Off Topic Poker Forums

again, i think a lesser of 2 evils. but there's an assumption that being "screwed" by the government is better because it results in less upfront costs as the system stands now. you've acknowledged that you're aware there are hidden costs when government gets involved based on your reply further down, so the real question is which system can be more efficient, based on both upfront and hidden costs.

further, we should consider the results for the economy as a whole when private enterprise engages in an activity for profit vs government engaging in the same activity w/o a profit motive. profits by businesses are not just shoved under a mattress. that money is used to fund new business, new employment, either directly or indirectly (through being saved in banks, which in turn loan out that money to other businesses).

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conversely, what does government give back to the economy? government creates nothing. it saves nothing. it merely spends.

You are selling government way short. We don't call it venture capitalism when government does it, but they fund myriad new industries and businesses, as well as jobs by extension or bureaucratic jobs. IBM wouldn't exist if it weren't for government dollars. Tons of research is paid for by government, from which new businesses are created. GPS, cell phones, new battery technologies, you name it, government has funded. Lots of innovations have been funded by government when it was not cost effective for the private sector to do it. Yet government doesn't keep or own what they invest in. When government spends, it spends into new growth areas, into future technologies. I have a buddy who is contemplating starting a solar company (he worked on solar technology in grad school) because of incentives provided. Government spends on business loans and grants.

Government doesn't do everything great, and they shouldn't be involved everywhere, but they are the biggest venture capitalists playing in our economy. In fact, they should probably be handing out less money to businesses and individuals than they do.

You are selling government way short. We don't call it venture capitalism when government does it, but they fund myriad new industries and businesses, as well as jobs by extension or bureaucratic jobs. IBM wouldn't exist if it weren't for government dollars. Tons of research is paid for by government, from which new businesses are created. GPS, cell phones, new battery technologies, you name it, government has funded.

good point. i did sell government short. i think strong national defense is one crucial role of government, and most if not all of those technologies came from defense spending, and that's pretty cool. and i wish we spent more on the space program today, but ... i think this has little relevance to the health care discussion here (which is probably my fault for going off on my soapbox and being on a Milton Friedman man-crush right now).

If you like Milton Friedman (Nobel Prize), you will probably really like Thomas Sowell, who was a student of MiltonFriedman.
Sowell was a much younger guy in the 1980 "Free to Choose" videos.


I am a bit behind on Sowell's weekly columns. All of his books/columns are solid history lessons.

primary care system is weak for poor/unisured populations. diabetes, asthma or difficulties in breathing (COPD) should not need to be treated in hospital

While I agree ED's shouldn't be used in lieu of a PCP, shortness of breath truly is a life threatening emergency. Without proper ventilation/oxygenation you WILL die. So I definitely disagree with you there. Some of my worst calls in EMS have been COPDers shitting the bed.


Something else that also adds to costs (and I might be biased here) is EMS inability to turn down patients as well. It's actually abandonment if we show up, then leave.
Now like it's been mentioned it's primarily a lower socioeconomic problem, however some real honest to god 9/11 calls I've gone on:

"I think I overdosed on weed"
"Well if we call an ambulance we won't have to wait in the waiting room"
"She's 5 months pregnant and we think she's gonna have a baby"
"I need my psych meds adjusted"

3am
Woman: " I have back pain"
Me: "How long has it been going on?"
Woman" About 10 years"
Me:"..."

Infant mortality - 6.5 deaths per 1000 live births, is well above the OECD average of 4.4
[ed: i agree this is a disgrace for the U.S. being like a 3rd world country]

I think this is absolute BS. Infant mortality rates in the US are NOT even close to those in other countries.
http://www.nationalreview.com/articles/276952/infant-mortality-deceptive-statistic-scott-w-atlas?pg=1

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If you like Milton Friedman (Nobel Prize), you will probably really like Thomas Sowell, who was a student of MiltonFriedman.
Sowell was a much younger guy in the 1980 "Free to Choose" videos.


I am a bit behind on Sowell's weekly columns. All of his books/columns are solid history lessons.

+1. he was only outshone by Friedman in that program imo. as such, i'm reading his book, Intellectuals and Society, right now.

While I agree ED's shouldn't be used in lieu of a PCP, shortness of breath truly is a life threatening emergency. Without proper ventilation/oxygenation you WILL die. So I definitely disagree with you there. Some of my worst calls in EMS have been COPDers shitting the bed.

I think this is absolute BS. Infant mortality rates in the US are NOT even close to those in other countries.
http://www.nationalreview.com/articles/276952/infant-mortality-deceptive-statistic-scott-w-atlas?pg=1

ahhh, so this report is inaccurate and/or biased? i am not an expert. i was only condensing the PBS interview of Matthias Rumpf of the OECD (word for word mostly). it's a good thing our government doesn't make policy based on these reports... oh wait...

good point. i did sell government short. i think strong national defense is one crucial role of government, and most if not all of those technologies came from defense spending, and that's pretty cool. and i wish we spent more on the space program today, but ... i think this has little relevance to the health care discussion here (which is probably my fault for going off on my soapbox and being on a Milton Friedman man-crush right now).

Those came from defense but there's tons of scientific research funded by government. I just picked the high profile ones people hear about. Not to mention, the development of the computer was not exactly defense spending.



Anyway, one thing is for sure - healthcare is not fixed now, and the rules are still going to change. Let's hope that somehow reality takes a vacation and those changes actually fix things.

time to go back to the well.

Milton Friedman explains how to lower healthcare costs..

i don't see how costs can go down when we've simply expanded the current system rather than fixing fundamentals. according to this analysis, we'd be better off if the US govt completely took over healthcare or completely got out of it.

as weird as it sounds, i think under this current design, costs might go down if there was a mass movement for employers to save costs by dropping the company health plan and paying the fines. once individuals start shopping for their own health insurance, there should be an increase in market forces. it won't be perfect since those costs are still being subsidized by govt, but it'll be a start.

start shopping for their own health insurance, there should be an increase in market forces.

I've been saying this to my friends that will put up with it for years now.

Employer paid healthcare is a pivotal reason why the costs are so atrocious. There are other reasons of course. When Obamacare came out, I looked down the line at all the changes and not a single one addresses any of the cost problems. Therefore, I know, that costs will only go up and up and will NOT come down.

If they (the politicians) wanted the costs to go down, there were simpler and very much more effective changes they could have put into place. However, (IMO) the ones that wrote the bill (read between the lines there) wouldn't have liked it.

But, If I were in charge, I'd consider banning employer paid healthcare - or at least make it so that the consumer is the one buying instead of a third party (like the employer). There's countless other things I'd do too, and some of those couldn't be stomach'ed by the people

Employer paid healthcare is a pivotal reason why the costs are so atrocious. There are other reasons of course. When Obamacare came out, I looked down the line at all the changes and not a single one addresses any of the cost problems. Therefore, I know, that costs will only go up and up and will NOT come down.

Just because the bill is law doesn't mean there won't be changes. Massachusetts is working on cost measures now to lower the costs of Romneycare. It's not over. It's mutable.

But, If I were in charge, I'd consider banning employer paid healthcare - or at least make it so that the consumer is the one buying instead of a third party (like the employer). There's countless other things I'd do too, and some of those couldn't be stomach'ed by the people

Didn't you mention some uncovered costs for the birth of your child to the tune of $25,000? What if you had to pay the covered costs too? Because if you think getting rid of employer based care is going to instantly make medical costs reasonable, you're not living in reality. Those uncovered costs of yours aren't there because your employer offers you health coverage.
Ultimately, we do need to shift off of employer based care, but there is no way on this earth an individual can afford to pay for it themselves. No one does, anywhere in the world. That's not devious socialist policy, that's recognition of the impossibility of individuals managing it themselves.


I agree there were other changes that could've been made. If I hurt my arm, I have to go to a primary care physician first, who orders x-rays, and then sends me to an orthopedist. What a waste.

Create a public health insurance. If you don't have a job it is free. If you have a job it is paid by the employer.

Use the public hospitals to measure the costs of the different treatments. Treatments at private hospitals are then covered by the insurance if and only if they are in the same price range as equivalent treatments at the public hospitals.

This is far too sensible to ever take off in the states.

The only problem with allowing market forces to take over, is that they truly can't until insurance can be sold over state lines.

I'm not sure how many other states are, but here in PA there's a virtual monopoly in that area.

Highmark controls 60% of the market share.
UPMC controls 30%.
EVERY other health insurance carrier controls the remaining 10%.

UPMC and Highmark also have locks on many of the hospitals through contracts and their "provider network"

If you don't have insurance through one of the big 2 companies, you can pretty much forget about going to most doctors or hospitals.

The only problem with allowing market forces to take over, is that they truly can't until insurance can be sold over state lines.

There are a whole host of problems and this is a huge one also.

And as for me living outside of reality, no I don't think taking away the employer aspect of healthcare would solve the problem. I said there's a bunch of reasons the costs are so high, that's ONE reason. The more you cause the receiver of care, payer of care, and decider of care to be more or less the same person, the more market forces you inject into the system. Employer paid care has two really big problems 1. shields the costs from the consumer (I'm rare in that I pay my entire insurance out of my own pocket, most just get what their employer gives them) 2. that insurance isn't transferable. Get laid off, sorry pal, sign for "cobra" and deal with that headache while you search for a new job (and who knows what their plan will be... or if they have a plan)

I'm still waiting on the bill for that 25,000 of not covered. If they bill me that amount, they WILL get stiffed. I'm confident the hospital will re-submit those items under a different medicare code to make sure it's "covered"... since they also would likely know that a bill like that is a lot less likely to get paid if they don't.

The bigger issue isn't if I'm stuck with a bill of 25k or not. The issue is how the hell did it get that high to start (and this doesn't count the stuff that WAS included, which guessing would be at least that much). It's ridiculous. No other country on the planet has prices anywhere near that.
And why is that?
While this particular hospital is state of the art (and currently treating multiple gun shot victims ATM BTW) there's no way you can tell me that there aren't hospitals around the world that are just as or close to the same expertise and quality.... and yet, I'm guessing the pricing would be, half or a quarter the amount at the most? Why?

There's no one reason, it's a bunch of reasons.

Stueyskid, if you do have the intention of paying the bill.....what you will want to do, is contact them and tell them that you are personally paying. I have seen bills knocked down a huge amount (if paid in a short time period).

Like everything in life, intention goes a long ways. They will work with you for far less than $25k (could be 10-25% of that). You will probably be surprised how quickily you get to the better number. Just contact their billing department.

Thank you Sneakers! Will keep that in mind should the need arise.

I have a relative that works at the hospital and prior to this whole thing, I asked him about people negotiating their bills. He told me there's an entire department dedicated to this. He also told me that a big determining factor at hospital viability is the rate at which bills go unpaid. The unpaid bills, or loss, is greatest where there's a large minority (of a certain kind) in the area. For example, one hospital down south in the affluent areas has almost no loss - whereas the ones closer into the urban center suffer quite a bit. Those "unpaid" bills are then diluted in a sense and covered by those that DO pay - a very large cost shift. I would gladly pay a reasonable amount... and will cross that bridge should I need to, but right now I'm still guessing that I won't need to...
crossing the fingers!

Stueyskid, if you do have the intention of paying the bill.....what you will want to do, is contact them and tell them that you are personally paying. I have seen bills knocked down a huge amount (if paid in a short time period).

+a ton. we should totally have a video on negotiation. And a life improvement series too

medic2038 wrote:

The only problem with allowing market forces to take over, is that they truly can't until insurance can be sold over state lines.

As I'm sure you already know, the trouble with this is that each state will have different rules. States that aren't advantageous to insurers will find themselves without any.

Highmark controls 60% of the market share.
UPMC controls 30%.
EVERY other health insurance carrier controls the remaining 10%.

UPMC and Highmark also have locks on many of the hospitals through contracts and their "provider network"

If you don't have insurance through one of the big 2 companies, you can pretty much forget about going to most doctors or hospitals.

This is another odd quirk of America. Somehow we have a need to consolidate. Everything is centralized to a few powers. The easiest and quickest example is the power industry. Everything comes from some massive plant. If we decentralized power, we would save a ton of money and produce less pollution.

Stueyskid wrote:

Employer paid care has two really big problems 1. shields the costs from the consumer (I'm rare in that I pay my entire insurance out of my own pocket, most just get what their employer gives them) 2. that insurance isn't transferable. Get laid off, sorry pal, sign for "cobra" and deal with that headache while you search for a new job (and who knows what their plan will be... or if they have a plan)

I would amend 1 a bit to say that the receivers of care have no knowledge of cost, but agree in principle. Also, cost is not the only thing employer based care shields consumers from. As with most industries in America, there is only an illusion of choice when your health care comes from your employer.

The issue is how the hell did it get that high to start (and this doesn't count the stuff that WAS included, which guessing would be at least that much). It's ridiculous. No other country on the planet has prices anywhere near that.
And why is that?
While this particular hospital is state of the art (and currently treating multiple gun shot victims ATM BTW) there's no way you can tell me that there aren't hospitals around the world that are just as or close to the same expertise and quality.... and yet, I'm guessing the pricing would be, half or a quarter the amount at the most? Why?

There's no one reason, it's a bunch of reasons.

You're right that there's no one reason, but I think what drives all of those reasons is that here in America it is a business like any other. There's no difference really between health care and sodas, as n0whereman pointed out earlier. Once you treat it like any other business, then it just becomes about interests. And then those interests, as you point out, get to write the bills and shape the policy. Instead of trying to find this or that reason and this or that solution, we need to throw the whole thing over. I cannot for the life of me figure out why Americans feel like our unalienable right to life should be based on profit motives. Everywhere else in the first world has figured out a way, some with government, some with a mix of government and business, to base health care instead on the right to life.
This bill we've gotten is not an overhaul, despite that word being used to describe it. We need a real overhaul.

As I'm sure you already know, the trouble with this is that each state will have different rules. States that aren't advantageous to insurers will find themselves without any........

So, you have identified a problem with healthcare. Shouldn't the bill deal with this, rather than creating a 50statewide monopoly for the federal government.

Acknowledging the issue is much different than addressing the issue. Obamacare created its own private market. Open the state-borders for all insurers, and the price would drop, and no doubt, people would find cheaper insurance easily.

Woooo go Oklahoma!

http://www.wnd.com/2012/07/lawmaker-to-put-teeth-in-anti-obamacare-bill/

I'm glad we have state representatives to determine the constitutionality of things. Otherwise, we'd be stuck leaving that responsibility to the Supreme Court. That would just be silly!

http://www.hotcoffeethemovie.com/

This is a deeply disturbing and informative documentary on the subject of Tort reform. It changed my opinion 100% on the issue. Particularly frightening and cynical is the manipulation of the justice system through judge election. Everyone should watch this.

So, you have identified a problem with healthcare. Shouldn't the bill deal with this, rather than creating a 50statewide monopoly for the federal government.

The bill does deal with it. Creating the monopoly as you put it deals with it. You may not like the way they dealt with it but they did.

Open the state-borders for all insurers, and the price would drop, and no doubt, people would find cheaper insurance easily.

Nonsense.

Nonsense.

I do not think so. Capitalism works best -- for the consumer -- when there is competition.

Here we go again....Razor. Simple stuff really, but it is worth repeating. lol
What happens is that the government creates artificial barriers to businesses which do not have deep deep financial pockets (50 offices, 50 law depts vs one main office). You admit that this is what Obamacare does; it creates a Federal-owned monopoly with nearly nil competition (which is also allowed to serve all 50 states). Yes, we got a government answer, but not a private-sector answer (more competition).

More competition is always best. But with Government artificially isolated markets (regulation caused) , completely stifles competition.
Remove artificial barriers, and prices fall. Not "nonsense" at all. This works for all PRICE CONTROL issues (rent etc).

I do not think so. Capitalism works best -- for the consumer -- when there is competition.

Here we go again....Razor. Simple stuff really, but it is worth repeating. lol

+1

but i think we're having a insurmountable standoff of beliefs here. i think simply stating one side's conclusions as rebuttals can only takes a conversation so far (tho i would have thought the clarity of Milton Friedman explaining the markets would have spurred someone to dig deeper on their own, but guess not).

i never believed in the power of free markets either, thought evil monopolies were the natural consequence of capitalism, etc., until i actually tried to learn about it myself by reading Economics in One Lesson. it breaks down economic assumptions i always held since very young but never questioned for myself. i found the experience very similar to a spiritual deconversion where the muddiness of organized religion's explanations of the world are replaced by cold, hard logic. but this type of learning can be discomfiting and unwelcome to some people (tho i found it liberating), and ymmv.

+1
i never believed in the power of free markets either, thought evil monopolies were the natural consequence of capitalism, etc., until i actually tried to learn about it myself by reading Economics in One Lesson. it breaks down economic assumptions i always held since very young but never questioned for myself. i found the experience very similar to a spiritual deconversion where the muddiness of organized religion's explanations of the world are replaced by cold, hard logic. but this type of learning can be discomfiting and unwelcome to some people (tho i found it liberating), and ymmv.

While I don't hate capitalism either, I heard an interesting philosophical point in a documentary.
It said something along the lines of "capitalism is the enemy of democracy". It kind of went on to elaborate that on a long enough timeline money buys politicians, who act in corporate interests rather then the interest of their constituency. Sounds kind of familiar to me. It also argued that we don't actually live in a democracy either, but rather a polyarchy.

Interestingly, the US has never been a "Democracy", and it was never intended to be this. Pure democracy would be anarchy -- where the mob rules -- with Discriminiation and Reverse Discrimination or the Passion/Crisis of the given day.
Note: we could say "Representative Democracy", which is a form of "Republic".

The US framers intentionally intended for it to be a representative "Republic".
--
Pledge of Allegiance
....and to the republic, for which it stands....

Constitution
The United States shall guarantee to every State in this Union a Republican Form of Government" (Article IV, Section 4)

James Madison -- Federalist No.63
There are particular moments in public affairs when the people, stimulated by some irregular passion, or some illicit advantage, or misled by the artful misrepresentations of interested men, may call for measures which they themselves will afterwards be most ready to lament and condemn. In these critical moments, how salutary will be the interference of some temperate and respectable body of citizens, in order to check the misguided career and to suspend the blow meditated by the people against themselves, until reason, justice and truth can regain their authority over the public mind.