Who'd a thunk it? Obamacare not repealed

Intended for constructive conversations. Exhibits of polarizing tribalism will be deleted.
BRUTE
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Joined: Sat Dec 26, 2015 5:20 pm

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 Obamacare not repealed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 Obamacare not repealed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.

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 Obamacare not repealed

Post by Riggerjack »

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.
Yes, my sister when young, paid 3k for brakes on a car not worth 750 when she was done. However, that is not the typical exchange, and people are just naturally distrustful of technicians who fix things they are clueless about.

And competing for the most cost sensitive customer is always putting downward pressure on shop prices.

I just don't understand why you think complexity invalidates the pricing mechanism of the free market. In a free market, part of getting a higher price is justifying the higher price, by making the better service more obvious. Not only does our crony system obscure pricing, it obscures quality.

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 Obamacare not repealed

Post by Campitor »

Laura Ingalls wrote:
Fri May 12, 2017 3:48 pm
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
The price difference is a result of a hospital's ability to negotiate prices and refuse patients with insurance plans that don't provide satisfactory reimbursement rates for elective procedures despite not refusing emergency cases.

Hospitals can't browbeat government for the same reimbursement rates nor refuse patient care to the enormous population on medicare/medicaid without losing a reliable revenue stream.

And since many hospitals have merged and dominate the local landscape, they monopolize the patient population that will not join an insurance plan which doesn't let them visit doctor BestBedSideManner at their local hospital. It wasn't that long ago when there were dozens of competing and independent hospitals in my New England area. But when insurance companies started capping reimbursements, the hospitals all started merging quickly to gain leverage over insurance companies and monopolies over patients.

Patients lose because of lack of competition. If insurance companies could enroll customers across state lines similar to medicare/medicaid, they could force hospitals and medicine to compete for finite dollars (like a normal free market system), thereby driving down cost.

If insurance companies were allowed to increase rates for patients with poor lifestyle choices such as <insert none obligatory vice here>, it would incentivize individuals to think about their unhealthy habits and adopt healthier lifestyles that reduce the need for expensive procedures or prescription medicine - big pharma would react accordingly and my healthcare premiums would drop. Those who refuse to quit their bad habits would at least pay for their choices and I wouldn't be forced to subsidize their care.

Hospitals would be forced to be more efficient with their dollars and eliminate waste that doesn't compromise or affect patient care. Single payer will fail not because it's a bad idea, it will fail because there is little incentive to be efficient at cost containment within the healthcare system and patient population.

No single entity can keep track of or foresee the consequences of medical policies or regulatory decisions. Healthcare, like any other commodity, is subject to the laws of the market and the incentives (good or bad) derived from its regulatory framework. The most efficient planner of allocating dollars is the individual consumer and the cumulative decisions of other consumers that force market responses. It's not perfect but its the reason why free markets always tend to raise the standard of living for ALL individuals despite the wealth aggregation within the top 1%.

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

Post by Chad »

Riggerjack wrote:
Sat May 13, 2017 10:30 am

I just don't understand why you think complexity invalidates the pricing mechanism of the free market. In a free market, part of getting a higher price is justifying the higher price, by making the better service more obvious. Not only does our crony system obscure pricing, it obscures quality.
Because, it's not just complexity. Though, I think it's enough to cause major issues with creating a free market. It's also because, as I noted, you don't actually get choice in most towns and even in some major cities. I don't think removing the regulation frees them up. Oh, removing regulations would maybe free up low end services like general practitioner visits, blood labs, etc, but even though those costs are elevated they aren't the services drastically increasing overall healthcare costs.

You also don't really get choice a lot of the time because it's an emergency.

On top of all this, even if you did eliminate regulation and I'm wrong and the innate obstacles in healthcare don't prevent a free market it is still unlikely we would get one. Why? Because, people would still be buying insurance, which implements it's own regulation. I don't see anyone successfully convincing the majority of the public to give up their insurance for them to do another 10 hours of work a month to research "good deals" in healthcare. Companies will just keep providing insurance similar to what they currently give, as even if your free market would materialize no one would believe it or take the risk. They have been conditioned to have some form of insurance, be it private or public.

Then what do you do with drug costs? You can't take away patent protection or no company will research drugs. You can't let them keep the patent protection or they will overcharge like they do now. Especially, when the rest of the developed world forces them to lower their prices for single payer.

I just don't see a free market having a chance in this industry.

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

Post by OTCW »

It will never happen, BUT, if all the subsidies went away - employer provided plans, tax breaks, ACA subsidies, medicare, medicaid, health insurance in general, tax exemptions on premiums, HSAs, FSAs, all of it - I'd be willing to bet prices would come way down.

As examples, look at 2 procedures that are not generally subsidized or have minimal subsidies:

Lasik and breast augmentation.

Prices are way down from what they were on both of these fairly complex procedures. I really believe the lack of being able to use money that isn't yours to pay for them is the reason. Providers have to price them accordingly or go out of business.

Another example is OTC medication. You can get a giant bottle of aspirin or ibuprofin or acetaminophen for just a few bucks. Go get a prescription pain killer without insurance paying for it and note the difference.

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

Post by classical_Liberal »

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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
.

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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