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I have to agree with the both of you. Quite astonishing how expensive US healthcare really is and then you must take into account the lower life expectancy compared to the rest of the world....it is a shame that some countries in the developed world have better systems
There is no perfect system, anywhere.
There is no free market healthcare, anywhere.
In the US states were and remain the primary regulator of insurance, all insurance, not just healthcare. No two states have the same regulations. For example, what medications an insurer must include in coverage varies state to state
In an attempt to reduce premiums, some states chose to ignore the ACA and allowed hospitals to use out of network contractors. Patients had no reasonable way of anticipating which providers/ services were in vs out of network until their plan reimbursed the invoices at out of network rates and balance billEd the difference to the consumer. Surprise !
Then there are state approved plans that do not include all ACA required specialties. Those enrolled in such plans have no choice but to use an out of network provider. Surprise !
No shortage of legislators and Trump chose to portray ^ as evidence the ACA/ Obamacare was bad. Reality is some state chose to not comply with a federal law and the Fed chose to not prosecute the states that allowed these practices. No need for an EO or new legislation. Just enforce the Federal law as it relates to PPO, on the books. That however has political ramifications.
Insurance premiums are based on the cost of healthcare in every local market. The premium for the same individual plan sold by the same insurer can and does vary within and across states. Premiums are based on many factors including # and type of claims made and ratios of hospital beds, providers and insurers in every given region. For example, Florida has 69 regions. The regional thing predated the ACA and remains.
To eliminate the regional thing means healthier and more competitive regions would need to subsidize less healthy/ competitive regions. Again, a state decision.
There is nothing at the federal level to prevent insurance from being sold across state lines. The devil is in the detail. Insurers don’t have PPO networks in states they are not licensed in. Therefore, all claims would be treated as out of network and the consumer balance billed for the diff. Obvious Trump did not comprehend this when he used to mutter allowing insurance to be sold across state lines. Shortly after inauguration, Trump let loose with “ no one knew healthcare was so complicated”. Well, when the only trusted advisors are your children who have no experience, it makes sense. Trump says a lot of things that don’t make sense.
I voted for Trump in 2016 but did not drink the kool- aid.
Neither Trump or Biden have a solid plan to reduce the cost of healthcare. It’s all political noise.
While the rest of the developed world focuses on medical outcomes, hospitalS in the US increasingly use things like valet parking, private rooms/ baths, room service meals, feeding Patient visitors, spa like services, thread count in sheets and so on to create a better experience. The private room thing is often sold as preventing infection. Reality is most infections acquired in a hospital are urinary tract, not spread patient to patient.
Yes, they do. And what's the primary driver for that? The need to focus so obsessively on patient satisfaction that we've turned healthcare into just another service industry where the customer is always right. Do poorly on your patient satisfaction scores as measured by Press Ganey et al, and the federal government will punish you, hospitals and doctors alike, by withholding reimbursement. So, we focus on the things you describe above as opposed to actual clinical and safety indicators (although payor want to see all that data too).
BTW, I've always found your posts on healthcare to be knowledgable, realistic and balanced. I don't get to Rep you as often as I'd like
What about all the retirees who paid into Medicare for 40 years, and are now at the point of needing health care? How is it fair to them to water down the program so that illegal aliens can get coverage?
There is no such thing as Medicare for All. There is Medicare, which you pay into all of your employment years, with Your Employer contributions AND there is Medicaid for the Poor which is paid the same way. Nobody has to pay into Medicaid to use it. It can often be difficult to find doctors who accept Medicaid payments because they are so low.
What the Leftist have proposed with the Catchy Title of “ Medicare For All” will be Medicare for none and Medicaid for All. The seniors who support losing their program appear clueless that they also lose their Private Advantage Plans. Unions appear clueless that the Lose their Negotiated Plans and get dumped into Medicaid type of program.
How soon everyone forgets all the LIES we were told about the last Medical Insurance Program the Democrats tricked us on. The LIE of the Year at the Washington Post was ”If you Like your Doctor, you can keep your Doctor AND If you like your Insurance, you can keep your Insurance”
Quote:
Originally Posted by krichton
Hmm, so you're praising socialized medicine, like medicare, but you're critical of socialized medicine on a wider scale. Great argument there, lol.
It’s a great argument because it’s true ... as others have pointed out.
Quote:
Originally Posted by lauradrops
Biden doesn't support medicare for all. That was a major difference between their campaigns.
He had to say that to attempt to show how ‘moderate’ he is .... anyone who thinks Biden will be calling any shots if he is elected is not paying attention. Even Harris calls it the Harris Administration with Joe as President (figurehead).
Black Lives Matter leaders, organized labor, progressive groups and members of the House Democratic “Squad” are unveiling a 2021 agenda Thursday, laying down markers for how big a Joe Biden administration could go on coronavirus aid, economic relief and more next year.
Known as the Working Families Party’s “People’s Charter,” the 1,000-word proposal calls for universal free health care, a jobs program employing 16 million people, retroactive hazard pay for essential employees and the reallocation of resources from policing toward education and other services. It also promotes giving the public an ownership stake in firms that receive bailouts, as well as buying out gas and oil companies, among other policies.
The platform, shared first with POLITICO, is the latest move from progressives as they prepare to wrangle with moderate Democrats over the scale of new government spending and programs if the party wins control of Washington. It’s part of a different strategy for progressives this year than in the 2016 election: putting more organizational muscle behind Biden than they put into backing Hillary Clinton’s campaign, but also vowing to turn around and place immediate pressure on Biden to stand with them on key issues if he is elected.
That's of course a contributor, but New Zealand, Australia also have similar percentages , yet per capita HC expenditure is much less. Realistically overweight/obese percentage is high in many of the developed countries.
People are getting fatter throughout the world. WHO defines it as a top global healthcare risk.
We are the fattest in the developed world.
As I understand it, most Aussies rely on the Single Payer System where one has no choice of provider or public hospital. Wait times apply. Inpatient care tends to happen in multi bed/ bath rooms ( wards).
There is a 2% tax on all income without a cap. High income earners pay the tax despite they are expected to use private insurance, providers and hospitals. If a high income earner chooses to participate in the Single Payer System, they have to pay an additional tax. Nonetheless, these taxes are not enough to cover costs without subsidy from general tax revenues.
Corporations pay a flat 30% income tax. The individual tax system is highly progressive. The highest tax bracket for individuals is 45%. There is a 10% VAT tax. Everyone, everywhere in the world complains about taxes and healthcare costs.
Private healthcare insurance is also available to the masses with the government subsidizing premiums based on an income test. There is clear intent to transfer risk from the public to the private sector to manage costs.
The size of and average age of a population are factors of healthcare expenditures. For example the average age in Japan is 48 years. It’s 38.2 in the US and 37.2 in Australia. Japan’s population is 5x that of Australia.
One can appreciate Japan’s focus on weight control given the size and age of its population. The Japanese must submit to an annual waist measure. Those with measures beyond the healthy range are strongly encouraged to engage in counseling. The majority of the burden of measuring falls to employers. Government gives each employer an annual goal for reduction of waist size. If a business fails to hit the target, it is required to make a higher payment to the Sickness Fund. Government audits results because of gaming.
The connection between weight and healthcare costs is understood in Japan and the country has chosen to use its muscle to combat it and better manage healthcare expenditures.
Yes, they do. And what's the primary driver for that? The need to focus so obsessively on patient satisfaction that we've turned healthcare into just another service industry where the customer is always right. Do poorly on your patient satisfaction scores as measured by Press Ganey et al, and the federal government will punish you, hospitals and doctors alike, by withholding reimbursement. So, we focus on the things you describe above as opposed to actual clinical and safety indicators (although payor want to see all that data too).
BTW, I've always found your posts on healthcare to be knowledgable, realistic and balanced. I don't get to Rep you as often as I'd like
Thank you.
My husband has had a few instances of inpatient experiences over the past few years. The patient satisfaction surveys that followed, reminded me of the sort of thing one receives from a holiday resort.
Smiles and food matter. Lol. Did you use our Dine Around Dinner Service ( ordering in from a local restaurant)? If so, what restaurant? Was the food tasty? Were you treated respectfully? Did staff smile?
This hospital recently completed a $$$$$ addition/ renovation. All rooms/ baths are private. One is not going to find this in countries that rely mostly on public hospitals where the focus is primarily clinical who somehow manage similar outcomes.
Local hospitals in my area rely on volunteers to work with Medicare patients to complete the patient satisfaction form before discharge. Nothing quite like listening to someone go on for 20 minutes about their perception the food was too spicy Or cold or hot or something and a perception all females are nurses and males are the doctors. Lol.
I agree.. But there are countries where they healthcare is cheaper, the coverage is Universal and the life expectancy are far higher than the United States. I believe the United States is the last country in the developed world to lack a universal healthcare coverage...
That 75% of us are overweight/ obese means the US population is substantially more vulnerable to otherwise preventable disease, has much to do with why the US spends more per capita. Somewhere along the way, personal responsibility fell off a cliff.
If the population were to magically right size, the population would be healthier and not need medical attention to the extent it does. When nearly 1/3 of the population is Diabetic or pre- Diabetic, something is wrong. Some states trend substantially healthier or sicker than others are it tends to correlate to the percentage of the population overweight/ obese.
How does a healthcare system take care of all its people when the majority of the people don’t take care of themselves?
While obesity is based on an individual's actions, the sad part of it is that we have a government, both under a left and right presidency, who has allowed a system to stay in place that allows unhealthy food industries to be subsidized (via the subsidies given to the sugar industry).
As such, almost everything in our food these days is ladened with sugar, which has a huge link to obesity.
As well, our culture in some part of this country need to shift. When Michelle Obama tried to introduce healthy alternatives to our kids school lunches, some in this country lost their mind.
Obesity need to not only be tackled on an individual level, but also on a societal and governmental level.
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