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Reimbursement schemes are part of the government protected racket that goes away.
The reason physicians choose to get absorbed into hospital monopolies is the loophole in the law that let's them get referral kickbacks so long as they are part of the conglomerate. That and the guaranteed >=15% pay raise they get by being under the hospital monopoly's various protections.
For government reimbursement schemes, yes. But the private insured can be charged whatever the hospital chooses, to offset the lower reimbursement of Mediwelfare. This is what gives the illusion that Mediwelfare is preferable.
My entire point is that most regulation regarding healthcare exists to limit competition at every step of the health care chain. Limiting supply. Of doctors, of buildings, of insurers, of nurses, equipment, drugs, etc.
Get rid of every law that artificially limits supply. Period. Stop protecting the players in that industry from competition. Period.
Are the reimbursement schemes going away if we have more providers?
Is Medicare going to disappear with more providers?
Privately insured patients are not charged whatever the hospital chooses. Those reimbursements are negotiated.
Your idea that limiting numbers of docs raises HC costs. It does not. More docs, and more gets done with more medical encounters. When TX enabled MP tort reforms, that helped paved the way for more docs to practice there. So overall HC costs have gone up.
Third parties are not going away with any HC reforms. Health is way too risky a proposition for that.
Are the reimbursement schemes going away if we have more providers?
Is Medicare going to disappear with more providers?
Privately insured patients are not charged whatever the hospital chooses. Those reimbursements are negotiated.
Your idea that limiting numbers of docs raises HC costs. It does not. More docs, and more gets done with more medical encounters. When TX enabled MP tort reforms, that helped paved the way for more docs to practice there. So overall HC costs have gone up.
Third parties are not going away with any HC reforms. Health is way too risky a proposition for that.
So there is no way to reduce monopoly tactics anywhere in the entire healthcare industry, so we should simply hand it over to the largest, most powerful monopoly and hope the have our best interests at heart, yes?
So there is no way to reduce monopoly tactics anywhere in the entire healthcare industry, so we should simply hand it over to the largest, most powerful monopoly and hope the have our best interests at heart, yes?
Monopolies don't apply much to typical docs.
Local hospital monopolies can be important with higher local costs. Especially in more isolated areas.
But somehow allowing many more docs into an area won't lower local overall HC costs from competition.
What caused this thread on health care to turn into yet another bash Canada thread? Do I detect envy?
I don't bash Canada, nor their political system, nor their health system, nor their tax system
But I do see a Canadian (you) bashing the USA and its systems, which are different form Canada's
we (the USA) are not Canada
we have a very different type of government...and a very different type of taxation
our government is like a boss standing over you saying your time is his money...a micro-manager
much of our higher prices are BECAUSE of the government....mostly the FDA
the problem is not about following the Canadian (or swiss, or Danish, and on, an on) model
the main problem we have here is the USA is OUR OWN GOVERNMENT RED TAPE
so a drug, prescribed in Canada(you can substitute any country you like), by Canadian doctors, approved in the Canada, is good enough for the Canada, but the US FDA says no....is that a correct thing to do....NO.....but it happens all the time
Metamizole...non-opioid, non-addicting painkiller, It is the perfect painkiller in-between of Paracetamol and Opioids. It does not have the serious side effects of nsaids and no dependency issues like Opioids but it has a quite strong analgetic potential also it is spasmolytic and helps a lot with pain after surgery and in surgical emergencies.....used throughout Europe, Canada, Australia....yet...NOT FDA approved...
the FDA is quite possibly the worst organization in our government and is one of the main reasons that healthcare is so expensive.
our government...will NOT have cheap health care.....NEVER..... everything our government puts its greedy hands on goes to crap
see its not about should we follow ______ model (insert any country)...its not about singlepayer or UHC being better..... the problem will always be our governments red tape... no matter what model we try
get the government out of my body, and I guarantee it will be better
============================
now if you want to talk about the pros/cons of M4A
there is no guarantee M4A could lower any costs or overhead
it will cost an additional 4.1 trillion yearly (according to the CBO)..even Bernie said an ADDITIONAL 4.1 trillion to our budget...and increasing yearly with inflation
with all the denial of service that medicare has...with the staggering cost to the taxpayer
why not take it in steps
why go for mount Everest, when you can do the rockies first
what we could do is... revise the current medicare and SS systems...yes we could do that
how about (assuming passing this idea into law in 2020) lower the age for medicare to 60 starting 2020...(as most who want to retire don't because medicare is stuck at 65) adjust the cost factor (payroll tax) by 1% (1% is not going to hurt many peoples take home)...revise the formulary so there are less denials of service (too include knee and spinal disc replacements that currently medicare denies because the person is "too old"))....then analyze the cost before next step of lowering to 55 in ten years..then also increase the payroll tax from the new 2% to 2.5% or 3%...(based on the analysis of cost). revise the medicare benefit chart so doctors get their fair share, and so patients get less denial of care
take SS raise the FULL retirement age to 72, (prorated as) those entering the workforce (turning 18) in 2020 FRA is 68..those entering the workforce in 2026 is 69...entering 2032 is 70...etc 6 year steps
raise payroll from 6.2% to 7%...lower the reduced age of retirement (currently 62) to match the new eligibility age for medicare
this would fix the problem of people still working at 55/60 because of health ins...they would retire if they could get medicare….this would also get you a better idea of the overall cost to revise it even more in the future
it makes more sense than to abolish "private insurance" and shoot your whole load on a pipe dream
Remove the myriad barriers the government has erected that limit all of the above under the dictate of protected monopolies. Examples:
Remove every certificate-of-need law in existence.
Remove every "any willing provider" law in existence.
Remove every "network adequacy" law in existence.
Repeal ACA ban on new physician-owned hospital construction.
Remove the barriers between the states to encourage medical tourism.
Require the same pricing transparency for health care that you do for virtually every other good or service sold in the US.
Remove the AMA monopoly on licensing, or at the very least make their licensing requirements and quotas transparent so that the world can see how they cap the number of new guild members
Repeal every "approved/preferred vendor" contract for medical equipment and pharmaceuticals at every level of government, and make every new contract for same valid only via voter referendum on actual ballots, with all terms and conditions listed on the actual ballot.
Those are a good start, and I would welcome you to add anything for any area I might have missed.
Go back to barbers being surgeons. Yikes!
I don't have the entire afternoon to search for links about why these are a bad idea, or at least not feasible.
"For every complex problem. . ."
I don't have the entire afternoon to search for links about why these are a bad idea, or at least not feasible.
"For every complex problem. . ."
As I said to Hoonose - clearly the solution is to let all the current monopolies simply roll up to te biggest, most powerful, most vile monopoly, and then things magically get cheaper.
I get it.
There is no solution, we just watch it get inexorably worse. Sorry to bother with proposals that seek to work within economic laws rather than violate them wholesale. And you can skip the "healthcare isn't like any other product" stuff, I already figure that is the 1st Excuse.
I don't bash Canada, nor their political system, nor their health system, nor their tax system
But I do see a Canadian (you) bashing the USA and its systems, which are different form Canada's
we (the USA) are not Canada
we have a very different type of government...and a very different type of taxation
our government is like a boss standing over you saying your time is his money...a micro-manager
much of our higher prices are BECAUSE of the government....mostly the FDA
the problem is not about following the Canadian (or swiss, or Danish, and on, an on) model
the main problem we have here is the USA is OUR OWN GOVERNMENT RED TAPE
so a drug, prescribed in Canada(you can substitute any country you like), by Canadian doctors, approved in the Canada, is good enough for the Canada, but the US FDA says no....is that a correct thing to do....NO.....but it happens all the time
Metamizole...non-opioid, non-addicting painkiller, It is the perfect painkiller in-between of Paracetamol and Opioids. It does not have the serious side effects of nsaids and no dependency issues like Opioids but it has a quite strong analgetic potential also it is spasmolytic and helps a lot with pain after surgery and in surgical emergencies.....used throughout Europe, Canada, Australia....yet...NOT FDA approved...
the FDA is quite possibly the worst organization in our government and is one of the main reasons that healthcare is so expensive.
our government...will NOT have cheap health care.....NEVER..... everything our government puts its greedy hands on goes to crap
see its not about should we follow ______ model (insert any country)...its not about singlepayer or UHC being better..... the problem will always be our governments red tape... no matter what model we try
get the government out of my body, and I guarantee it will be better
============================
now if you want to talk about the pros/cons of M4A
there is no guarantee M4A could lower any costs or overhead
it will cost an additional 4.1 trillion yearly (according to the CBO)..even Bernie said an ADDITIONAL 4.1 trillion to our budget...and increasing yearly with inflation
with all the denial of service that medicare has...with the staggering cost to the taxpayer
why not take it in steps
why go for mount Everest, when you can do the rockies first
what we could do is... revise the current medicare and SS systems...yes we could do that
how about (assuming passing this idea into law in 2020) lower the age for medicare to 60 starting 2020...(as most who want to retire don't because medicare is stuck at 65) adjust the cost factor (payroll tax) by 1% (1% is not going to hurt many peoples take home)...revise the formulary so there are less denials of service (too include knee and spinal disc replacements that currently medicare denies because the person is "too old"))....then analyze the cost before next step of lowering to 55 in ten years..then also increase the payroll tax from the new 2% to 2.5% or 3%...(based on the analysis of cost). revise the medicare benefit chart so doctors get their fair share, and so patients get less denial of care
take SS raise the FULL retirement age to 72, (prorated as) those entering the workforce (turning 18) in 2020 FRA is 68..those entering the workforce in 2026 is 69...entering 2032 is 70...etc 6 year steps
raise payroll from 6.2% to 7%...lower the reduced age of retirement (currently 62) to match the new eligibility age for medicare
this would fix the problem of people still working at 55/60 because of health ins...they would retire if they could get medicare….this would also get you a better idea of the overall cost to revise it even more in the future
it makes more sense than to abolish "private insurance" and shoot your whole load on a pipe dream
Didn't we go over this just a few days ago? Why yes, four days ago, in fact. You posted the exact same rant about drugs. My response then, as now:
Calm down, my friend. Yes, a big complaint about the FDA is that it's too slow to approve drugs. Do you happen to recall a drug called Thalidomide? It was approved in many countries for as a sedative or hypnotic, with claims also to cure "anxiety, insomnia, gastritis, and tension". Later, it was used to treat nausea and to alleviate morning sickness in pregnant women. Thalidomide became an over-the-counter drug in West Germany on October 1, 1957. https://en.wikipedia.org/wiki/Thalidomide
It was also sold in many other European countries, Canada and Australia. But. . . the FDA would not approve it. In fact, ironically, it was a doctor originally from Canada who worked for the FDA who would not approve it. And good thing! It caused many birth defects in the infants of pregnant women who took it. https://www.npr.org/sections/thetwo-...de-dies-at-101 And yeah, yeah, yeah, I know it was reapproved in the US in 1998 for treating leprosy and 2006 for use in treating multiple myeloma.
Your wonder drug, Metamizole, was once approved in the US but withdrawn from the market due to side effects, particularly blood toxicity in 1977. It was also withdrawn from the market in Sweden and India, though reinstated in India. https://en.wikipedia.org/wiki/Metamizole
The search for the wonder pain med with no addictive properties and no side effects reminds me of alchemy.
Didn't we go over this just a few days ago? Why yes, four days ago, in fact. You posted the exact same rant about drugs. My response then, as now:
Calm down, my friend. Yes, a big complaint about the FDA is that it's too slow to approve drugs. Do you happen to recall a drug called Thalidomide? It was approved in many countries for as a sedative or hypnotic, with claims also to cure "anxiety, insomnia, gastritis, and tension". Later, it was used to treat nausea and to alleviate morning sickness in pregnant women. Thalidomide became an over-the-counter drug in West Germany on October 1, 1957. https://en.wikipedia.org/wiki/Thalidomide
It was also sold in many other European countries, Canada and Australia. But. . . the FDA would not approve it. In fact, ironically, it was a doctor originally from Canada who worked for the FDA who would not approve it. And good thing! It caused many birth defects in the infants of pregnant women who took it. https://www.npr.org/sections/thetwo-...de-dies-at-101 And yeah, yeah, yeah, I know it was reapproved in the US in 1998 for treating leprosy and 2006 for use in treating multiple myeloma.
Your wonder drug, Metamizole, was once approved in the US but withdrawn from the market due to side effects, particularly blood toxicity in 1977. It was also withdrawn from the market in Sweden and India, though reinstated in India. https://en.wikipedia.org/wiki/Metamizole
The search for the wonder pain med with no addictive properties and no side effects reminds me of alchemy.
Kat the point is not about the particular drug mentioned..its about how many drugs ...many GOOD drugs (medications) and medical services that have been used in Europe, or Canada, for years, and yet the monopoly of the FDA wont allow them here
for example
its not that americans or American doctors haven't figured it out..its the government
actually the government is a major part of the problem..specifically the FDA
the FDA is quite possibly the worst organization in our government and is one of the main reasons that healthcare is so expensive.
our government...will NOT have cheap health care.....NEVER..... everything our government puts its greedy hands on goes to crap
the FDA (our government) is a major part of the problem, along with AMA, AHA, VA, medicare/Medicaid(they are full of denial of service)
I was injured in Iraq..(my back)..the VA (government ) wanted FUSING, would not approve the disc replacement...yet BCBS (private ) would PAY FOR IT overseas (except for travel and lodging)it wasn't until dec 2004 that the fda approved it for single level...still the VA and tricare (government ) would not do it (said it was 'experimental' ...even though it had been successful in Europe for nearly 3 decades)...FINALLY I won the battle against the government and had my back surgery in 2007
the lumbar DISC REPLACEMENT surgery was done in Europe for nearly 30 years before the FDA approved for it to be done here
and its BECAUSE OF GOVERNMENT (especially the FDA)...believe me government care is not what the basic American wants
its the way the government works....and it sucks
here what I went through: va patient needs a MRI...the government (va) NOPE use an xray...first time
2. xray doesn't show much..patient needs an MRI...the government (va) use the xray...you have DDD 3. patient doc I am in pain,,are you sure its DDD..doc the xray shows some funny spaces, could be DDD or could be something else...let's ask for a MRI..the government nope lets xray (each xray is RADIATING the person btw)...again funny spacing...must be DDD 4. same
5. same
6. same
7. same
8 same
.
.
15 same
.
.
23 same
23 times with the VA xray...its DDD(degenerative disc disease)
got to the doctor and PAY FOR THE MRI out of pocket...and we find out its... one CRUSHED disc, and 2 ruptured discs....now choices...the government(va) FUSION and still have pain, and limited movement(because at the time the FDA would not allow the replacement that had been being done in europe for 30 years)(the FDA finally approved single level artificial discs in 2004, (the va and tri-care refused saying it was 'experimental"))...or non-government(blue cross) which would have covered me to fly to Europe to get it (minus lodging and the airfair) .....4 years of big pain, before my battle was won against the government
and medicare……. will deny lumbar artificial disc replacement.... not allowed (guess they see no need for people to not have back pain)…. keep in mind this operation has been done, successfully, in Europe for 35 years
As I said to Hoonose - clearly the solution is to let all the current monopolies simply roll up to te biggest, most powerful, most vile monopoly, and then things magically get cheaper.
I get it.
There is no solution, we just watch it get inexorably worse. Sorry to bother with proposals that seek to work within economic laws rather than violate them wholesale. And you can skip the "healthcare isn't like any other product" stuff, I already figure that is the 1st Excuse.
The first excuse is very true though. Not many 'products' have an unknown cost at the outset. And not many 'products' have such an enormous variably in cost.
And I'm not talking about the variability of pricing of a med or test here vs there.
At the outset of many medical encounters, the end point costs are commonly not known.
A 'chest cold' could cost $100 or $1M.
So we need 3rd parties/insurance. And we need central controls, mandates and oversight.
All of that making easy free markets next to impossible for the vast bulk of HC.
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