Who'd a thunk it? Obamacare not repealed

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Campitor
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Re: Who'd a thunk it? Obamacare not repealed

Post by Campitor »

Philosophically, I'm a libertarian , but modern health care is one of those unique situations from a macroeconomic standpoint in which maximum benefit can not be achieved by a free market
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You don't have a choice. The laws of the market are inescapable regardless of the systems it resides in be it capitalist, socialist, quasi-socialist, etc. All economies are trying to utilize scarce resources that have other uses - money, materials, time, personnel. Individuals will adjust their resources and efforts to maximize their returns or personal utility regardless of the economic construct in which they reside.

Either the free market will ration your care or mandated caps will. Socialized medicine will throttle the treatment you can and will receive irrespective of emergent/urgent status. Only you know what is best for your circumstances and how you want to approach those circumstances. It's these micro decisions that affect the macro decisions of the free market and inform producers of goods and services within a free market where to best allocate their resources or face elimination by competitors or loss of revenue by disappearing consumers. Dollars are forced to be efficient and the race to keep customers happy and provide services reduces the cost of delivery of these goods and services thereby increasing the standard of living for everyone.

Don't equate the free market with no regulation. Every market has underlying regulations even if they are informal. Before contracts, tort, and patent law, there were handshakes and physical consequences for breaking agreements. The free market depends on limited regulations to quantify the cost and efficiency of the underlying mechanisms that help industry grow. The problem is when regulations become so overriding and burdensome they begin to impede competition and dictate the decisions that individuals and business can make on how to allocate their time and resources.

Healthcare is replete with inefficiencies and crony capitalism. There is no single payer without reform - it will wither on the vine and those with more resources (the 10 and 1 percent everyone hates) will pay for private insurance or take medical holidays to countries that provide the same quality of medical service for less cost to the private payer.

You can't compare European or Canadian healthcare models to US healthcare models because the underlying cost is different and models that may work in Europe may not work here because of the differences between markets and their underlying support systems (educational costs, immigration rates, social culture, political climate, cost of living, population density, etc.)

classical_Liberal
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Re: Who'd a thunk it? Obamacare not repealed

Post by classical_Liberal »

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Toska2
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Re: Who'd a thunk it? Obamacare not repealed

Post by Toska2 »

If we are agreeing to spread the post health care costs, can we also agree on spreading pre health care effort? 15 minutes of jumping jacks after work everyone!*


* I say this because lifestyle diseases are the fastest growing category, chronic, and easier to prevent. In other words, "low hanging fruit". I have no long term solution.

Laura Ingalls
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Re: Who'd a thunk it? Obamacare not repealed

Post by Laura Ingalls »

Riggerjack wrote:
Sat May 13, 2017 10:00 am

Code: Select all

The job I quit in 2014 had 15k of premiums for family coverage (13k paid by the employer 2k ish by the employee). We had dental coverage from my DH employer and paid $700 a year for that. We had $3250 individual and $6500 family deductibles.
Who else gets a cut of that premium? For instance, I belong to a union, who negotiates both the price the company pays for insurance, and provides that health insurance. Strangely, the 14400 per year our insurance costs, is just under 3 times what similar insurance runs on the obamacare exchange. Now, maybe the socialists are exceptionally bad at negotiation, or maybe they pocket that difference. I really can't understand why unions are so closely associated with organized crime...
This was a union job but the union didn't provide the insurance they did negotiate the contract. We actually belonged to a health care cooperative that made a huge group out of school district, county, and municipal employees in that part of the state.

Anyway everyone lives in terror of being on Medicaid yet my experience has been that it is equal or better than any employer based system I have participated in 40 plus years of living in the US.

Maybe I would hold a different opinion if my mom was in an awful Medicaid excepting nursing home?

BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE »

Toska2 wrote:
Sat May 13, 2017 5:08 pm
If we are agreeing to spread the post health care costs, can we also agree on spreading pre health care effort? 15 minutes of jumping jacks after work everyone!*


* I say this because lifestyle diseases are the fastest growing category, chronic, and easier to prevent. In other words, "low hanging fruit". I have no long term solution.
this would reduce the cost of health care so much in the long term, this whole debate would become pointless. that it seems impossible to even prevent the growth of these lifestyle diseases makes brute somewhat sad.

classical_Liberal
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Re: Who'd a thunk it? Obamacare not repealed

Post by classical_Liberal »

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BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE »

brute thinks it's not as easy. he doesn't recall, but were there ever completely split opinions about the health aspect of smoking? at least 50% of the medical establishment is very invested in the idea that carbs are great and fat causes those "diseases of civilization". another 30% believe that excess of any kind, or lack of exercise, is the cause. brute knows both of these to be factually incorrect.

there are way more differing opinions on diet, and it's much more culturally ingrained than cigarettes.

[edit]

in fact, the anti-fat campaign from the 70s to the early 2000s could be viewed as such an attempt by government to vilify fat - completely backfiring and creating the biggest growth in diabetes and obesity ever. thus, taking random action vigilantly actually caused more harm than pretty much any campaign in history.

classical_Liberal
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Re: Who'd a thunk it? Obamacare not repealed

Post by classical_Liberal »

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Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

this would reduce the cost of health care so much in the long term, this whole debate would become pointless. that it seems impossible to even prevent the growth of these lifestyle diseases makes brute somewhat sad.
I'm not sure this is true. Yes, obesity causes many lifestyle diseases, no question.

But the average age of first heart attacks in America is 44, with a fatality rate of 44%. Dying early, with minimal costs. I don't know if this offsets the cost of lifetime insulin treatment for the rest or not. But better geberal health for everyone is not necessarily cheaper healthcare.

I doubt anyone has put the numbers together on this...

But this gets to my primary objection to a single payer system, the tyranny of the majority. We have seen, many times, the bitching from some about how much other people's choices cost them. How long, when push comes to shove, will it be before we just cut off Healthcare to smokers, or put fat people in camps? More to the point, you being put out over my weight, makes both you and I less happy, with no offsetting gain in happiness elsewhere. The more costs are shared, the less we as people tolerate differences. It's like applying a roommate policies on our whole lives. Most people get out of roommate situations precisely because freedom is worth the price.

classical_Liberal
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Re: Who'd a thunk it? Obamacare not repealed

Post by classical_Liberal »

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Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

Riggerjack wrote: ↑
So, you are thinking that before we fix an economic problem with a political solution, we just need to fix politics? Just somehow realign the incentives of Congressmen to be closer to the interests of their constituents?

Yes. Politics and economics are two sides of the same coin. Just human beings imposing rules on eachother and reacting to incentives.
This false equivalent has me scratching my head. Do you really see no moral difference between paying someone more to do something and beating someone until they capitulate? Are you really equally comfortable with using a carrot or a stick? Is that because you have never used either, or did you just use what was easier? When would you decide to use the he stick? When others were egging you on, or just when it was appealing?

Now I won't say forcing compliance is universally wrong, but I certainly wouldn't consider it equivalent to rewarding compliance. Maybe I'm just a bleeding heart... Paying people to work for me rather than simply enslaving them. Two sides, and all that, I guess. :roll:

Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

When costs get out of control in medical, the market IS being efficient. It makes perfect sense to spend anything and everything to save your life, the life of a loved one or, in the case of chronic disease, restore health to maximum functionality. Arguments can be made for some freer market systems to be in place for some parts of healthcare and this may help reduce costs. At the end of the day though, people are willing to spend what it takes (their money AND everyone elses) to maintain life and maximize health. Anyone who thinks differently has never had a chronic life altering illness, nor have they faced personal demise which could be prevented. IOW, if you are sick, you will pay whatever it takes to get healthy, the more complex and expensive our (society's) medical knowledge becomes, the more it becomes possible to spend greater amounts of money/resources.
And it is logical to want a yacht, since they exist, but strangely, there is still a conoe making industry. Maybe nobody told them?

Seriously, there are finite options, regardless of budget. If you have an inoperable brain tumor, and an unlimited budget, there are still only so many scans that can be ordered, so much snake oil to inject, or so many mind/body/spirit healing centers to attend.

The vast majority of medical treatment is not life saving. Most treatment is maintenance and diagnostic, and that can be priced by the average Joe, in the normal course of a business day. As I pointed out above, not every decision needs to be well informed for pricing to work.

While I think it is nice that you have never had to factor cost into healthcare, I can tell you it is factored in every day by some percentage of the customer base. I have known many people who have chronic pain or disability that isn't fixed for cost reasons. That you haven't made that choice is nice, but that's not the reality on the ground.

Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

I'm not sure where those numbers come from, but Harvard Medical disagrees
Yeah. They came from an old doctor I used to see. I remember them just for their symmetry. A quick Google search confirms your numbers, with none for mine. Please disregard my 44% at 44 statement above.

But I stand behind my concept, that those who die early and quickly may not make overall costs go down by living longer, and possibly dying more slowly. Maybe our system only chuggs along because fat people die early and/or cheap.

Do we then subsidize Hostess to keep costs down?

BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE »

except they don't - they take decades of insulin, metformin, expensive personal care, emergency bypass operations.. the cost problem with the diseases of civilization is exactly that they don't kill quickly, but over decades.

7Wannabe5
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Re: Who'd a thunk it? Obamacare not repealed

Post by 7Wannabe5 »

OTOH, the annual incidence of hip fractures is supposed to exceed 500,000 by 2040. Current cost per incidence being over $88,000. This is why I think it might not be a very good idea for a middle-aged female with low diabetes/heart disease risk to adopt an anti-estrogenic diet. IMO, our society focuses too much on what is likely to kill men in their 60s, and not enough on what is likely to disable women in their 80s.

Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

I'm not making the claim that fat is good. I'm saying that we have a lot of people that die early and cheap. That better overall health may not be cheaper overall healthcare.
Insulin is cheap, $30/month, with no insurance. (I had a diabetic dog) I have no idea about metaformin. And most people don't get personal help, or bypass surgery.

This communal unhappiness with the choices of our fellow citizens is a byproduct of sharing their costs.

The conspiracy theorist in me wonders if that is unintended. I mean it's so divisive, and what a wonderful way to stir things up. If you believe that the rich divide and conquer the rest, this must resonate.

My mind doesn't work that way, but it is fun to speculate.

BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE »

Riggerjack wrote:
Tue May 16, 2017 8:31 am
This communal unhappiness with the choices of our fellow citizens is a byproduct of sharing their costs.
t-shirt please. this is one of the defining principles of libertarianism for brute.

classical_Liberal
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Re: Who'd a thunk it? Obamacare not repealed

Post by classical_Liberal »

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IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave »

7Wannabe5 wrote:
Tue May 16, 2017 5:35 am
OTOH, the annual incidence of hip fractures is supposed to exceed 500,000 by 2040. Current cost per incidence being over $88,000. This is why I think it might not be a very good idea for a middle-aged female with low diabetes/heart disease risk to adopt an anti-estrogenic diet. IMO, our society focuses too much on what is likely to kill men in their 60s, and not enough on what is likely to disable women in their 80s.
Since the leading cause of death in US women is heart disease, and I'd guess a good share of those deaths occur before age 80, maybe it's not so bad focusing attention in such a way as to potentially have more women live into their 80s to begin with? I lost an aunt this weekend, perhaps ironically just 5 days after she fell and broke her femur a few inches from her hip. She probably fell from a combination of heavy duty pain medication and oxygen deficit due to lung cancer. She was too weak to seek any sort of treatment for the cancer after a ~10 year battle with heart disease. I don't think a focus on heart disease and it's precursors is a conspiracy against women.

Riggerjack
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Re: Who'd a thunk it? Obamacare not repealed

Post by Riggerjack »

If society suddenly decides it's OK for people to die if they can not afford life saving medical care, that could change. I don't see that kind of social change taking place any time soon, hence we have to make the ground rules even for all. A fair playing field.
Well, you seem more in touch with modern medicine than I am. So help me out here. What are you describing as life saving care? I ask, because I come from the bottom of the socio-economic ladder, and nobody I grew up with has these expectations you describe.

As an example, let me tell you about my grandma's death. Sensitive readers should skip to the next post.

In 1997, my grandma was 91, had lung cancer, a shiny new hip(provided by Medicaid), and in her assisted living apt, she had a heart attack.

My sister and I saw her the next morning, she had a temp pacemaker in, and she was drugged to the gills. The docs were concerned about her kidneys. She had a catheter in, and we were trying to get her to eat ice chips, watching the bag for signs her kidneys were working.

After the first day, I cornered her doc, and asked about getting her on dialysis. He said dialysis was generally long term, once you started it, you rarely stopped. And that he couldn't justify putting a 91 year old woman with lung cancer, on Medicaid, on dialysis.

This is a level of honesty I doubt is available anymore, but this was 1997, and in a former VA hospital.

I went back to the ice chips. She spent the next 2 days unconscious, or delirious. When she was talking, most of it didn't make sense, but she was clear about wanting to die. I don't know what kidney failure feels like, but it sure looked unpleasant. In the middle of the night, the 3rd night we were there, a nurse came in and talked to us. They didn't have any real hope left, it was all about pain management, now. Then after her morphine, she said something about how she could give her more, if we wanted. You know, to help her along. The nurse gave her 3 more shots, and she was dead 20 minutes later.

My take away was that my grandma was euthenized because she was on Medicaid. The only part of this that seemed wrong was that they waited as long as they did.

I've told this story a few times since, and there is a variety of reactions. Some get pissed about the "extra pain management", some talk about suing the doc who wouldn't start dialysis. But I expect that the last 2 days after she started begging to die would be the only part that would have bothered her. She was tough.

I have known plenty of folks who get broken, and don't get fixed. I was working with one this last weekend. I honestly don't know many people who have this expectation of free medical, because they are poor. They know they will get minimum treatment, and shown the door.

I think this
If society suddenly decides it's OK for people to die if they can not afford life saving medical care, that could change. I don't see that kind of social change taking place any time soon, hence we have to make the ground rules even for all. A fair playing field.
is just a story middle class folks tell themselves as justification for a system that meets their needs, and allows them to feel better about deflecting the costs, because they do it for "the Poor."

But poor folk know better. It not their needs the system is set up to meet.

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