Who'd a thunk it? Obamacare not repealed

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 Obamacare not repealed

Post by Chad »

Riggerjack wrote:
Tue May 09, 2017 1:14 pm
So, Chad, Spartan Warrior, Dragline, help me out here. I tend to dismiss your enthusiasm for singlepayer as you mashing your ideals against the reality we live in, and when they don't fit, concluding that reality is wrong. I have done this myself, it isn't comfortable.
I see your views the same way. It seems like you are trying to fit the square peg in the round hole. As Dragline noted, I don't see the "Golden Era" of medical care in the US you do. During that time frame there basically was no care that couldn't be performed by a single doctor in their own office. A broken bone set, stitches, and maybe some penicillin. A free market might work for this level of care. One can judge the quality and cost of the service received, as you would be going to that medical provider multiple times for the same services. Many of these services wouldn't bankrupt you even now. This is essentially like shopping at different grocery stores where it's easy to judge quality and cost if you just pay attention.

This is not the same now, as the number of drugs and services has increased massively and many of these drugs/services are rather specific. This means you probably don't use these services multiple times (chemo, open heart surgery, etc.) and might not even know anyone who does, so you can't focus your buying on the vendor giving you the best quality/cost because you have no way of knowing (Yes, I agree certain aspects of the current system obfuscate actual costs.).

I used my mother's brain cancer treatment as an example earlier. There was basically no way to judge the care she was going to receive. How would we? A handful of star ratings for the overall hospital and some research online, and, now, after going through that with her, it's highly unlikely the knowledge I gained about the specific treatments for that disease will be helpful. It's not like we could have gone somewhere else after the treatment/surgery if we were unhappy with results.

All of this really muddies the waters concerning the free market forces and makes them much less effective. In my view, so much so that a free market can't really exist for most of healthcare even in a completely regulation free environment.

I just don't see how using a system resembling one of the ones I noted in my previous post highlighting the differing costs between countries isn't a good starting point for our healthcare system.

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

Post by Riggerjack »

I see your views the same way.
Thank you. I knew we were talking past each other. I needed you to spell out your thinking.

I'll try to organize my thoughts and post tonight.

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

Post by jacob »

I read Campitor's link. I also read the conclusion (on that site). That was good stuff!

One of the points it made is how things are locked down due to the large amounts of people currently benefiting from the system because it's their job. Because so much money is being made from maintaining [a complicated] system, there are many interests groups working to prevent changes. If health care GDP is ~twice as high in the US as anywhere else, it means that twice the number of people are somehow affected by it.

Never forget that whenever we (on average) complain about paying twice as much ... there's probably someone (on average) that's taking twice as much to "support their lifestyle".

Similar dynamics is seen wrt the calls for reforming the tax system. As it is, tax preparers and accountants have an interest in maintaining the complications because if the tax system is turned into a few numbers on the back of a postcard, a large number of people would be out of a job. We "civilians" can make all kinds of ideological arguments this way or that way but what it ultimately comes down to is certain interest groups paying several millions bucks (not really a lot of money(*) but enough) to hire people to make arguments ... and the rest of us neither having the time nor the skills or connections to have a clue about just how complicated this mess is just squabble online. "Nobody knew", right ... that's really the biggest problem.

(*) The ROI on lobbyism is overall INSANELY high. Maybe someday there'll be a way to invest directly in that afterwhich we can all go to hell, so to speak, and in a deservedly and ironic matter.

It's as if we had a tangled mess of 100' of electrical cable. It's quite clear that the best solution would be a nice coil. However, try fixing the mess if each action of untangling a subknot would require transfering money from some pocket to another one. You'd never get anywhere. For example, compare what US doctors are paid with UK doctors. Now compare how much their respective educations cost. An immediate change would leave US doctors (now being paid UK rates) with student loans that just became utterly ridiculous by UK standards. Forgive those loans? Sure ... but now you're asking for a lot of pension funds and local/state governments to take a big hit. To remedy the situation, we now need to look at tuition rates. But that means messing around with university wages too. And so on ...

This is why all solutions take the form of kicking the tangled mess around for another round. Everybody knows health care is that/so complicated ... but I don't think it's appreciated that it's really "complicated squared".

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

Post by Riggerjack »

Yes, campitor, that was an excellent link. He explained it better than I did.
The health insurance companies aren’t hiding any money— they know that would be stupid. Instead, they’re distributing the money to all providers so they can drive up their revenue by driving up their costs. This strategy helps to ensure that most providers will side with insurance companies in opposing health care reforms. They also know that the more everything costs in health care, the more everyone will rely on them to manage these costs. They’ve effectively rigged the game in a way that allows them to win every time they make things worse for everyone.
Our healthcare system is based on chrony capitalism. Everything is rigged to stop price transparency. There is no cost control, if nobody knows what anything costs.

When you mix capitalism and regulation, this is just the way it works. Examples:
College costs
Healthcare costs
Wholesale energy markets
Defense contractors

You can spot aberration this by looking at industry and government reports. When they emphasise costs and low profits, you have to know they are covering up a scandalous mess.

In real capitalism, some businesses fail.

I'm an auction junkie. Online, and in person, I am constantly monitoring auctions. I see equipment from failed businesses auctioned off every week. Lots of heavy equipment, office equipment, even some medical equipment. But while I have seen dental chairs, and one x-ray machine, lots of physical therapy equipment, I've never seen any advanced imaging equipment.

Now, auctions are not where the high resale equipment usually goes. When you are going out of business, you try liquidating on your own, if you aren't getting sued out of existence. So, mist heavy equipment contactors will sell mist of their equipment on their own, then the specialty equipment and supplies go to the auction. But I gave never seen most medical equipment in auctions. Funny, because expensive med equipment is sold with warranty, and service plans, and payment plans and calibration in the contract.

Expensive equipment without service/payment/warranty is exactly what I expect to find at auction. From this, I conclude that not enough medical bankruptcies are happening, and those that do are done to dodge creditors, not to shut down the business. This shows again that capitalism is being held in check.

Now I keep bringing up capitalism. This is because:
It's as if we had a tangled mess of 100' of electrical cable. It's quite clear that the best solution would be a nice coil. However, try fixing the mess if each action of untangling a subknot would require transfering money from some pocket to another one. You'd never get anywhere. For example, compare what US doctors are paid with UK doctors. Now compare how much their respective educations cost. An immediate change would leave US doctors (now being paid UK rates) with student loans that just became utterly ridiculous by UK standards. Forgive those loans? Sure ... but now you're asking for a lot of pension funds and local/state governments to take a big hit. To remedy the situation, we now need to look at tuition rates. But that means messing around with university wages too. And so on ...

This is why all solutions take the form of kicking the tangled mess around for another round. Everybody knows health care is that/so complicated ... but I don't think it's appreciated that it's really "complicated squared".
Capitalism is the automated system that fixes this. If you try to manually go through and find the worst offenders, come up with a fix, and move on the the next worst offenders, you create more opportunity for cost shifting, you never fix the first problem, and waste everyone's time. But, when you remove the cover, businesses compete with each other, and find their own ways to cut costs.

End result? Fewer employees. Better and/or cheaper services. More bankruptcies. And I get to have my own MRI in my basement. ;)

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

Post by Riggerjack »

And for the record, I agree that single payer, in the European style would be better than what we currently have. But I don't know how long it would continue to be, and I am not certain that research would even match our current low levels.

I'm 46. We need some serious improvements, and soon!

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

Post by Riggerjack »

I see your views the same way. It seems like you are trying to fit the square peg in the round hole. As Dragline noted, I don't see the "Golden Era" of medical care in the US you do. During that time frame there basically was no care that couldn't be performed by a single doctor in their own office. A broken bone set, stitches, and maybe some penicillin. A free market might work for this level of care. One can judge the quality and cost of the service received, as you would be going to that medical provider multiple times for the same services. Many of these services wouldn't bankrupt you even now. This is essentially like shopping at different grocery stores where it's easy to judge quality and cost if you just pay attention.
When I say a working system, I was speaking of a working pricing system, but apparently wasn't very clear about that. I have no desire to go back to pre WWII medicine.
This is not the same now, as the number of drugs and services has increased massively and many of these drugs/services are rather specific. This means you probably don't use these services multiple times (chemo, open heart surgery, etc.) and might not even know anyone who does, so you can't focus your buying on the vendor giving you the best quality/cost because you have no way of knowing (Yes, I agree certain aspects of the current system obfuscate actual costs.).
By this logic, you couldn't get a car fixed. How many times will you have an electrical problem fixed? It could be a component, or wiring, or just water penetration of a connector. And yet, I can know the shop rate, the mechanical schooling, that the shop is in business, and has been for 20 years, that they specialize in hybrids, etc. Most importantly, their competition knows that I can know all this, so neither shop can decide to raise the rate they charge me to 10x what they charge you.
I used my mother's brain cancer treatment as an example earlier. There was basically no way to judge the care she was going to receive. How would we? A handful of star ratings for the overall hospital and some research online, and, now, after going through that with her, it's highly unlikely the knowledge I gained about the specific treatments for that disease will be helpful. It's not like we could have gone somewhere else after the treatment/surgery if we were unhappy with results.

All of this really muddies the waters concerning the free market forces and makes them much less effective. In my view, so much so that a free market can't really exist for most of healthcare even in a completely regulation free environment.
I really think you should read campitor's link above. None of your objections are to a capitalistic system, but rather the chrony capitalism that we are stuck with, as a result of trying to fix this politically.
I just don't see how using a system resembling one of the ones I noted in my previous post highlighting the differing costs between countries isn't a good starting point for our healthcare system.
The difference between your previously posted examples and our current system is 50 years if cronyism. It would require dismantling of everything we currently have (not a bad idea), then fixibg it by applying more of the the process that messed it up. That might work, but capiatism WILL work, and it's easier. Still, there's nothing wrong with having BOTH, so long as they are kept separate. It is the intermingled pricing system that is so prone to abuse.

If we did fix healthcare with capitalism, it creates a different problem. Unemployment. Making medicine efficient, will require far fewer people. Letting those cuts come from the experts within means trimming out all the noncore personnel, who could be at any stage of their careers. (As an example, my job used to be done by 58 people before deregulation. It is now done by 4. This isn't a function of software improvement.) This is one more reason the cuts should be made from within, by people with skin in the game, rather than by legislative fiat.

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

Post by Riggerjack »

I disagree with the premise that we had "working medical system". That's a Golden Era fallacy. It worked for some people. It didn't work for a lot of other people. It didn't work for people trying to buy medicine that turned out to be poison. That's why there is an FDA. It didn't work for veterans with unique problems. That's why there is a VA. It didn't work for old people who were living longer but couldn't afford their chronic conditions. That's why there is medicare. It didn't work for the destitute. That's why there is medicaid. It didn't work for a lot of working people. So the government artificially incentived employers to provide it. It became expensive as treatments and options improved. Insurance markets developed and were treated like other forms of insurance that are traditionally regulated by the states. These programs did not appear out of thin air for no reason. Moreover, the kind of high-tech medicine that is available now never really existed before our lifetimes either.
Your reasoning is faulty, but my reply was both poorly expressed, and poorly reasoned.

A more accurate and hopefully better reasoned response would be:

You make the case that government programs are only the result of broken systems. You know, like agriculture, thank God our betters saved us from farmers.
Or the DEA, saving us from ... Us?
Or DARPA, saving us from effective national defense.

You get my point.

I will be happy to admit there are things the government does better than free markets, but they are not common, and action on the part of politicians is NOT the standard of where to find that distinction. Usually, the problems people complain about were caused by regulation, not fixed by it.

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

Post by ThisDinosaur »

Yeah, that link is solid. Its even got good actionable ideas like telling providers and pharmacies you dont have insurance to get their real/lower prices.

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

Post by ThisDinosaur »

It seems unrelated, but maybe the first step in any healthcare reform would have to be addressing the lobbyist influence on congress. We won't get functioning single payer or real free market healthcare until that's fixed. Campaign finance reform and conflict of interest legislation have been forgotten promises of lots of progressives after election. But the laws in this country won't start to resemble what the voters want until money is out of politics.

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

Post by Chad »

@Riggerjack
I will probably have to get back to you tomorrow. I had a really good response for the discussion, but the site logged me out when I tried to preview it and I lost it all. I don't have the heart to try and retype right now.
Last edited by Chad on Thu May 11, 2017 12:37 pm, edited 1 time in total.

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

Post by Dragline »

Chad wrote:
Thu May 11, 2017 12:23 pm
@Riggerjack
I will probably have to get back to you tomorrow. I had a really good response for the discussion, but the site logged me out and when I tried to preview it I lost it all. I don't have the heart to try and retype right now.
That's frustrating. I usually type long responses somewhere local or in a draft email, and then cut and paste them here, if that helps.

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

Post by Chad »

@dragline

Thanks, I do that too, but the site hadn't done it to me for the last 5-6 months (it's a combination site and my work computer). I got complacent. Plus, I ended up writing double or triple what I initially thought I was going to.

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

Post by jacob »

I find that the back button often comes to the rescue if the forum or connection breaks. At least on firefox. It seems to remember "what was filled in".

Another trick is ^A followed by ^C to put the text into the copy&paste buffer before you hit send.

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

Post by Riggerjack »

It seems unrelated, but maybe the first step in any healthcare reform would have to be addressing the lobbyist influence on congress. We won't get functioning single payer or real free market healthcare until that's fixed. Campaign finance reform and conflict of interest legislation have been forgotten promises of lots of progressives after election. But the laws in this country won't start to resemble what the voters want until money is out of politics.
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?

I feel like we're talking about making Stonehenge, and I'm trying to convince you to put the screwdriver back in the tool box. Then you pointed out the whole thing would work best if we just rearrange the stars to line up with the stones.

That may in fact be easier, but I have no idea how to do that. :lol:

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

Post by ThisDinosaur »

Riggerjack wrote:
Thu May 11, 2017 3:08 pm
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.

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

Post by BRUTE »

Riggerjack wrote:
Thu May 11, 2017 3:08 pm
I feel like we're talking about making Stonehenge, and I'm trying to convince you to put the screwdriver back in the tool box.
what does Riggerjack suggest instead? unfortunately, brute's current best hope amounts to little more than "let it burn".

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

Post by Chad »

Riggerjack wrote:
Wed May 10, 2017 9:05 pm
When I say a working system, I was speaking of a working pricing system, but apparently wasn't very clear about that. I have no desire to go back to pre WWII medicine.
No, I understood. I knew you didn’t want WWII medicine. My point in showing those examples was to demonstrate how much simpler and more common medicine was back then. This simplicity lends itself to a free market more than the current complicated and specialized treatments.
This is not the same now, as the number of drugs and services has increased massively and many of these drugs/services are rather specific. This means you probably don't use these services multiple times (chemo, open heart surgery, etc.) and might not even know anyone who does, so you can't focus your buying on the vendor giving you the best quality/cost because you have no way of knowing (Yes, I agree certain aspects of the current system obfuscate actual costs.).
Riggerjack wrote:
Wed May 10, 2017 9:05 pm
By this logic, you couldn't get a car fixed. How many times will you have an electrical problem fixed? It could be a component, or wiring, or just water penetration of a connector. And yet, I can know the shop rate, the mechanical schooling, that the shop is in business, and has been for 20 years, that they specialize in hybrids, etc. Most importantly, their competition knows that I can know all this, so neither shop can decide to raise the rate they charge me to 10x what they charge you.
It’s a valid point. We can’t always treat people like they are morons, even if they are. However, I still see the complexity of current medical services far outstripping the complexity of auto repair and people still don’t do a good job judging auto repair shops. It’s not like auto repair industry has a good track record of not scamming its customers. The local news loves showing some little old lady being ripped off by an auto repair shop.

Then when you factor in that the same guy at a local shop is probably doing your radiator, brakes, electrical system, etc., while the medical professionals that do the heart, spine, lungs, etc. are all different and specialized. We start see how hard it is to be an informed consumer, which is critical for a free market.
Riggerjack wrote:
Wed May 10, 2017 9:05 pm
I really think you should read campitor's link above. None of your objections are to a capitalistic system, but rather the chrony capitalism that we are stuck with, as a result of trying to fix this politically.
I went back and read it. Really good article, thanks Campitor.

You are correct none of my objections are to a capitalistic system and it’s actually the system I would normally support for economic problems.

I also agree that a lot of the issues with the current system could be classified as crony capitalism. What I don’t see is a way for market forces to remove these problems. There seems to be natural obstacles to free market forces in to medical services.

For instance, most towns only have one hospital. Even major cities don’t have a lot of choice. Pittsburgh basically has either UPMC or Allegheny General. How do you even know who is better to make an informed decision? And, even if you could determine that you don't really get much choice.

Also, no one is going to ask the ambulance to take them 30-90 minutes out of the way for a different hospital during an emergency, as time matters.

There are other natural barriers to market forces in medicine too. Just trying to keep this short.

These types of obstacles that are not the fault of regulation prevent a free market from working properly.
Riggerjack wrote:
Wed May 10, 2017 9:05 pm
The difference between your previously posted examples and our current system is 50 years if cronyism. It would require dismantling of everything we currently have (not a bad idea), then fixibg it by applying more of the the process that messed it up. That might work, but capiatism WILL work, and it's easier. Still, there's nothing wrong with having BOTH, so long as they are kept separate. It is the intermingled pricing system that is so prone to abuse.
We would basically agree on what the problems are. We differ on whether capitalism can solve this problem or not. You think it can and I don’t see it being able to hurdle the natural obstacles in the industry. There is too much natural complexity and we use the major medical services, which are the main culprit for expense, too infrequently for free market forces to work properly.

Some industries just don't fit well in a free market, like defense. Most medicine is another.
Riggerjack wrote:
Wed May 10, 2017 9:05 pm
If we did fix healthcare with capitalism, it creates a different problem. Unemployment. Making medicine efficient, will require far fewer people. Letting those cuts come from the experts within means trimming out all the noncore personnel, who could be at any stage of their careers. (As an example, my job used to be done by 58 people before deregulation. It is now done by 4. This isn't a function of software improvement.) This is one more reason the cuts should be made from within, by people with skin in the game, rather than by legislative fiat.
However, we would do this there will be worker displacements, but if anyone in any industry isn’t expecting some type of upheaval concerning their job/career they are fools. I have no problem helping them, but no one has a right to their chosen profession for life. They will just have to adapt.

Not quite as good as the response I lost, but it covers our differences.

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

Post by Laura Ingalls »

I just can't get over the price difference between Medicaid and private insurance. 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.

Medicaid in my state averages 2k per non disabled adult and a bit more for kids. My portion of the old plan was the same as Medicaid average for a family of four

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

Post by Riggerjack »

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...

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

Post by Riggerjack »

@chad
This is not the same now, as the number of drugs and services has increased massively and many of these drugs/services are rather specific. This means you probably don't use these services multiple times (chemo, open heart surgery, etc.) and might not even know anyone who does, so you can't focus your buying on the vendor giving you the best quality/cost because you have no way of knowing (Yes, I agree certain aspects of the current system obfuscate actual costs.).
You seem to obsess over the difficulty of getting information to make an informed decision as being an inherent requirement to correct pricing. Yes, it is best if I can make a solid, informed choice. But, regardless of industry, sometimes I just have to make a choice with the information at hand. For instance, if I want to hire a lawyer, I have no way I'm aware of to pick the very best one, so I am likely to pick the cheapest not working out of his car.

Competing for my business puts a downward pressure on the price of all lawyers not well off enough to ignore my business. The pricing system works, despite my ignorance. No cost shifting or regulation required.

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