spend whatever they collect in tax revenues earmarked for health care, and that's it.
Read this until you understand it....
"VHA obligated $4,800 per OCO patient, on average, compared with an average of $8,800 per patient for veterans from all eras who were being treated at VHA."
So what happens if Congress only budgets $5,000 per patient?
Then the VA can only spend $5,000 --- except it costs $8,800 per patient -- so some patients will have to be denied care.You didn't even blink on the P1, P2, P3, etc.
Those are priority groups. I'm in Priority Group 2. That means health care money and resources are allocated to Priority Group 1, and then to us in Group 2, before to people in P3, P5, P6 and so on.
Quote:
Originally Posted by Wardendresden
Doctors in the VA system are salaried and not concerned with finding where the next buck is coming from, unlike the profit system.
Primary care doctors in the VA are salaried, but specialists are not part of the system. None of my doctors work for the VA --- they all work for the University of Cincinnati Hospital -- everyone of them.
No doubt, you think doctors are your personal private slaves and should work for free and at be at your beck-and-call 24/7.
Quote:
Originally Posted by Wardendresden
As a matter of fact I DO believe government healthcare would NOT be about money. And I have proof that that is in fact the way the government operates right now with Veteran's Administration Hospitals which is being hailed internationally as one of the best healthcare systems anywhere…. Yes, government run healthcare can be more efficient AND more effective than a "for profit" system--and the proof is in the pudding.
I just thoroughly demolished your argument so you don't have any proof.
Well, wasn't that fun?
In the future, it would behoove you to do real research.
Anytime there is Capital or commodities involved, the Laws of Economics are in play.
Your “feelings” about health care are irrelevant; whether you believe health care is a “right” or that it shouldn’t be “traded” as a commodity, or that it should be not-for-profit doesn’t alter reality.
Since 2001, the FDA has approved 229 NMEs (New Molecular Entities – Drugs). Everyone one of those uses Neodol-65 or Neodol-67, which is an organic alcohol refined exclusively from imported light oil.
What would happen if the US no longer had access to imported light oil?
Those 229 drugs, plus about 350 others approved by the FDA between 1994 and 2000 would disappear. And people would die without those drugs. So how can you possibly say the Laws of Economics do not apply to health care? If the price of light oil goes up, the price of pharmaceuticals goes up.
You say Supply & Demand does not apply?
Okay, good news --- they found a cure for cancer. Bad news – it takes one chemical laboratory with 120 people working for one year to synthesize the chemical compounds for the drug to provide enough for 10 people.
Ooooops.
You're going to have a Supply & Demand issue there.
By all estimates, you're going to have a shortage of about 60,000 doctors thanks to Obamacare. Naturally, the proper course of action is to hire 18,000 IRS agents.
Why does health care spending need to be reduced?
What I’m seeing is a serious disconnect, probably stemming from the fact that people don’t really understand how their own health care system works.
You need to reduce wasteful spending. If something costs $40 then it costs $40 and you can't get around that, unless the spending of the $40 is frivolous, unnecessary or wasteful.
The reason you cannot control costs is due to the fact that you have allowed one group, namely the American Hospital Association, to lobby Congress and State legislatures to eliminate all incentives and disincentives to control costs.
From 1942 onward, no American has ever borne the true cost of health care. You have been shielded. For example, the amount of your weekly, bi-weekly health plan premiums paid by you and your employer are non-taxable.
You wanna health care system, like Europe? Fine, then you need to start paying your share of the taxes, like Europe. That means you need to be paying FICA and HI payroll taxes, plus local, State and federal income taxes on your health plan premiums. Your employer needs to start paying the FICA and HI payroll taxes, plus the State Unemployment Tax, plus the Federal Unemployment Tax, plus the worker’s compensation rates on the amount paid by your employer.
Premiums paid by an employer on policies of group life insurance without cash surrender value covering the lives of his employees, or on policies of group health or accident insurance . . . do not constitute salary if such premiums are deductible by the employer under Section 23(a) of the Code.
That’s from the 1954 tax code change – lobbied by the American Hospital Association.
Note that at this point there are no longer any such animals as individual policies. Everything is “group.”
Also, look at the wording “...without cash surrender value…”
The health plan providers (what people erroneously call health insurance companies) no longer have set limits --- that is to their disadvantage – and just more proof that what people have are glorified pre-paid medical service plans.
If you want to control costs, then rescind all of the insurance regulations lobbied by the American Hospital Association and allow health plan providers to provide individual-based policies without restrictions.
That will restore the incentives and disincentives.
I believe Medicare now issues a charge-back when a patient is re-admitted for the same condition within a certain time period. That is called a “disincentive” and such disincentives were legislated out of existence thanks to the lobbying efforts of the American Hospital Association.
I’m hoping people are starting to get the message that “not good things” happen when you allow Special Interest Groups to run your country.
Obamacare actually bans two of the most important controls in health care, and that is annual per person spending and life-time per person spending.
It used to be that if you burned through $2 Million in health care costs in a single year, the health plan providers would cut you off. Obamacare bars them from doing that, so if one person uses up $12 Million in one year, that’s just too freaking bad.
And it used to be that after an health plan provider spent $15 Million on you in a life-time, they would cut you off. No any more. Obamacare says that if you have to spend $250 Million on one person in a life-time, then that’s what you have to do…..never mind that you don’t have the money to be playing that game.
Why would I recommend anything? This is a debate on whether or not the US should have a national health caresystem like the United Kingdom where health care is totally run by the government and all health care providers are government employees.
As a point of fact, Britain's NHS with 4 Million employees is the 4th largest employer in the world.
It will take a lot more than that. Best thing to do is just rescind the thousands of regulations en masse and start over…..and put a restraining order on the American Hospital Association to prevent them from coming without 1 mile of any elected or appointed public official or any civil servant.
That’s true.
The very same people who paid $8.50 in the 1980s for a ticket to sit 2nd row stage center at a Rolling Stones concert, think nothing of paying $75 to $125 for the same ticket today.
But those very same people who also paid $15 in the 1980s for an office visit start frothing at the mouth and fall over backwards in a seizure if they have to pay $45 for an office visit.
That’s very Soviet.
When you have Capitalist Property Theory paired with Free Market Economics, you have a system where no individual can coerce any other --- all coopera*tion between individuals, between groups or between individuals and groups is voluntary.
That is Freedom.
The people who are uninsured are not the problem with your health care system, but apparently they make great scape-goats.
Subjecting...
Mircea
Just a couple of comments here. First of all, you comment on people complaining about that $15 office visit now costing $45. Which doctors are charging only $45? I'd be doing cartwheels if it was that cheap to go to a doctor! Any place I've lived in the last few years, any general practitioner I go to charges around $100 for a visit, and insurance is of no help because you usually have to spend a couple thousand dollars to get up to your deductible before insurance will start paying even a dime of my office visit costs.
And talking about how if something costs $40 then it will cost $40, no way around it. Well that is fine, but the problem is hospitals and clinics charge WAY too much for things, way more than they actually cost. We're not talking about wasteful spending, we're talking about overcharging for the sake of profits! That is what's wrong with this whole system. For example a couple months ago I had a kidney stone late on a Saturday night so I had to go to the emergency room. Later when I received the bill I was shocked- they charged $700 simply for the saline solution IV that I was given for hydration. $700!! I work at another hospital and asked a coworker what that would actually cost- he said maybe $10 for the solution, a couple dollars for the bag and the needle, and about $45 per hour for the nurse who actually set it up for me. So let's just be generous and give the nurse the entire hour's worth of pay even though it only took a couple minutes to hook me up with the IV, giving this cost a total of $50 or $55. So why do I end up getting charged $700??? That is ridiculous, it is nothing more than hospitals charging whatever they want to make profits because they know they can. Thinking that either we are stuck and have no choice anyway, or we have insurance that would just pay it for us. In my case insurance wouldn't touch it, because again the total cost for my visit was $1900, just below my $2000 deductible.
So THAT is what's wrong with our system- it is for profit, and there are several layers who all want profits, leaving us with RIDICULOUSLY high bills for even the simplest of things.
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P.S. Hasn't helped my fear but at least I appear brave and understanding.
