U.S. Healthcare

[Ten oz]

President Trump's backed healthcare plan was recently pulled. However Congress can revive debate and propose another bill in the future. What are some of the solutions we'd like to see? *keeping in mind that we aren't starting from scratch.

 

It seems solutions are dominated by who pays for healthcare: single payer, employer based, individual tax credits, etc. Cost cutting solutions tend to revolve around malpractice protection. I think one outlooked area is education. It is very expensive and academically difficult to pursue a medical career. That limits the number of people who are willing and able to pursue a medical career and also influences how much salary those who do need in order to both pay off educational debt and enjory the quality of life their efforts have earned. I believe that finding a way to make medical school less expensive, or even free, would increase the number of qualified people in the medical industry and reduce costs by increase the supply to meet an increasing demand.

 

Paying for the education could be achieved by a local govts cooperartion with insurers and Hospitals to pay into federal managed scholarship programs that contracted graduates to their region. For example Beverly Hills CA has no trouble getting Doctors, Nurses, Physician Assistants, Physical Therapists, and etc. Meanwhile Morgantown WVA does. In trade for scholarships graduates owe a contracted number of years to work in a designated part of the country. Rather than Hospitals and insurers having to spend money travling around trying to recruit professionals, offering bonuses, and etc They could direct funds to a federal established scholarship program which would then place graduates. Local govts (cities, counties, states) would contribute as having such professionals in their localities would benefit their communities in the long run for obvious reasons. And of course there would need to be some federal money in the pot as well.

 

A single payer system is the best in my opinion but unfortunately I don't believe we are ready for it. We run annual deficits and pay as much towards interest on debt as we do all non DOD discretionary spending. We need serious changes to our tax policy, defense spending reprioritization,and banking reform before we can embark on a the journey towards single payer. Attempting to do sure now may bit like reshuffling deck chair on the Titanic. Our tax policy is inadequate to support what we all ready have and our spending priorities are all stick and absolutely zero walking softly.

 

What plans do the rest think would work: expansion of Medicare, massive tax credits, health insurance accounts, etc?

 

 

[John Cuthber]

I guess the first question would be "why change the current system?"

[Ten oz]

I guess the first question would be "why change the current system?"

In my opinion the current system needs improving. Care is expensive relative to what millions can afford and emergency care takes too long. The system can be improved. We don't need a scrap it and start over approach but it could be a lot better.

[John Cuthber]

Good point.

Without going into details, the US pays roughly twice as much per head for healthcare as most of the Western world.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

 

And it does so without a correspondingly good set of outcomes

https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

 

It seems reasonable to assume that a system more like they typical European or Aussie/NZ Japanese system would be a better approach.
I understand that the Affordable Care Act was a step in that direction.

Is my understanding correct?

[Airbrush]

We should focus more attention on how the other developed nations are getting better health care results with lower costs.

[Delta1212]

Good point.

Without going into details, the US pays roughly twice as much per head for healthcare as most of the Western world.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

 

And it does so without a correspondingly good set of outcomes

https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

 

It seems reasonable to assume that a system more like they typical European or Aussie/NZ Japanese system would be a better approach.

I understand that the Affordable Care Act was a step in that direction.

Is my understanding correct?

To the extent that it mandates a bare minimum of coverage that all insurance plans must meet, disallows denying anyone coverage and provides government subsidies to lower-income people to help pay for whatever plans they get, yes. The expansion of Medicaid to cover a ton more people is probably the biggest step in that direction.

[Ten oz]

We should focus more attention on how the other developed nations are getting better health care results with lower costs.

How would we accomplish that? It is always a good pratice to incorperate what works form other systems but that is easy said than done when those other systems are single payer and we're not. Those systems very well might be too different for use to plug pieces from into our system. Truly I should say systems because there are several. We have millions on Medicare, millions of federal employers using Tricare, millions covered under the VA, millions on civilian employer brought coverage, millions paying for their own, and millions with none at all. Making it even hard to get a round turn on is the fact that all of it varies State to State. So what might help Texas greatly has the potential of accomplishing nothing in another State.

 

Which is why I proposed focusing on trying to increase access to medical training. Try to increase the supply of those able to provide the service in hope that lowers costs and support innovation (educating more people typical does increase innovation). It obviously is not the be all end all solution but a step we can take without transforming the whole system top to bottom.

[John Cuthber]

As far as I can see the US currently has a mess of systems a bit like that in the UK in 1948 whe the NHS was set up.
There is a precedent for improvement.

[OldChemE]

The solution I'd like to see is driven by the situation wherein those who make the laws and enforce them also tend to exempt themselves, which I believe lessens their incentive to get it right. My suggestion (not original to me) is that the US constitution be amended to require that all systems (retirement, health, etc) developed by the Government are mandatory for all government and elected officials, not just the rest of the population. If Congress had to depend on Social Security and Medicare for health (not Tricare or other plans) they would have more incentive to do their best.

[Phi for All]

Just open Medicare insurance to all, and work hard on improving payouts to private healthcare. It will be cheaper so people will want it, it will pay quicker so doctors will want it, and it will be focused on health instead of wealth so it will be effective as a risk pool for implementing healthcare.

[Ten oz]

Just open Medicare insurance to all, and work hard on improving payouts to private healthcare. It will be cheaper so people will want it, it will pay quicker so doctors will want it, and it will be focused on health instead of wealth so it will be effective as a risk pool for implementing healthcare.

I would love, love, love, love, love it with we moved to a single payer system. One of the problems is that it isn't politically viable. We currently spend about a trillion dollars a year on Medicare and Medicaid. For over a decade our deficits have been around half a trillion dollars a year or greater. I know stupid tax cuts and wars are responsible for the deficits and that entitlement spending is different than discretionary spending but that doesn't change the political reality. People do not want to contribute "more" even if it means people will be contributing less. By that I mean a few would lose their tax credit and such while the majority will pay less. Sadly tens of millions take their cue from those who want the credits. Despite covering 20+ million citizens who otherwise would have coverage the ACA cost Democrats seat all over the country. Perhaps too many seats.

[rangerx]

In Canada, health insurance is the law. It's an individual mandate. Hospitals treat people based upon military triage, not economic status or underwriting. There is no onus upon the employer whatsoever to provide insurance unless it's agreed through the collective bargaining process. People leave their jobs for any number of reasons. Some disabled persons, parents or mentally ill are unemployable. Quitting one's job to raise a family ought not to be punished. Simply put, it is discriminatory. Forcing employers to pay health insurance is a job killer and flies in the face of anti-government involvement. Denying coverage for previously existing conditions is too. Refusing to cover treatment for a person after a motor vehicle accident because they had cancer several years ago is not only ruthless, it's despicable.

 

In Canada, health insurance premiums are inextricably linked to income tax. Lower brackets are offered premium assistance, hence reducing their costs. It's a bell curve, not a sliding scale as American politicians would have you believe. An indigent person pays nothing. A low income person pays a higher percentage of their annual income for insurance than an affluent person. For example, a person making 40k per year pays 2k in premiums, hence 5% of their annual income. A person making 200k pays 4k in premiums, hence 2% of their annual income. This is why tax breaks fail the health care system. Being poor is penalty enough, but letting rich people off the hook is not only unfair, but makes services unavailable to those who can least afford it.

 

In Canada, for general practice, you may choose your doctor. If you like your doctor, you can keep your doctor. If you need a specialist, you are assigned the next available specialist. If you don't like that specialist, you can wait for the next one. You can even request a specific specialist, but it's by a co-operation agreement, not a right.

 

Republicans need to get off their delusional high horse about "their" tax money. We hear, ad nauseam... I don't want MY MONEY used on abortions (for example). I got news for you. It's not your money. It's in the coffers of general revenue, where funds are allocated accordingly through budgets and transfer payments. A person who does not own a car cannot demand their money not be used on roads. A person with no children cannot demand their money not be spent on schools. The truth is, even if a person has no car, they buy products which were transported by truck. A single person may hire another person for a job who was qualified by their education. Health care and disease prevention is a benefit to otherwise healthy people, because they're not exposed to sick people who remain untreated. Persons who obtain proper treatment return to work sooner, those who are not adequately treated remain disabled. Overpopulation or neglected citizens give rise to higher crime rates, addiction and welfare. An ounce of prevention being worth a pound of cure, is lost on the shortsightedness of politicians and their pundits.

 

Can you imagine a fire department refusing to respond to your house fire because they cannot profit because you have no insurance? Home insurance doesn't put out fires, it merely compensates loss after every alternative has been exhausted. Why should insurable health services be any different?

 

America stubbornly refuses to follow the lead of other countries who provide universal health care to their citizens as though it doesn't exist. Instead cling to profit, ideology and little else. Gotta appear superior and exceptional, ya know. Instead, developed their very own modern plague and in doing so, refuse to mitigate it unless there's a buck to be made. It's draconian and barbaric IMHO.

[MigL]

I am Canadian also, and the US could do much worse than copying our system, as it seems to work reasonably well.

It does have its problems however...

 

Doctors are paid by the 'system', and as a result are capped at a specific value. This has the double whammy of the best doctors leaving for the US where they can earn large, and the rest only taking so many patients to reach that cap. As a result we have doctor shortages in Hospitals resulting in long wait times for surgeries and difficulty finding family doctors.

 

But at least EVERYONE has coverage !

I've said this before, and I repeat, for a rich country like the US, not to have a viable universal health care system is a shame and an embarrassement.

Maybe having one would 'make America great again'.

[John Cuthber]

I would love, love, love, love, love it with we moved to a single payer system. One of the problems is that it isn't politically viable.

I'm sure they said that about ACA.

People can be re-educated,

[rangerx]

It does have its problems however...

 

Doctors are paid by the 'system', and as a result are capped at a specific value. This has the double whammy of the best doctors leaving for the US where they can earn large, and the rest only taking so many patients to reach that cap. As a result we have doctor shortages in Hospitals resulting in long wait times for surgeries and difficulty finding family doctors.

 

But at least EVERYONE has coverage !

 

Yeah, there's problems. Wait times for sure, but most are for elective or non-emergency procedures. Those with serious conditions (ie) cancer, injuries etc. get treatment immediately.

 

What Americans don't know is many things are not covered by health care in Canada. Without extended insurance plans like Blue Cross etc., we pay for our dentistry, eye glasses and occupational therapists out of our pockets.

 

I don't know any poor doctors. Most are pretty well off, despite being paid per visit or irrespective of clinic costs. Most doctors and dentists have two offices, so they can see patients simultaneously. Attend one patient while the freezing sets in on the other, if you will. It's a harmless workaround for efficiency and viability, as opposed to gouging or denial of service. Canada also provides jobs for foreign accredited doctors and surgeons, especially in rural areas. Many of whom have better training than even we provide.

 

Our health care system is basic at best. Even most emergency rooms deal with immediate issues like bleeding and splints or stability, then refer the patient to a clinic for further treatment. Get healthy, then get back to work is what makes a country great. Not red hats and lies from arseholes with chips on their shoulders.

 

As if becoming sick or injured isn't bad enough, at the very least nobody loses their home, investments or children's schooling. The republican agenda is motivated to hijack the houses and bank accounts of hard working folks under the guise of evil socialism. *spit* I'd rather the government tell me to wait a month for a procedure, as opposed some political crony or greedy board of directors picking my pocket of my life savings any day of the week. Putting people on the street or kids out of school in exchange for health services is just flat out reprehensible.

 

As I'm sure you're aware, even the conservatives in our country do not make abortion or health care into election issues because they know it's political suicide. Conversely, the liberals are some of the worse hatchet men when it comes to transfer payments to the provinces for health care. We still have the burden to hold either party's feet to the fire.

 

Which brings us to an important point. Health care in Canada was brought on by the CCF, which is today's NDP. There are merits to the three party system. While that tends to split liberal voters from time to time, it also gives rise to coalition government, which has the power to take down the Prime Minister in a non-confidence vote for any reason. Americans, in their protest of the parliamentary system, sold themselves short on ousting a dictator (other than violently with caches of guns). *facepalm* Their burden of impeachment is much higher, even impossible under partisan rule. Meanwhile, they just keep shooting each other with those same guns at rates higher than most anywhere on the planet. Ensuring mentally ill Americans have access to guns while systematically denying health care, pretty much tells you all you need to know about American politics.

 

Health care in Canada is not perfect, but apart from my own motivation for well being, I owe much of my good health to universal health care and I'm grateful for it. American neocons can call me a socialist all they like, because at the end of the day they're the one's suffering for the lack of it. Not me. If they'd rather bite off their noses to spite their faces, that's on them, not me either.

 

Later, my friend.

[Ten oz]

I'm sure they said that about ACA.

People can be re-educated,

While you are right look at the collateral damage surrounding the ACA (tea party moment, loss of over a thousan state seats by dems) meanwhile the ACA might be torn up and lit on fire. "Obamacare" became almost the singular issue used by the right to win seats, block legislation, and raise money. It was certainly the only real issue as the others were based on lies/exaggerations. Obviously people can be educated and what not but we must be honest about where we are. The environment that we exist in. Trump is POTUS, Ryan & McConnel rule the roost in Congress, and the GOP control the majority of state seats & Governships.

[Phi for All]

While you are right look at the collateral damage surrounding the ACA (tea party moment, loss of over a thousan state seats by dems) meanwhile the ACA might be torn up and lit on fire. "Obamacare" became almost the singular issue used by the right to win seats, block legislation, and raise money. It was certainly the only real issue as the others were based on lies/exaggerations. Obviously people can be educated and what not but we must be honest about where we are. The environment that we exist in. Trump is POTUS, Ryan & McConnel rule the roost in Congress, and the GOP control the majority of state seats & Governships.

 

I've often seen the numbers showing how much more Americans pay for healthcare than other major countries. Do we know where that extra money goes? Is that strictly private profit, is it lots of little overages that add up to a lot, is it due to lobbying efforts by mega-corporations? If we want Americans to be alarmed about the state of healthcare, we should point out exactly how they're being cheated.

 

The whole misguided affection for the idea of the country being run like a business instead of a country needs to be slapped out of a lot of people. I prefer non-violent protest, so a virtual slap or something like a bucket of iced water over the head would be good. The purpose of business is profit, and when governments are run that way, the People are ignored. People are an operational expense and thus the least amount possible will be spent on them.

 

We should be pointing out how much money has been wasted opposing our good health as a society. Billions in dollars and so many hundreds of thousands of work hours dedicated to NOT providing what our allies (and even our enemies) from WWII provide to their People. So much effort to avoid doing what a good government should do, and healthcare opponents would tell you it's to save money.

[Ten oz]

Run like a business really means run for the benefit of business.

[Phi for All]

Run like a business really means run for the benefit of business.

 

Is he going to start laying us off as citizens, in order to cut costs and improve the bottom line?

[John Cuthber]

 

Is he going to start laying us off as citizens, in order to cut costs and improve the bottom line?

Yes; they call it "disenfranchising".

[Phi for All]

OK, multiple insurers force the healthcare system to over-administer, which means 25% of our costs are for administration, compared to 16% in the UK. Source: http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs

 

Our drug costs are stupid, mostly because we can't negotiate as a country, thanks to Bush II Medicare Part D. Strike that and Medicare can be used as a single-payer system, getting drugs as cheaply as the VA and Medicaid (because they can negotiate).

 

Another thing we should be able to fix is malpractice, which leads to defensive medicine. I don't have a solution for this one, since the doctors continue as private practitioners. This costs us a great deal, and doesn't lead to better care.

[Ten oz]

OK, multiple insurers force the healthcare system to over-administer, which means 25% of our costs are for administration, compared to 16% in the UK. Source: http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs

 

Our drug costs are stupid, mostly because we can't negotiate as a country, thanks to Bush II Medicare Part D. Strike that and Medicare can be used as a single-payer system, getting drugs as cheaply as the VA and Medicaid (because they can negotiate).

 

Another thing we should be able to fix is malpractice, which leads to defensive medicine. I don't have a solution for this one, since the doctors continue as private practitioners. This costs us a great deal, and doesn't lead to better care.

How do we pay for it? Medicare, Medicaid, and the VA cost us over a Trillion dollars a year now as is. Obvious the a single payer system would cost less overall but current the govt isn't paying the overall bill. The amount the govt would have to pay will go up. So rather than employers and individuals paying for private plans they will need to pay the govt. That is where it gets tricky because such a large percentage of the country is conditioned to think giving the govt money is a bad thing. It is crazy but people rather pay Kaiser $300 a month for a private plan than the give the govt $150 a month for the exact same care. To make universal Medicare work, viable as a political reality, people will need to accept giving more money to the govt than they currently do.

 

What you are saying is the right answer but not viable in a country that elected Trump and beliefs background checks for buyers of military grade assualt rifles is a violation of their rights. The ACA was a baby step toward getting every covered and the right spent 7yrs demagoguing it to the tune of thousand of won elected seats across the country. What's palatable to the electorate simply has to be part of the conversation. "Keep Obamacare as is forever" isn't going to go over well as a position for Dems or Repubs in 2018. "Everyone pay more tax and we'll all have medicare" will go over better among many Dems but still is a cold served dish. More of a gazpacho than a universally loved American classic like chicken noodle soup.

 

Remember, Bill Clinton pushed Universal Healthcare. Democrats had majorities in both houses of Congress and it failed. The healthcare push was blamed for Democrats losing the majorities that had in Congress to the "Republican Revolution "of 1994. In fairness Bill Clinton's proposal wasn't Medicare for all but the point is Democrats have lost many seats over the years in this issue.

[StringJunky]

 

Our drug costs are stupid, mostly because we can't negotiate as a country, thanks to Bush II Medicare Part D. Strike that and Medicare can be used as a single-payer system, getting drugs as cheaply as the VA and Medicaid (because they can negotiate).

 

Trump wants to change that:

 

 

President Donald Trump is back with more drug-pricing promises. This time, he says he's aiming to push prices lower than anywhere else in the world.

Speaking at a meeting with members of the Congressional Black Caucus (CBC) on Wednesday, the president said U.S. patients pay far too much.

It's "really unfair what’s happened in our country" around pharmaceutical prices, he said, according to a White House transcript, adding that Americans are being "ripped off."

"So we’re going to be instituting a very, very strong bidding process," he said, repeating a plan he's endorsed repeatedly over the last several weeks.

Transforming U.S. drug prices into the lowest worldwide would be quite a feat: Now, they're generally among the highest—if not the highest—on the planet. Bringing them down to the other end of the spectrum would mean pushing them lower than those in India and other developing countries, where drugs can go for pennies on the dollar compared to the U.S.

http://www.fiercepharma.com/pharma/u-s-to-push-for-world-s-lowest-drug-prices-trump-says

[John Cuthber]

Trump wants to change that:

 

It's very hard to tell what Trump wants (rather than what he says).

[Ten oz]

Trump says a lot of stuff. During the campaign he said universal coverage for all paid for by the govt. The reality is that he just says whatever feels good at the moments but ultimately doesn't write policy, doesn't know how govt operates, and doesn't actually care all that much what happens.