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Old 03-07-2010, 11:44 PM
 
30,401 posts, read 34,275,119 times
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Quote:
Originally Posted by AwayAndBackToSac View Post
Again, I assert...

How far do "we" want to limit our freedom's?

WOW... ...to actually limit our freedom to eat what we want, because some "consensus" doesn't think we should eat twinkies and ho-ho's.

he he

And considering the last post... How far do "we" want to limit the freedoms of business, and shove even more of it away from America, into other developing nations?
In my mind, we should let people pay out of pocket for their own health care and only have insurance for medical catastrophes. If people really saw the true cost of their care, they, long ago would have become more proactive about changing their lives; and the health care companies would have been forced to move away from their "pills and surgery" approach to health because people simply wouldn't stand for it.
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Old 03-08-2010, 08:30 AM
 
212 posts, read 444,631 times
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"In my mind, we should let people pay out of pocket for their own health care and only have insurance for medical catastrophes. If people really saw the true cost of their care, they, long ago would have become more proactive about changing their lives; and the health care companies would have been forced to move away from their "pills and surgery" approach to health because people simply wouldn't stand for it."

"Hear, Hear"


Thank you. As I head off to work, you have made my morning.
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Old 03-08-2010, 10:51 AM
 
Location: CO
1,603 posts, read 3,356,110 times
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Quote:
Originally Posted by mysticaltyger View Post
In my mind, we should let people pay out of pocket for their own health care and only have insurance for medical catastrophes. If people really saw the true cost of their care, they, long ago would have become more proactive about changing their lives; and the health care companies would have been forced to move away from their "pills and surgery" approach to health because people simply wouldn't stand for it.
I agree with this and I think the result of any of the proposed bills will lead us in the direction of individuals paying for more of their health care. More employers will stop offering health benefits no matter what happens - if no reform takes place, the prices will force them to stop offering it. If reform does take place, the bills on the table (on both sides) seem to lead us in the direction of individuals paying for their own insurance.

And I think that's going to be the key to real change in this country. Once people start realizing how expensive it truly is, they'll have a choice to make - start living healthier or pay higher costs. And I think it's only fair that those who live unhealthy lifestyles pay higher costs. Strip out the employer-paid health care and we'll finally get rid of the major barrier that has kept the majority insulated from the realities many of us have been forced to accept.

Employer-paid benefits have acted as an insulator for far too long. It's become almost financially impossible to be self employed with a family these days. Too much risk and much higher costs. Once we get some meaningful reform passed, we'll probably see a boom in small business start-ups, as it will open the door to many who have been forced to give up on their dreams of running their own business because they need health insurance that they either couldn't get otherwise, or couldn't afford for them and/or their families.

Do I think we have to legislate away our freedoms for this? No, not necessarily. We don't have to legislate what we eat and what we like to do. People should be free to live any lifestyle they want. But they should also have to pay the extra costs for doing so, and part of that should be higher health care costs for those who don't eat right, or smoke, or partake in any number of unhealthy or risky activities. I don't care that people eat twinkies and don't exercise. If they want cheaper health care costs, they should take better care of themselves. Instead of higher costs for preexisting conditions, there should be higher premiums for smokers, and price breaks for those who have gym memberships, etc. That should be how the system works.
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Old 03-08-2010, 11:24 AM
 
30,401 posts, read 34,275,119 times
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Quote:
Originally Posted by Ludachris View Post
I agree with this and I think the result of any of the proposed bills will lead us in the direction of individuals paying for more of their health care. More employers will stop offering health benefits no matter what happens - if no reform takes place, the prices will force them to stop offering it. If reform does take place, the bills on the table (on both sides) seem to lead us in the direction of individuals paying for their own insurance.

And I think that's going to be the key to real change in this country. Once people start realizing how expensive it truly is, they'll have a choice to make - start living healthier or pay higher costs. And I think it's only fair that those who live unhealthy lifestyles pay higher costs. Strip out the employer-paid health care and we'll finally get rid of the major barrier that has kept the majority insulated from the realities many of us have been forced to accept.

Employer-paid benefits have acted as an insulator for far too long. It's become almost financially impossible to be self employed with a family these days. Too much risk and much higher costs. Once we get some meaningful reform passed, we'll probably see a boom in small business start-ups, as it will open the door to many who have been forced to give up on their dreams of running their own business because they need health insurance that they either couldn't get otherwise, or couldn't afford for them and/or their families.

Do I think we have to legislate away our freedoms for this? No, not necessarily. We don't have to legislate what we eat and what we like to do. People should be free to live any lifestyle they want. But they should also have to pay the extra costs for doing so, and part of that should be higher health care costs for those who don't eat right, or smoke, or partake in any number of unhealthy or risky activities. I don't care that people eat twinkies and don't exercise. If they want cheaper health care costs, they should take better care of themselves. Instead of higher costs for preexisting conditions, there should be higher premiums for smokers, and price breaks for those who have gym memberships, etc. That should be how the system works.
I agree with most of what you're saying here. I definitely agree that employer sponsored health insurance (and actually, Medicare & Medicaid as well) have insulated people from the true costs of the system. And since people don't know the true cost of their care, they don't question the "pills & surgery" service model. And even if they do, we don't have a truly competitive system that would allow people to take their business elsewhere. I'm basically stuck with my Kaiser HMO whether I like it or not because I'm not going to get a better deal than I get with my heavily subsidized employer plan. And, as you allude to, the market doesn't cater to individual policies like other kinds of insurance, but to large employers and the government. That definitely needs to change, but I won't be holding my breath on that one.

However, I am very concerned that any legislation that passes will focus on guaranteeing coverage for everyone, with precious little in the bills to encourage more efficient service delivery from health care providers or more healthy lifestyle choices from consumers.

I've heard it said by some that it doesn't matter how crappy the health care bill is as long as it passes...we can just modify it in future years as we go along. I think that's the wrong approach. That is how we got the current mess we have, which dates back to WW2 and still hasn't been properly reformed in 70+ years.

The Federal government doesn't do such a good job at fixing things and resists making the tough decisions (Like, you know, telling people they're too fat and they're going to have to pay more for the privilege if they want coverage. What politican is going to say or vote for something like that?)
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Old 03-08-2010, 12:55 PM
 
109 posts, read 357,602 times
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We already have free nationwide health care irrespective of one's ability to pay for it. You don't even have to be a citizen to qualify for this health care.

Overview EMTALA

The problem is that we are providing it in the most expensive manner possible. In any hospital, the emergency room is going to be providing some of the most expensive health care. Its incredibly expensive to set up a place to handle any type of emergency any time of day.

When you have people coming into the emergency room for lower level care, the emergency room is too full to receive patients with life threatening conditions. Additionally the cost the cost of providing this free care makes the emergency room is a huge financial black hole. This is why hospitals like King-Drew Medical Center are either closing emergency rooms or shutting down completely.

Troubles at King-Harbor: Full coverage of hospital in crisis - latimes.com

As emergency rooms get shut down, then even people with health care insurance can't actually get emergency room care because they have problems finding an emergency room that is currently open and receiving patients. So you have people in ambulances calling different hospitals trying to find one with space to accept a patient.

Now some might argue that we should just get rid of EMTALA, but think about the consequences of that. When you go into an emergency room, you may not always have your Kaiser card with you and you might not be sent to a hospital set up to process your health insurance. It was these huge delays in verifying health insurance before treatment was begun that caused the feds to implement EMTALA in the first place. People were dying in emergency rooms because they weren't in a position to verify their health insurance (ie they
were unconscious after a car accident).

But once you set up a system where emergency care is mandated, people either get sick enough to need mandated emergency care (which is really expensive) or the emergency room treats the care in the emergency room to prevent the person from coming back later when its even more expensive to treat it. In either case the emergency room is treating all kinds of people.

Already if you are old, the feds provide health care under medicare. If you are poor enough, the state with funding from the feds is going to provide health care under medical or one of the medically indigent adult health care programs.

If you are under 18 and you meet the eligibility requirements, you have access to health care under Chips.

Children's Health Insurance Program

Because of all of these various government health care programs plus the health care purchased for government employees as an employee benefit, the largest provider of health care in the country in every state is the government.

One might argue that I am advocating the socialization of health care, but that boat as sailed. Long ago we socialized health care. We just do it in the least well thought out and most expensive manner possible.

Nationwide as percentage of GDP, we are spending more money on health care than any other country and we are having some of the worst outcomes of any country. For all of these reasons, we really do need to restructure the health care industry.

Now my ideal health care system looks something like Brad De Long proposed here

An Unrealistic, Impractical, Utopian Plan for Dealing with the Health Care Opportunity - Grasping Reality with All Six Feet

or Scott Sumner proposed here.

TheMoneyIllusion » Equity vs efficiency in health care: Let’s pretend there’s a third way

Brad De Long is a UC Berkeley professor and bleeding heart liberal. Scott Sumner is University of Chicago paleo libertarian. Both come up with fairly similar suggestions.
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Old 03-08-2010, 02:51 PM
 
4,182 posts, read 6,255,121 times
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Quote:
Originally Posted by mysticaltyger View Post
In my mind, we should let people pay out of pocket for their own health care and only have insurance for medical catastrophes. If people really saw the true cost of their care, they, long ago would have become more proactive about changing their lives; and the health care companies would have been forced to move away from their "pills and surgery" approach to health because people simply wouldn't stand for it.
Many diseases have a genetic basis. You have no control over the genes you get from your parents. While exercise, smoking cessation, losing weight, avoiding pollutants, etc may help ameliorate environmental factors that contribute to disease, you can't eliminate the genes that make you susceptible to illness. Unless we start a program of genetic manipulation at the time of conception, there will always be a large subset of the population who will get sick regardless of how healthy a lifestyle it tries to lead.
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Old 03-08-2010, 03:18 PM
 
Location: CO
1,603 posts, read 3,356,110 times
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Quote:
Originally Posted by ndfmnlf View Post
Many diseases have a genetic basis. You have no control over the genes you get from your parents. While exercise, smoking cessation, losing weight, avoiding pollutants, etc may help ameliorate environmental factors that contribute to disease, you can't eliminate the genes that make you susceptible to illness. Unless we start a program of genetic manipulation at the time of conception, there will always be a large subset of the population who will get sick regardless of how healthy a lifestyle it tries to lead.
And I don't think many will suggest those people be treated the same as smokers or people who eat burgers every day. We're talking about lifestyle choices, not genetic illness. The trouble is determining a way for the health care providers to accurately and effectively distinguish between the two fairly.
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Old 03-08-2010, 03:44 PM
 
4,182 posts, read 6,255,121 times
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Quote:
Originally Posted by AwayAndBackToSac View Post
I not trying to start a fight here.

I'm wondering what people generally think is going to happen to the delivery of health care. Trying to be a private physician is close to impossible in California. In this area it seems that Kaiser, Sutter, UCDavis, and Mercy predominate... Will these "managed systems" continue to rein and increase? Will "your own" doctor cease to be, replaced by "hired guns" for the "managed systems"?

My largest concern it the future. I don't know what is going to be feasible as the large number of boomers, expecting every increasing health care, hit the medicare rolls... Medicare reimbursement will have to decrease... Medical is already so bad most can't take it. Even with severe tort reform and cross state competition I don't know if health care can continue the way it is.
The reason mom-and-pop doctors' practices are going the way of the dinosaur in CA is because they have very little clout in negotiating professional fees with insurance companies. A solo practitioner has virtually little power to refuse the fee structures that Blue Cross, Aetna, etc will impose on him. Insurance companies will pay you $1 for a 1 hour complex office visit if they can get away with it. Hence the trend for health care providers to band together into bigger groups that own their own hospitals, surgicenters etc (like Sutter, Mercy, etc). These groups have negotiating power.

Having said that, a classmate of mine practices as a solo dermatologist in San Jose and is very financially successful at it. The reason he is successful is because he doesn't accept insurance, Medicare, or Medical. All his patients pay cash, and he can charge them whatever he wants. This will work with dermatology because 99% of cases are non-emergencies, they don't require hospitalizations, and they are affluent to begin with (i.e. lots of patients spending discretionary income for cosmetic procedures).

This business model will not work for bread and butter internal medicine, family practice, cardiology, oncology, etc where patients suffer from life threatening illness that do require hospitalization and therefore a large outlay of cash which most patients don't have.
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Old 03-08-2010, 03:47 PM
 
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I don't know what the best answer is but they have to do SOMETHING. The price of health care insurance is bankrupting this country
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Old 03-09-2010, 01:52 PM
 
212 posts, read 444,631 times
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"This business model will not work for bread and butter internal medicine, family practice, cardiology, oncology, etc where patients suffer from life threatening illness that do require hospitalization and therefore a large outlay of cash which most patients don't have."


Actually, I know of a few Internists and FP's who are doing well by not taking insurance here.

Additionally, I know Cardiologists and GI's who are doing very well in Texas by not taking insurance, but your right concerning the "expensive" true medical emergencies....

Hospitalization's and expensive possibilities were initially the intention for "health insurance" in the past, which some hail as the desire for "catastrophic health insurance" now... These policies were not initially set up for weekly visits, and standard labs. I have to wonder if starting to cover the small stuff was a way to rationalize increased fees/increase profitability, and slowly encroachment into all medicine, which reinforces the attitude of entitlement by the patient (so that the cycle continues, kind of like big government entitlements). Conversely, you could choose "health insurance" with large deductibles, but generally the American citizen has not been a saver in the last few decades...

Now the government is talking about mandating "standard baseline coverage for all", while mandating a maximum profit margin. I have to think that this is the only way to guaranty the death of private health insurance, especially as the boomers retire, or to guaranty that only one or two remain...

...leaving, you got it, the federal government in charge. And if the government offers basic care, you end up with a two tier system, just like the UK, and now Canada (they recently let you buy your own private care: how enlightened!), which does give somewhat adequate low level care to most... But top level care to a very few.



Regardless, I've gotta get back to work (Yes, even here in California)

My question was what do people expect here in Sacramento, and in California. ...sadly, it seems people expect managed care to continue to expand... Which reinforces my fear as above. Looks like I better start saving if I want really good care for my kids. As I would have/should have a few decades ago. Now, I just hope that there are a few good doctors who stay and practice here.
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