Let's really talk about Healthcare

[iNow]

We know about Medicare fraud. Have for years. In fact, Obamacare reduces that quite a bit. It also gets better when you treat based on quality of outcome instead of quantity of procedures. What's your point? Are you suggesting fraud is absent in private insurance? That fraud only happens when governments get involved? Seriously... I don't follow.

[JustinW]

iNow,

 

We know about Medicare fraud. Have for years. In fact, Obamacare reduces that quite a bit.

Yeah but they didn't have to totally take over BEFORE they adressed these types of problems. Maybe if they woud have, we could have been on a better track to reduce spending. That was my point. People want to pass this off to government control without even adressing the problems first.

[Airbrush]

To control health care costs you need to penalize people for overusing health care. Healthy people who work hard at taking good care of themselves don't need to see a doctor as much as irresponsible people who don't make any effort at staying healthy.

 

Accidents will happen and even the most dilligent "physical-fitness-health-nut" may need a doctor to sew up a bad cut, set a broken bone, or rotator cuff surgery. But if somebody lives on junk food and never exercises, they should have to pay a higher premium.

[Phi for All]

To control health care costs you need to penalize people for overusing health care. Healthy people who work hard at taking good care of themselves don't need to see a doctor as much as irresponsible people who don't make any effort at staying healthy.

 

Accidents will happen and even the most dilligent "physical-fitness-health-nut" may need a doctor to sew up a bad cut, set a broken bone, or rotator cuff surgery. But if somebody lives on junk food and never exercises, they should have to pay a higher premium.

But the only ways to monitor behavior are way too invasive. This brings us back to taxing the unhealthy food. Or is there a way to encourage exercise, perhaps allowing a write-off for gym or community center membership?

[Airbrush]

But the only ways to monitor behavior are way too invasive. This brings us back to taxing the unhealthy food. Or is there a way to encourage exercise, perhaps allowing a write-off for gym or community center membership?

 

Simple physical exams include weighing-in, blood and urine tests, a series of questions, etc, are not terribly invasive. A doctor can track the progress of his patients. Progress is what counts. People simply need to be inspired to try to be healthy. Gym membership is not enough.

 

Oh yeah, and tax junk food to subsidize healthier alternatives. Also, produce is often poor quality. How often do you eat an orange that is really sweet? Is there a way to control the fertilizing and growing of produce to ensure is it top quality? People bite into a sour orange and throw it away (for life) and grab that dependable candy bar, which is always sweet.

[Phi for All]

Simple physical exams include weighing-in, blood and urine tests, a series of questions, etc, are not terribly invasive. A doctor can track the progress of his patients. Progress is what counts. People simply need to be inspired to try to be healthy. Gym membership is not enough.

I wasn't aware that a general practitioner could tell how much junk food you've been eating. Certainly they can track fitness progress, but I think people's metabolisms are so different that it'd be hard to distinguish between the person who could eat just about anything and never gain weight and the person who eats salads but finds it hard to keep fit. Especially when there might be financial penalties involved.

 

Oh yeah, and tax junk food to subsidize healthier alternatives.

This has been tried, in fact it's how the Tea Party came to be, in organized protest against a law to tax non-diet soda.

 

Also, produce is often poor quality. How often do you eat an orange that is really sweet? Is there a way to control the fertilizing and growing of produce to ensure is it top quality? People bite into a sour orange and throw it away (for life) and grab that dependable candy bar, which is always sweet.

I've had some really good fruit lately, and unfortunately it came from Chile instead of being locally grown. I don't know how any healthcare proposition would be able to affect the quality of crop production.

[Airbrush]

As usual, you make good points Phi for all. It will take time for me to respond, if I can.

[iNow]

Healthcare costs can also be controlled by paying for quality of outcome as opposed to quantity of procedures.

 

 

Justin - I've become impatient with the "yeah, but" responses that seem to dismiss entire well-crafted arguments topically and seemingly without any reasonable reflection, so I won't be responding with anything of substance for the time being. Cheers, mate.

[JohnB]

Airbrush

To control health care costs you need to penalize people for overusing health care. Healthy people who work hard at taking good care of themselves don't need to see a doctor as much as irresponsible people who don't make any effort at staying healthy.

 

But what is healthy? How do you measure it and how do you ensure that there aren't long term disadvantages? It's all very well to say "Tax the lazy, the healthy are looking after their bodies" but what happens when you find that the healthy things they do have negative effects in the future? Since step aerobics are linked to more knee injuries than any other exercise, shouldn't we also be taxing the people who do that more than the general public? After all, through their lifestyle choice they have probably increased their need for medical attention down the road.

 

Justin,

 

But I'm trying to get an idea of what you pay:what you get, compared to what we pay:what we get.

 

Maybe we should go back to basics then rather than bounce around. Three groups are responsible for health care provision down here, the Federal Gov, the individual State Govs and the Individual. Federal funding for health comes from the Medicare Levy and as much as is needed out of "Consolidated Revenue". From this money the Feds pay the rebates I've mentioned earlier, the PBS and sundry other schemes and give a large amount of cash to the State Govs for Healthcare. The Feds also provide co-ordination for bulk discount negotiations. An individual hospital won't get a discount on an MRI machine, but when the Feds are talking about buying 50 or 60 of them the companies talk discounts in a big way. They also do the leg work for bulk discounts from Pharma for drugs, something I think your Health people are actually banned from doing. It's an "economy of scale" thing, if I want to buy one car I talk to a dealer, if my country wants 10,000 cars, we talk to the Head Office. Here is also where the reverse side of your "rationing" coin comes in, we have a department dedicated to the idea of getting everything it can for the lowest possible price. This doesn't mean playing the "inflated tender" game, it means going to the various companies and screwing their arse to the wall for the cheapest price. "You want $40 per pack of pills? ABC over in India will do them for $24 a pack and give a discount. Care to try again?".

 

The philosophy behind the PBS is not that all medicines should be free or subsidised, simply that paying for medicines needed for continued life should not cause unreasonable hardship. A good example here is that I've had my thyroid removed and will be on pills for the rest of my life. While the pills are now required for my continued existence, the cost is only $80 odd annually and is therefore not considered to be worthy of PBS inclusion. This would be a different matter if the cost was higher. This is constantly being assessed WRT annual incomes (with age taken into account), costs of drugs, alternatives, etc. Note that the cost of administering the scheme isn't part of the deliberations which sinks your "rationing" line of reasoning.

 

The individual States look after the actual running of the hospitals and set the standards for both public and private. They also look after the ambulance services. Ambos are paid for either by direct levy as we do in Queensland ($75 per annum is added to our power bills) or are paid out of a States Consolidated Revenues. Most Doctors and Surgeons are private practice and some do rotating clinics in various hospitals. Virtually all clinics outside a hospital are purely private practice and there are heaps of them. I probably have a choice of 30 doctors within a 10 minute drive from my house, all are private practice and charge different prices, but I still get my Federal rebate of the same amount regardless of which one I go to.

 

To illustrate how this all meshes together, I burst my appendix some years ago. Aware of pain in the side but not concerned I didn't do anything for a day or so. By the second day I was sick of the pain so I went to the Drs (private, so I paid $50 and got a $40 rebate from the Feds) who ordered blood tests (private clinic that bulk bills Federal Medicare, so free). Third day no better, fourth day back to Drs (private and another $50 and $40 rebate) who sends me to the Royal Brisbane, (Ambulance, State gov, free) where they prep for surgery. (State public hospital, mucho Federal funds, free) On discharge I was given a prescription for anti biotics and got them from the pharmacy on site and paid whatever for them.

 

Our system isn't supposed to pay for everything, it's just supposed to ensure that a medical problem doesn't become financially crippling as well. Other oddities include that if a Dr orders a test, say a CT scan it is free, but if I decide I want one, I pay for it. This isn't a problem as I Just phone around the various clinics that do CT scans and find one with an appointment time that suits me. Any time I've needed something like that it's never been later than 2pm the following day which I think is reasonable. (Same for untrasounds BTW)

 

So that's what we get for our 1.5% levy and some money out of Consolidated Revenue. If we want more, then we can get private insurance as well.

 

This gives us a choice of Drs in hospitals and private rooms rather than a ward. Since two of the last three times I've been in hospital I've had a room to myself anyway I don't see much benefit in this. Same thing with "Doctor of your choice", my local GP isn't going to be cutting my appendix out and I'll be unconscious anyway so what do I care who cuts the damn thing out so long as s/he is competent? If they aren't competent then this is a question for the Medical Revue Board but has nothing to do with health insurance. Private will also cover optical and dental, massage, some cover aromatherapy, there's pretty much a plan to cover anything that you want, even what we call "Gap" cover which gives you the extra little bit back between the Medicare rebate and what the Doctors consult actually cost you.

 

As I said earlier most of the "choice" in private insurance is an illusion, a fantasy. You take your child to the ER bleeding from a head trauma, they fell off their bike. Are you going to be loudly demanding a Doctor, any doctor look at your child or will you contact your GP, so that s/he can come in and go through the CVs of the various Doctors on duty to work which one to choose? There is only real choice in elective surgery because you can plan for it.

 

I think I see what you're saying here, but am not sure that I would pick that over a competitive structure that we see in a free market. When two different surgeons compete for higher pay. That higher pay is a direct reflection of quality of work. Or at least in theory. When government gets involved it tends to change the game a bit.

 

Not as much as you might think, our Doctors are paid quite well, if we don't pay them well they would bugger off and start a private clinic. Just because the Gov is involved doesn't remove the competition, it just makes the Gov one of the competitors. You have to remember that GPs can make between 150k and 800k PA down here. Hospitals have to pay well to get and keep staff, and the various States are competing against each other.

 

And you don't think that competition would drive employment. A hospital employee here in the US has benifits to consider when making a choice on where to work. Do your hospital employees get offered any benifits?

 

See above. Of course they do, our hospitals are bidding for the services of staff so they need the terms to be attractive.

 

Where does it show that Obama's new reform will actually cut costs? I've heard people say it, but it has since been debunked by a lot of folks.

 

I said "change to our system", which has nothing to do with Obamas one. The simple fact is that we provide as good or better healthcare than your system does and we do it for less than half the per capita costs that you have. If you changed to our system it would automatically halve your costs. Yes, it would take a great rewriting of laws and a number of States would get all precious about their "rights", but the savings would be huge. I somehow get the feeling that admitting that somebody else had an idea for a better system than an American did would stick in the craws of many people and the wailings and gnashings of teeth would be great and long, along with comments containing the phrase "Our Great Republic" and great lamentations for lost "freedoms".

[JustinW]

JohnB,

 

The philosophy behind the PBS is not that all medicines should be free or subsidised, simply that paying for medicines needed for continued life should not cause unreasonable hardship. A good example here is that I've had my thyroid removed and will be on pills for the rest of my life. While the pills are now required for my continued existence, the cost is only $80 odd annually and is therefore not considered to be worthy of PBS inclusion. This would be a different matter if the cost was higher. This is constantly being assessed WRT annual incomes (with age taken into account), costs of drugs, alternatives, etc. Note that the cost of administering the scheme isn't part of the deliberations which sinks your "rationing" line of reasoning.

 

It makes a whole lot more sense to me now that you've explained it this way. You're saying that the PBS doesn't deny drugs because they cost too much, but rather deny the drugs that should be easily affordable in order to keep a surplus for those that are not?

 

 

Just because the Gov is involved doesn't remove the competition, it just makes the Gov one of the competitors.

Some hefty competition in any arena.

 

 

 

Yes, it would take a great rewriting of laws and a number of States would get all precious about their "rights", but the savings would be huge. I somehow get the feeling that admitting that somebody else had an idea for a better system than an American did would stick in the craws of many people and the wailings and gnashings of teeth would be great and long, along with comments containing the phrase "Our Great Republic" and great lamentations for lost "freedoms".

Yes, and I'd probably be one of them. I don't feel it necessary to give up on my beliefs in freedom just to save a buck.

 

iNow,

 

I didn't think you would've considered, "We know about Medicare fraud", a well-crafted argument that needed alot of reflection.

[iNow]

Big picture, Justin. My comment was not specific to that lone exchange. Best.

[Phi for All]

Yes, and I'd probably be one of them. I don't feel it necessary to give up on my beliefs in freedom just to save a buck.

To me, this is where the conversation ends. If you see healthcare reform as giving up your beliefs in freedom, nothing anyone could say will ever sway you. You'll always see everything like this in the light of you giving up some sort of mystical freedom, all the while burdening the rest of us with costs that are twice what the rest of the FREE world pays, just so American capitalism gets to pretend it has a free market while pocketing it's unethical, hypocritical, favoritism-based profits.

[iNow]

I too ran into an interesting article today that supports my take on fraud and how much it actually affects our spending and availability.

<snip>

And keep in mind that without even covering patient abuses this type of fraud alone is estimated to cost taxpayers upwards of 160 billion dollars a year.

We know about Medicare fraud. Have for years. In fact, Obamacare reduces that quite a bit. It also gets better when you treat based on quality of outcome instead of quantity of procedures. What's your point? Are you suggesting fraud is absent in private insurance? That fraud only happens when governments get involved? Seriously... I don't follow.

iNow,

 

Yeah but they didn't have to totally take over BEFORE they adressed these types of problems. Maybe if they woud have, we could have been on a better track to reduce spending. That was my point. People want to pass this off to government control without even adressing the problems first.

FYI

 

http://www.whitehouse.gov/infographics/medicare-fraud-0512

 

[JustinW]

iNow,

 

Big picture, Justin. My comment was not specific to that lone exchange. Best.

When you comment on a specific remark that I make, it doesn't quite imply a big picture response is necessary. My, "yeah buts", are usually followed by something that has either been left unsaid or is refutable with your well thought out remarks.

 

 

Phi,

 

What you call mystical, others (and I would say a majority) view as litteral. Just because you don't mind trading freedom for comfort/security (you know, that warm fuzzy feeling that helps you folks sleep better at night), doesn't mean that others should be just as willing. And you talk about burdening the rest of you....YOU never talk about getting rid of that burden. YOU just want to make that burden mandatory by law. How was it put in another thread.....Oh yeah, intimidation through the use of violence and imprisonment.

 

all the while burdening the rest of us with costs that are twice what the rest of the FREE world pays

It seems that you and big business have something in common Phi. Hunger for money. Who would've thought? Oh I get it. When people think of money in terms of profit it's bad, and freedom only matters if it's something you support, is that it? Is that the way of this new social movement? No principles that are set in stone? Just whatever's trendy at the time? Oh...wait...there is one, rock solid principle, I've seen that has pretty much been the statis quoe with this whole movement. It is the principle of government control always being the solution. If other parts of the world do so much better, then what the hell are you still doing here? Why not join those other FREE WORLD people if you like their kind of freedom better.

 

 

just so American capitalism gets to pretend it has a free market while pocketing it's unethical, hypocritical, favoritism-based profits.

Sounds just like a "free market" guy to me. Maybe you need to take a step back and decide what philosophy you politically ascribe to. One thread to the next seems a little jumpy. One instant profit is good (with restrictions). The next, the whole goddamn market is unethical pondscum taking advantage of the down-trodden poor folk. Give me a f***ing break. For some reason Marxism comes to mind. "Control the middle class by creating a crisis based on smaller problems", does that seem familiar? My gripe ain't about reform. It's about the solution outweighing the problem.

 

 

If you see healthcare reform as giving up your beliefs in freedom

I never said anything of the kind, and in fact have stated that reform is fine. Just not your kind. I see your kind of healthcare reform as a blaitant slap in the face to the freedom of, not just Americans, but people in general. You got one thing right though.

You'll always see everything like this in the light of you giving up some sort of mystical freedom

Yep you definitely got that right. But let me let you in on a little secret that the underground isn't telling you. FREEDOM IS NOT MYSTICAL. Since the conversation has ended for you, I will not await your rebuttal.

 

iNow,

 

Oh yay. What about the rest of the programs? Anything on them? Does this in no way seem just like a political scheme to you? If fraud and embezzlement mattered to these polititions, don't you think that it wouldn't be happening in just this one area?

 

Oh BTW, nice graph.

Edited May 8, 2012 by JustinW

[questionposter]

Logically, if a society wants money to be put into taking care of each other, it has to come from somewhere in the form of either money or the energy to accomplish the tasks themselves. If a majority of people are willing to pay for it, it should be fine. We are already sacrificing certain freedoms by being in a government, but the sacrifice in turn gives us security. The only problem is when officials abuse the deciding how the sacrifice should be made.

Edited May 8, 2012 by questionposter

[JustinW]

Questionposter,

 

If a majority of people are willing to pay for it, it should be fine.

Sure, but the majority don't want to pay for it as it stands today. They might have if two things would have happened. 1- The public could have had time to study the bill before it was rammed through behind closed doors. 2- If the government didn't take it upon itself to penalize it's citizens for not buying a product.

In my arguments on this issue I include alot of other things that I think are legitimate reasons for not liking this form of system, but I think this thing would have had alot more support had those two things been done. On the number one reason, it's the fact that when you see things like this happen in a democracy, 9 times out of 10 they turn out to be shady in one way or another. On the number 2 reason, this whole reform revolves around this mandate, which is against some very core principles that alot of Americans hold. So if number 2 doesn't stand up, then the whole thing gets shot down. I think those are the main two reasons for such opposition to the reform.

[jeskill]

OKAAAAAY, so Phi said:

You'll always see everything like this in the light of you giving up some sort of mystical freedom, all the while burdening the rest of us with costs that are twice what the rest of the FREE world pays, just so American capitalism gets to pretend it has a free market while pocketing it's unethical, hypocritical, favoritism-based profits.

And Justin's response was

It seems that you and big business have something in common Phi. Hunger for money. Who would've thought? Oh I get it. When people think of money in terms of profit it's bad, and freedom only matters if it's something you support, is that it? Is that the way of this new social movement? No principles that are set in stone? Just whatever's trendy at the time? Oh...wait...there is one, rock solid principle, I've seen that has pretty much been the statis quoe with this whole movement. It is the principle of government control always being the solution. If other parts of the world do so much better, then what the hell are you still doing here? Why not join those other FREE WORLD people if you like their kind of freedom better.

Justin... really? I agree with Phi. There is no point in debating this with you. If you truly believe that Phi's response means he thinks government control is always the solution, if you truly believe that a democratic government has no ability to enable certain freedoms, then you're way too hopelessly partisan to ever properly analyze this issue.

[JustinW]

Jeskill,

 

Justin... really? I agree with Phi. There is no point in debating this with you.

It's funny that others are just as hardheaded with their viewpoints but nno one seems to think debating with them is pointless.

 

 

If you truly believe that Phi's response means he thinks government control is always the solution

Name one solution proposed by Phi that didn't include government control of something. If there was a proposal of a free market solution or even a compounding comment on one, I must have missed. I would be glad if you would point at least one out for me so I could know if I'm as mistaken as you think I am.

 

if you truly believe that a democratic government has no ability to enable certain freedoms

Why sure they do. Did you even read post 66? Some freedoms can be taken, but whether they should are not is highly debatable among the populace. It just so happens that no one wants to debate about it with someone who opposes their view points. Classy.

[questionposter]

Questionposter,

 

Sure, but the majority don't want to pay for it as it stands today. They might have if two things would have happened. 1- The public could have had time to study the bill before it was rammed through behind closed doors. 2- If the government didn't take it upon itself to penalize it's citizens for not buying a product.

In my arguments on this issue I include alot of other things that I think are legitimate reasons for not liking this form of system, but I think this thing would have had alot more support had those two things been done. On the number one reason, it's the fact that when you see things like this happen in a democracy, 9 times out of 10 they turn out to be shady in one way or another. On the number 2 reason, this whole reform revolves around this mandate, which is against some very core principles that alot of Americans hold. So if number 2 doesn't stand up, then the whole thing gets shot down. I think those are the main two reasons for such opposition to the reform.

If a majority of people don't want to pay for it then they will see what it's like to have a fire-station let your house burn to the ground unless you pay them, which already happened in the early 20th century. Can you even imagine what would happen if police were privatized?

Edited May 10, 2012 by questionposter

[JustinW]

If a majority of people don't want to pay for it then they will see what it's like to have a fire-station let your house burn to the ground unless you pay them, which already happened in the early 20th century. Can you even imagine what would happen if police were privatized?

The analogy for this would be an equal to an ER. As the fire station is paid to put out the fire, the ER is paid to keep you from dying. A fire station doesn't rebuild your house, just like an ER doesn't rebuild your body. So we already have the medical equivelant of a fire station. NEXT.

[questionposter]

The analogy for this would be an equal to an ER. As the fire station is paid to put out the fire, the ER is paid to keep you from dying. A fire station doesn't rebuild your house, just like an ER doesn't rebuild your body. So we already have the medical equivelant of a fire station. NEXT.

 

You shouldn't be so quick to dismiss this concept. Would you really want to live in a society like that? ER is obligated to "rebuild" you if it's necessary for keeping you alive when you enter and cure whatever emergency you have, although after that emergency is taken care of, then your on your own, but that's because there isn't more taxes, not because there's too much. If there were more taxes, people wouldn't have to worry about it because those things could be paid for by the government. Generally in places where there's universal healthcare, there's generally less crime, I think people in those places are happier that they do not have to worry about as much.

Edited May 10, 2012 by questionposter

[JustinW]

You shouldn't be so quick to dismiss this concept. Would you really want to live in a society like that?

We already live in a world like that. Although it's not perfect it's not as bad as some make it seem either.

 

although after that emergency is taken care of, then your on your own

Just like when they put out the fire.

 

We already pay enough taxes. Too much if you ask me. This reform bill that was passed...how do you think it will effect employer provided insurance? I think once this mandate is implimented you'll see most employers dropping their employees health coverage for the simple fact that the penalty they would have to pay for not providing it is outrageously cheaper than the premiums they pay. What goes with that is a major job loss in the insurance business, ultimately shrinking the insurance market to what we see in europe. Do you think the government is ready or can handle, with any efficiency, such an abrupt change? And how big of an effect do you see job losses in the insurance industry having?

 

Generally in places where there's universal healthcare, there's generally less crime, I think people in those places are happier that they do not have to worry about as much.

Are you sure? The last 2001 interpol statistics show that crime rates in the EU were much higher than the US. http://danmark.wordpress.com/2006/07/01/last-comparison-of-crime-rates-between-nations-ever/ I didn't feel like going through all the numbers in the interpol stats, but here is the first site that popped up who had them. You can see that with all offenses per 100,000 residents, the US was much lower.

[Phi for All]

Are you sure? The last 2001 interpol statistics show that crime rates in the EU were much higher than the US. http://danmark.wordp...n-nations-ever/ I didn't feel like going through all the numbers in the interpol stats, but here is the first site that popped up who had them. You can see that with all offenses per 100,000 residents, the US was much lower.

If you take a closer look at the numbers, you'll see that they don't add up. For one, the US numbers don't include Fraud and Narco-criminality. Secondly, the only numbers for All Offenses that total correctly are for the US; all the other countries are off by thousands. For instance, Germany (which also doesn't list anything for Fraud) lists the totals as 7736.33, but my calculation gives 4140.83 (which is less than the US). You say you didn't feel like going through all the numbers in the interpol stats, but apparently you only went through the US.

 

And let's face it, without the numbers for Narco-criminality, none of these numbers are meaningful. The US has 25% of the world's prisoners in our facilities, and 25% of those are for drug-related charges.

[imatfaal]

Here are some pretty decent numbers on Homicide http://www.unodc.org/unodc/en/data-and-analysis/homicide.html. The USA considerably higher than most of Europe (excepting some of the ex-Soviet states).

 

 

Comparisons of crime statistics is very difficult - we don't have the same laws etc. Homicide is not perfect but it is one of the easiest and safest comparisons to be made

[JustinW]

Phi,

 

If you take a closer look at the numbers, you'll see that they don't add up.

That's because they aren't adding up the numbers in the column to arrive at the "all offenses" number. All offenses can include anything else that's considered criminal.

 

But after some further thought I do reconsider my statement. Obviously not just homicide, but also assault is higher here. That being said I still don't see how that can be tied to government run healthcare. The cause could just as likely be that pot is legal in most of those countries.