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This topic is not about the American Invasion of Iraq. Stop. - Page 23 |
On July 03 2012 04:03 jdseemoreglass wrote:Show nested quote +On July 03 2012 03:59 radiatoren wrote:On July 03 2012 03:13 jdseemoreglass wrote:
Whether or not smoking causes higher medical costs is completely irrelevant because you can charge higher premiums to offset those costs making the whole equation a wash.
So we see once again that the real problem is that some people don't pay for their own insurance. Well, dependency on other people requires that you lose some freedoms. The greater the dependency, the greater loss of freedom.
We should not be forcing people to pay a "sin tax" on cigs if they are capable of paying for their own health insurance. All I'm saying is you need to distinguish between certain people and their circumstances instead of lumping the entire nation into the same boat.
Because the only way to protect freedom for the majority is to distinguish the independent from the dependent. There is something to be said about enforcement. If you are an insurance company, how do you prove that a person is smoking and how do you quantify it? The answer is that it is expensive to prove that you are smoking and the amount is impossible to guess. If you put that burden of proof on the insurers, it will end in an I/O regulation: Either you smoke or you do not smoke and at the same time it will be tough on the already expensive ensurances. It is a fact that taxing the unwanted behaviour is so much easier at the source than in the other end. Smoking, candy and junk food is bad for you. If you want to discourage people from ingesting those, the best way to do it is when you buy the shit, rather than afterwards, when you have to sample the stomach content to prove what was eaten... But I DON'T want to discourage people from living how they want if they aren't dependent on me, that's my point. And just because it's "easier" to punish everybody for the few liars doesn't mean it is the right thing to do.
What I am saying is that it is not gonna be "a few" liars. It is almost impossible to prove that the people lie. If people can pay 200$ per month instead of 300$ per month it will almost never be advantageous to tell that you are a smoker. In the case of smoking you are btw. not hitting everybody but the smokers by taxes. Junk food and candy are different issues.
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On July 03 2012 04:15 jdseemoreglass wrote:Show nested quote +On July 03 2012 04:05 farvacola wrote:On July 03 2012 03:55 jdseemoreglass wrote:On July 03 2012 03:46 farvacola wrote:On July 03 2012 03:40 jdseemoreglass wrote:On July 03 2012 03:37 farvacola wrote:On July 03 2012 03:28 jdseemoreglass wrote:On July 03 2012 03:26 farvacola wrote:On July 03 2012 03:22 jdseemoreglass wrote:On July 03 2012 03:17 farvacola wrote:
There is a sweet spot which lies in between an ideally healthy population and a reasonable provision of "health freedom", I'm not sure we've found it yet though. That "sweet spot" is the distinction: Can you pay for you own health care or not? If someone is paying for their own health care then how does any other person have any legal say in what that person does with his own health? The number of people who abstain from the purchase of health insurance and yet are able to pay for their own care out of pocket is astronomically low, as it is a fairly stupid way to go about things. So no, that is not the sweet spot by any means. Having health insurance is paying for your health care.... :/ Then I will simply reiterate what I had previously stated. The old system was more or less predicated on the dynamic you've offered, and the result has proven to be widespread cost inflation, a reduction in health service utilization, and an effective shouldering of the burden of the uninsured by those with insurance through systemic premium raises. If we lived in some sort of horrible society in which those who cannot afford healthcare were simply left to die, merely asking "can you afford healthcare" might prove an efficient public health policy. Thankfully, this is not the case, and our humanitarian motivation to collectively stopper preventable death requires a more nuanced perspective on health insurance that takes this into account. I'm talking about a very limited issue here, and that is the degree of personal "freedom" people should be afforded when it comes to their own health. My argument is that if someone is paying for their own health care/insurance and the insurance is allowed to tailor the premium to their lifestyle, then there should be no restrictions placed on that person's health lifestyle. The greater the dependency someone has on others, the more you can restrict their behavior. But don't restrict everyone's.... And what I'm telling you is that US insurance companies, given the ad-hoc nature of insurance coverage in line with your reasoning, are charging the shit out of everyone because they can get away with passing the costs of uninsured treatment on to paying customers. Eliminate uninsured treatment and the problem more or less goes away, along with huge boosts in collective health made possible through a better framework through which preventative health policy can be enacted. It is not the insurance companies who are bearing the cost of treating the uninsured... They have no obligation to the uninsured, before Obamacare. EXACTLY! You've enumerated what lies at the base of the problem. US Insurance companies actually have no excuse when it comes to their charging the highest rates in the world by a longshot, due to the fact that the government/taxpayer ends up being the one paying for uninsured care. So, not only are insurance rates in the US some of the highest per care efficacy in the world, but the general taxpayer with insurance coverage then ends up having to pay for for the care of the uninsured on top of that, all because the system asks solely the question of "can you afford healthcare?". You seem quite concerned with individual freedoms, and what I'm suggesting is that personal health freedom is better provided for given a system of universal healthcare. Every post you change your argument and then pretend that was your argument to begin with... it's kind of annoying. Anyway you are wrong for a third time because you are making the assumption that insurance companies are price gouging and reaping large profits. Actually health insurance companies are below average with an average profit margin of around 4%. So the high premiums have almost nothing to do with the insurance companies margins, and everything to do with the fundamentally high cost of treating people in the US. If you REALLY want to get at the root of the high costs, we can discuss things like employer mandated insurance, tort reform, and removing the countless licensing and regulative restrictions on providing care. That's where the real costs lie. Your suggestion that personal health freedom will increase under universal health care is nothing but absurd. When everyone is responsible for paying for everyone, then everyone will have a say in how everyone lives their life. Freedom won't even be a consideration, only reducing the burden on others in the name of "fairness." I can't imagine a greater way to reduce the personal health freedom for the average citizen.
Whenever I see someone bring up "tort reform" in a healthcare debate I know its time to ignore them. I'll leave you with this. If the cost of healthcare is "fundamentally high" as you put it, then why does the cost of an appendectomy vary from a little over 1,500$ to 185,000$ within the state of California alone? The answer is not simple, but that you assume that no form of price gouging is taking place in any shape or form is very telling of your platform.
http://archinte.jamanetwork.com/article.aspx?articleid=1151669
http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-does-an-appendectomy-cost-somewhere-between-1529-and-186955/2012/04/24/gIQAMeKMeT_blog.html
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Not to derail too much, but does the ACA deal with any of the issues in the pharmaceutical companies, or do we need a separate law for that?
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On July 03 2012 04:26 farvacola wrote:Show nested quote +On July 03 2012 04:15 jdseemoreglass wrote:On July 03 2012 04:05 farvacola wrote:On July 03 2012 03:55 jdseemoreglass wrote:On July 03 2012 03:46 farvacola wrote:On July 03 2012 03:40 jdseemoreglass wrote:On July 03 2012 03:37 farvacola wrote:On July 03 2012 03:28 jdseemoreglass wrote:On July 03 2012 03:26 farvacola wrote:On July 03 2012 03:22 jdseemoreglass wrote:
[quote]
That "sweet spot" is the distinction: Can you pay for you own health care or not?
If someone is paying for their own health care then how does any other person have any legal say in what that person does with his own health? The number of people who abstain from the purchase of health insurance and yet are able to pay for their own care out of pocket is astronomically low, as it is a fairly stupid way to go about things. So no, that is not the sweet spot by any means. Having health insurance is paying for your health care.... :/ Then I will simply reiterate what I had previously stated. The old system was more or less predicated on the dynamic you've offered, and the result has proven to be widespread cost inflation, a reduction in health service utilization, and an effective shouldering of the burden of the uninsured by those with insurance through systemic premium raises. If we lived in some sort of horrible society in which those who cannot afford healthcare were simply left to die, merely asking "can you afford healthcare" might prove an efficient public health policy. Thankfully, this is not the case, and our humanitarian motivation to collectively stopper preventable death requires a more nuanced perspective on health insurance that takes this into account. I'm talking about a very limited issue here, and that is the degree of personal "freedom" people should be afforded when it comes to their own health. My argument is that if someone is paying for their own health care/insurance and the insurance is allowed to tailor the premium to their lifestyle, then there should be no restrictions placed on that person's health lifestyle. The greater the dependency someone has on others, the more you can restrict their behavior. But don't restrict everyone's.... And what I'm telling you is that US insurance companies, given the ad-hoc nature of insurance coverage in line with your reasoning, are charging the shit out of everyone because they can get away with passing the costs of uninsured treatment on to paying customers. Eliminate uninsured treatment and the problem more or less goes away, along with huge boosts in collective health made possible through a better framework through which preventative health policy can be enacted. It is not the insurance companies who are bearing the cost of treating the uninsured... They have no obligation to the uninsured, before Obamacare. EXACTLY! You've enumerated what lies at the base of the problem. US Insurance companies actually have no excuse when it comes to their charging the highest rates in the world by a longshot, due to the fact that the government/taxpayer ends up being the one paying for uninsured care. So, not only are insurance rates in the US some of the highest per care efficacy in the world, but the general taxpayer with insurance coverage then ends up having to pay for for the care of the uninsured on top of that, all because the system asks solely the question of "can you afford healthcare?". You seem quite concerned with individual freedoms, and what I'm suggesting is that personal health freedom is better provided for given a system of universal healthcare. Every post you change your argument and then pretend that was your argument to begin with... it's kind of annoying. Anyway you are wrong for a third time because you are making the assumption that insurance companies are price gouging and reaping large profits. Actually health insurance companies are below average with an average profit margin of around 4%. So the high premiums have almost nothing to do with the insurance companies margins, and everything to do with the fundamentally high cost of treating people in the US. If you REALLY want to get at the root of the high costs, we can discuss things like employer mandated insurance, tort reform, and removing the countless licensing and regulative restrictions on providing care. That's where the real costs lie. Your suggestion that personal health freedom will increase under universal health care is nothing but absurd. When everyone is responsible for paying for everyone, then everyone will have a say in how everyone lives their life. Freedom won't even be a consideration, only reducing the burden on others in the name of "fairness." I can't imagine a greater way to reduce the personal health freedom for the average citizen. Whenever I see someone bring up "tort reform" in a healthcare debate I know its time to ignore them. I'll leave you with this. If the cost of healthcare is "fundamentally high" as you put it, then why does the cost of an appendectomy vary from a little over 1,500$ to 185,000$ within the state of California alone? The answer is not simple, but that you assume that no form of price gouging is taking place in any shape or form is very telling of your platform. http://archinte.jamanetwork.com/article.aspx?articleid=1151669http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-does-an-appendectomy-cost-somewhere-between-1529-and-186955/2012/04/24/gIQAMeKMeT_blog.html
The cost of an appendectomy has nothing to do with insurance companies price gouging. It may reflect health care providers (hospitals) price gouging but just as likely a reflection of the fact that hospitals do not compete on price as a business would in a normal market. No one shops around for surgeries based on price and because of that hospitals have little incentive to consider cost when recommending treatments or purchasing equipment.
Ex. A hospital could buy a $1mm machine that lasts 10 years to increase the quality of certain rare surgeries. Since the surgeries are rare the hospital only uses it a couple times a year. The hospital would then be justified in charging each surgery that uses the machine ~$100K to cover the cost of the equipment. Ridiculously, every hospital in the same city could be doing the same thing.
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On July 03 2012 05:41 JonnyBNoHo wrote:No one shops around for surgeries based on price and because of that hospitals have little incentive to consider cost when recommending treatments or purchasing equipment.
Yeah that's true... But it seems that may be slowly changing for the better. I heard a few days ago about this site, it's getting pretty popular.
http://bidonhealth.com/
It's like an ebay for health care. So far it's mostly testing, I don't think they cover surgeries, but it's an interesting concept.
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On July 03 2012 05:41 JonnyBNoHo wrote:Show nested quote +On July 03 2012 04:26 farvacola wrote:On July 03 2012 04:15 jdseemoreglass wrote:On July 03 2012 04:05 farvacola wrote:On July 03 2012 03:55 jdseemoreglass wrote:On July 03 2012 03:46 farvacola wrote:On July 03 2012 03:40 jdseemoreglass wrote:On July 03 2012 03:37 farvacola wrote:On July 03 2012 03:28 jdseemoreglass wrote:On July 03 2012 03:26 farvacola wrote:
[quote]
The number of people who abstain from the purchase of health insurance and yet are able to pay for their own care out of pocket is astronomically low, as it is a fairly stupid way to go about things. So no, that is not the sweet spot by any means. Having health insurance is paying for your health care.... :/ Then I will simply reiterate what I had previously stated. The old system was more or less predicated on the dynamic you've offered, and the result has proven to be widespread cost inflation, a reduction in health service utilization, and an effective shouldering of the burden of the uninsured by those with insurance through systemic premium raises. If we lived in some sort of horrible society in which those who cannot afford healthcare were simply left to die, merely asking "can you afford healthcare" might prove an efficient public health policy. Thankfully, this is not the case, and our humanitarian motivation to collectively stopper preventable death requires a more nuanced perspective on health insurance that takes this into account. I'm talking about a very limited issue here, and that is the degree of personal "freedom" people should be afforded when it comes to their own health. My argument is that if someone is paying for their own health care/insurance and the insurance is allowed to tailor the premium to their lifestyle, then there should be no restrictions placed on that person's health lifestyle. The greater the dependency someone has on others, the more you can restrict their behavior. But don't restrict everyone's.... And what I'm telling you is that US insurance companies, given the ad-hoc nature of insurance coverage in line with your reasoning, are charging the shit out of everyone because they can get away with passing the costs of uninsured treatment on to paying customers. Eliminate uninsured treatment and the problem more or less goes away, along with huge boosts in collective health made possible through a better framework through which preventative health policy can be enacted. It is not the insurance companies who are bearing the cost of treating the uninsured... They have no obligation to the uninsured, before Obamacare. EXACTLY! You've enumerated what lies at the base of the problem. US Insurance companies actually have no excuse when it comes to their charging the highest rates in the world by a longshot, due to the fact that the government/taxpayer ends up being the one paying for uninsured care. So, not only are insurance rates in the US some of the highest per care efficacy in the world, but the general taxpayer with insurance coverage then ends up having to pay for for the care of the uninsured on top of that, all because the system asks solely the question of "can you afford healthcare?". You seem quite concerned with individual freedoms, and what I'm suggesting is that personal health freedom is better provided for given a system of universal healthcare. Every post you change your argument and then pretend that was your argument to begin with... it's kind of annoying. Anyway you are wrong for a third time because you are making the assumption that insurance companies are price gouging and reaping large profits. Actually health insurance companies are below average with an average profit margin of around 4%. So the high premiums have almost nothing to do with the insurance companies margins, and everything to do with the fundamentally high cost of treating people in the US. If you REALLY want to get at the root of the high costs, we can discuss things like employer mandated insurance, tort reform, and removing the countless licensing and regulative restrictions on providing care. That's where the real costs lie. Your suggestion that personal health freedom will increase under universal health care is nothing but absurd. When everyone is responsible for paying for everyone, then everyone will have a say in how everyone lives their life. Freedom won't even be a consideration, only reducing the burden on others in the name of "fairness." I can't imagine a greater way to reduce the personal health freedom for the average citizen. Whenever I see someone bring up "tort reform" in a healthcare debate I know its time to ignore them. I'll leave you with this. If the cost of healthcare is "fundamentally high" as you put it, then why does the cost of an appendectomy vary from a little over 1,500$ to 185,000$ within the state of California alone? The answer is not simple, but that you assume that no form of price gouging is taking place in any shape or form is very telling of your platform. http://archinte.jamanetwork.com/article.aspx?articleid=1151669http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-does-an-appendectomy-cost-somewhere-between-1529-and-186955/2012/04/24/gIQAMeKMeT_blog.html The cost of an appendectomy has nothing to do with insurance companies price gouging. It may reflect health care providers (hospitals) price gouging but just as likely a reflection of the fact that hospitals do not compete on price as a business would in a normal market. No one shops around for surgeries based on price and because of that hospitals have little incentive to consider cost when recommending treatments or purchasing equipment. Ex. A hospital could buy a $1mm machine that lasts 10 years to increase the quality of certain rare surgeries. Since the surgeries are rare the hospital only uses it a couple times a year. The hospital would then be justified in charging each surgery that uses the machine ~$100K to cover the cost of the equipment. Ridiculously, every hospital in the same city could be doing the same thing.
If I gave off the impression of being too critical or overtly focused on insurance companies, I apologize. Allocating culpability when it comes to the sad state of healthcare here in the US is a difficult task, but both care providers and insurers are playing arguably the most active roles in the upkeep of the current negative dynamic of extraordinary cost and underutilization. I can tell neither you nor jdsee actually read the JAMA study, so allow me to offer it forth in more digestible quantities.
Your simple attribution of the unbelievable variance in costs to a denial of market normalization or simple malpractice on the part of providers is directly challenged by the findings of the study, which suggest that the entire dynamic of how healthcare is provided is clumsy, unequal in application, and disastrously inefficient. From the study,
Finally, when considering the explanatory power of the covariates, we found that 67.8% of the variation in charges could be predicted by patient-level and hospital-level factors. The remaining 32.2% of the variation was unexplained.
Now I know what the inevitably reply to this information is going to be, some sort of return to an insistence that government regulation is the primary reason for this whole debacle that works in concert with an active ignorance of the millions upon millions of dollars private interests pour into lobbying and campaign donations (After all, in business, only a ineffective consumer doesn't end up getting what he paid for). This approach fails to take into account what I, and Jama it would seem, consider THE most important reason why healthcare is an exchange too idiosyncratic for the standards of the unregulated free market. They say it better than I.
Our first result of the median charge for treating “uncomplicated” appendicitis of $33 611 would certainly startle many patients. Given estimates that 60% of bankruptcies in the United States involve catastrophic medical expenses,7 these data should alarm those making decisions about our society's ability to obtain medical care without financial catastrophe.
A patient with severe abdominal pain is in a poor position to determine whether his or her physician is ordering the appropriate blood work, imaging, or surgical procedure. Price shopping is improbable, if not impossible, because the services are complex, urgently needed, and no definitive diagnosis has yet been made.8 In our study, even if patients did have the luxury of time and clinical knowledge to “shop around,” we found that California hospitals charge patients inconsistently for what should be similar services as defined by our relatively strict definition of uncomplicated appendicitis.
By virtue of the coupling of our societies humanitarian desire to see health provided equally with the nuanced and difficult to standardize "best case scenario" nature of appropriate care, the healthcare industry is fundamentally unsuitable for the plain free market.
http://archinte.jamanetwork.com/article.aspx?articleid=1151669
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There are goods which simply cannot be provided in any reasonable way by profit-driven groups. These include education, driver's licenses, national defense, and of course healthcare. For any inefficiency government may have (which can be corrected), it isn't nearly as harmful as the conflict of interest on the part of the free market world. What incentive would they have to provide something better when better = less profitable? None. And that's exactly what we see with healthcare.
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so has anyone managed to justify why it's cool to take money from the poorer sectors of society to provide for the richer sectors of society?
or if the act is so good, than why are so many companies and unions being granted exemptions?
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On July 03 2012 09:49 sc2superfan101 wrote:
so has anyone managed to justify why it's cool to take money from the poorer sectors of society to provide for the richer sectors of society?
Some numbers to back this assertion up would be nice.
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On July 03 2012 10:25 TOloseGT wrote:Show nested quote +On July 03 2012 09:49 sc2superfan101 wrote:
so has anyone managed to justify why it's cool to take money from the poorer sectors of society to provide for the richer sectors of society? Some numbers to back this assertion up would be nice.
a large portion of the uninsured are young adults. a large portion of the costs of health care come from seniors and older adults. older adults and seniors have more money in general than the young adults, as the collection of wealth is usually correlative with age. so the people who generally use health care the most are also the people who are generally more wealthy. a mandate would require the younger adults without as much wealth to help provide the older adults with more wealth with money in the form of either a tax or premiums. it is redistribution from the bottom up. instead of balancing it out, they make the system even more top-heavy.
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On July 03 2012 10:30 sc2superfan101 wrote:Show nested quote +On July 03 2012 10:25 TOloseGT wrote:On July 03 2012 09:49 sc2superfan101 wrote:
so has anyone managed to justify why it's cool to take money from the poorer sectors of society to provide for the richer sectors of society? Some numbers to back this assertion up would be nice. a large portion of the uninsured are young adults. a large portion of the costs of health care come from seniors and older adults. older adults and seniors have more money in general than the young adults, as the collection of wealth is usually correlative with age. so the people who generally use health care the most are also the people who are generally more wealthy. a mandate would require the younger adults without as much wealth to help provide the older adults with more wealth with money in the form of either a tax or premiums. it is redistribution from the bottom up. instead of balancing it out, they make the system even more top-heavy.
The older and generally more wealthy have health insurance either under Medicare or whatever they buy into.
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On July 03 2012 10:30 sc2superfan101 wrote:Show nested quote +On July 03 2012 10:25 TOloseGT wrote:On July 03 2012 09:49 sc2superfan101 wrote:
so has anyone managed to justify why it's cool to take money from the poorer sectors of society to provide for the richer sectors of society? Some numbers to back this assertion up would be nice. a large portion of the uninsured are young adults. a large portion of the costs of health care come from seniors and older adults. older adults and seniors have more money in general than the young adults, as the collection of wealth is usually correlative with age. so the people who generally use health care the most are also the people who are generally more wealthy. a mandate would require the younger adults without as much wealth to help provide the older adults with more wealth with money in the form of either a tax or premiums. it is redistribution from the bottom up. instead of balancing it out, they make the system even more top-heavy.
The data flat out disagrees with your assertion. The following is from a 2011 report authored by ASPE of the Department of Health and Human Services.
![[image loading]](http://i47.tinypic.com/4sjlut.jpg)
The system is not nearly as top heavy as you suggest. Furthermore, even the wealthy are being charged too much for their healthcare, meaning a universal system benefits everyone.
The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).
http://www.photius.com/rankings/who_world_health_ranks.html
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on the contrary, that data perfectly illustrates my point: the more wealthy and elderly have health insurance, the majority of the people without health insurance are both young, and poor. the majority of health care costs come from the elderly or older people. to require the younger and more poor people to either 1) get insurance or 2) face penalties in the form of a tax increase, would be to redistribute wealth from the young to the elderly. from the poor to the wealthy.
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On July 03 2012 10:56 sc2superfan101 wrote:
on the contrary, that data perfectly illustrates my point: the more wealthy and elderly have health insurance, the majority of the people without health insurance are both young, and poor. the majority of health care costs come from the elderly or older people. to require the younger and more poor people to either 1) get insurance or 2) face penalties in the form of a tax increase, would be to redistribute wealth from the young to the elderly. from the poor to the wealthy.
I'm sorry that you are unable to read basic charts, but the box where it says 26.7%, at juncture of the 45-64 age row and percent of the uninsured column, means that an ever increasing number of older Americans are finding themselves without insurance as employers drop coverage and job industries shift towards work with fewer employee benefits. Furthermore, as I already showed previously in the thread, this is clearly not a case of redistribution of wealth as even the rich will end up paying less in the long run, while the poor are simply given the grace of not worrying about the financial burden of a possible health disaster.
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On July 03 2012 10:56 sc2superfan101 wrote:
on the contrary, that data perfectly illustrates my point: the more wealthy and elderly have health insurance, the majority of the people without health insurance are both young, and poor. the majority of health care costs come from the elderly or older people. to require the younger and more poor people to either 1) get insurance or 2) face penalties in the form of a tax increase, would be to redistribute wealth from the young to the elderly. from the poor to the wealthy.
The poor uninsured receive insurance through expanded Medicaid, while the slightly less poor uninsured who aren't eligible for the expanded Medicaid will be able to get insurance at a heavily subsidized rate, up to 400% of the poverty level. The age limit to be covered under a parent has also increased.
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Governor Rick Scott announced
‘We care about having a health care safety net for the vulnerable Floridians, but this is an expansion that just doesn't make any sense,' he said.
Then during an interview Friday morning on a Jacksonville radio station, the governor said it was unlikely he would agree to the expansion because it will be too expensive to implement.
He has also complained about the growing cost of Medicaid, the $21billion program that primarily aids low-income people as well as senior citizens who reside in nursing homes.
Scott has rejected federal money in the past, including $2.4billion for high-speed rail. His administration has also said ‘no’ to funds attached to the Affordable Care Act.
Scott is not alone in his determination to defy the federal government on the issue of ‘Obamacare.’ Ohio, Pennsylvania and Colorado are also considering opting out of Medicaid expansion.
Source
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On July 03 2012 09:09 farvacola wrote:Show nested quote +On July 03 2012 05:41 JonnyBNoHo wrote:On July 03 2012 04:26 farvacola wrote:On July 03 2012 04:15 jdseemoreglass wrote:On July 03 2012 04:05 farvacola wrote:On July 03 2012 03:55 jdseemoreglass wrote:On July 03 2012 03:46 farvacola wrote:On July 03 2012 03:40 jdseemoreglass wrote:On July 03 2012 03:37 farvacola wrote:On July 03 2012 03:28 jdseemoreglass wrote:
[quote]
Having health insurance is paying for your health care.... :/ Then I will simply reiterate what I had previously stated. The old system was more or less predicated on the dynamic you've offered, and the result has proven to be widespread cost inflation, a reduction in health service utilization, and an effective shouldering of the burden of the uninsured by those with insurance through systemic premium raises. If we lived in some sort of horrible society in which those who cannot afford healthcare were simply left to die, merely asking "can you afford healthcare" might prove an efficient public health policy. Thankfully, this is not the case, and our humanitarian motivation to collectively stopper preventable death requires a more nuanced perspective on health insurance that takes this into account. I'm talking about a very limited issue here, and that is the degree of personal "freedom" people should be afforded when it comes to their own health. My argument is that if someone is paying for their own health care/insurance and the insurance is allowed to tailor the premium to their lifestyle, then there should be no restrictions placed on that person's health lifestyle. The greater the dependency someone has on others, the more you can restrict their behavior. But don't restrict everyone's.... And what I'm telling you is that US insurance companies, given the ad-hoc nature of insurance coverage in line with your reasoning, are charging the shit out of everyone because they can get away with passing the costs of uninsured treatment on to paying customers. Eliminate uninsured treatment and the problem more or less goes away, along with huge boosts in collective health made possible through a better framework through which preventative health policy can be enacted. It is not the insurance companies who are bearing the cost of treating the uninsured... They have no obligation to the uninsured, before Obamacare. EXACTLY! You've enumerated what lies at the base of the problem. US Insurance companies actually have no excuse when it comes to their charging the highest rates in the world by a longshot, due to the fact that the government/taxpayer ends up being the one paying for uninsured care. So, not only are insurance rates in the US some of the highest per care efficacy in the world, but the general taxpayer with insurance coverage then ends up having to pay for for the care of the uninsured on top of that, all because the system asks solely the question of "can you afford healthcare?". You seem quite concerned with individual freedoms, and what I'm suggesting is that personal health freedom is better provided for given a system of universal healthcare. Every post you change your argument and then pretend that was your argument to begin with... it's kind of annoying. Anyway you are wrong for a third time because you are making the assumption that insurance companies are price gouging and reaping large profits. Actually health insurance companies are below average with an average profit margin of around 4%. So the high premiums have almost nothing to do with the insurance companies margins, and everything to do with the fundamentally high cost of treating people in the US. If you REALLY want to get at the root of the high costs, we can discuss things like employer mandated insurance, tort reform, and removing the countless licensing and regulative restrictions on providing care. That's where the real costs lie. Your suggestion that personal health freedom will increase under universal health care is nothing but absurd. When everyone is responsible for paying for everyone, then everyone will have a say in how everyone lives their life. Freedom won't even be a consideration, only reducing the burden on others in the name of "fairness." I can't imagine a greater way to reduce the personal health freedom for the average citizen. Whenever I see someone bring up "tort reform" in a healthcare debate I know its time to ignore them. I'll leave you with this. If the cost of healthcare is "fundamentally high" as you put it, then why does the cost of an appendectomy vary from a little over 1,500$ to 185,000$ within the state of California alone? The answer is not simple, but that you assume that no form of price gouging is taking place in any shape or form is very telling of your platform. http://archinte.jamanetwork.com/article.aspx?articleid=1151669http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-does-an-appendectomy-cost-somewhere-between-1529-and-186955/2012/04/24/gIQAMeKMeT_blog.html The cost of an appendectomy has nothing to do with insurance companies price gouging. It may reflect health care providers (hospitals) price gouging but just as likely a reflection of the fact that hospitals do not compete on price as a business would in a normal market. No one shops around for surgeries based on price and because of that hospitals have little incentive to consider cost when recommending treatments or purchasing equipment. Ex. A hospital could buy a $1mm machine that lasts 10 years to increase the quality of certain rare surgeries. Since the surgeries are rare the hospital only uses it a couple times a year. The hospital would then be justified in charging each surgery that uses the machine ~$100K to cover the cost of the equipment. Ridiculously, every hospital in the same city could be doing the same thing. If I gave off the impression of being too critical or overtly focused on insurance companies, I apologize. Allocating culpability when it comes to the sad state of healthcare here in the US is a difficult task, but both care providers and insurers are playing arguably the most active roles in the upkeep of the current negative dynamic of extraordinary cost and underutilization. I can tell neither you nor jdsee actually read the JAMA study, so allow me to offer it forth in more digestible quantities. Your simple attribution of the unbelievable variance in costs to a denial of market normalization or simple malpractice on the part of providers is directly challenged by the findings of the study, which suggest that the entire dynamic of how healthcare is provided is clumsy, unequal in application, and disastrously inefficient. From the study, Show nested quote +Finally, when considering the explanatory power of the covariates, we found that 67.8% of the variation in charges could be predicted by patient-level and hospital-level factors. The remaining 32.2% of the variation was unexplained. Now I know what the inevitably reply to this information is going to be, some sort of return to an insistence that government regulation is the primary reason for this whole debacle that works in concert with an active ignorance of the millions upon millions of dollars private interests pour into lobbying and campaign donations (After all, in business, only a ineffective consumer doesn't end up getting what he paid for). This approach fails to take into account what I, and Jama it would seem, consider THE most important reason why healthcare is an exchange too idiosyncratic for the standards of the unregulated free market. They say it better than I. Show nested quote +Our first result of the median charge for treating “uncomplicated” appendicitis of $33 611 would certainly startle many patients. Given estimates that 60% of bankruptcies in the United States involve catastrophic medical expenses,7 these data should alarm those making decisions about our society's ability to obtain medical care without financial catastrophe.
A patient with severe abdominal pain is in a poor position to determine whether his or her physician is ordering the appropriate blood work, imaging, or surgical procedure. Price shopping is improbable, if not impossible, because the services are complex, urgently needed, and no definitive diagnosis has yet been made.8 In our study, even if patients did have the luxury of time and clinical knowledge to “shop around,” we found that California hospitals charge patients inconsistently for what should be similar services as defined by our relatively strict definition of uncomplicated appendicitis. By virtue of the coupling of our societies humanitarian desire to see health provided equally with the nuanced and difficult to standardize "best case scenario" nature of appropriate care, the healthcare industry is fundamentally unsuitable for the plain free market. http://archinte.jamanetwork.com/article.aspx?articleid=1151669
Let me clarify a few of my thoughts:
The JAMA study doesn't make too much sense to me. I don't understand the point of using a regression model to figure out how providers are pricing care (other than it's easy) when IMO they should be looking at the actual cost accounting practices that the providers are following.
I do not think that many parts of the healthcare market could ever be ordered into a true economic marketplace as too often they boil down to "your money or your life scenarios" where free markets cannot exist. Additionally many healthcare services (as the JAMA study points out) are customized one-off procedures that cannot be easily shopped around from provider to provider in an effort to find the best value.
That said many parts of healthcare work find as an open market place. You do not need insurance to buy Tylenol or its generic equivalent and prices are easy for the market to determine. Personally I believe that the real question is where the line should be drawn between healthcare that is purchased in a market and healthcare that should be purchased by some other means (mandatory insurance / nationalized healthcare / whatever). Whatever isn't regulated (in an economic sense) by the market would then need to be regulated and rationed by the government.
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On July 03 2012 12:54 farvacola wrote:
Florida ranks as one of the continuously worst run states in the union
What about Ohio, Pennsylvania and Colorado?
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On July 03 2012 16:05 Epocalypse wrote:Show nested quote +On July 03 2012 12:54 farvacola wrote:
Florida ranks as one of the continuously worst run states in the union What about Ohio, Pennsylvania and Colorado?
Sure, lets talk about Ohio. Certainly one of the states to embrace red during the 2010 election cycle, Ohio has made its own election regrets quite palpable. Governor John Kasich has suffered from dismal approval ratings practically since day 1 of his governorship, and has proven more or less totally ineffective as a state leader. He has only attempted to pass one landmark initiative, the vaunted Issue 2 which sought to end collective bargaining for state employees, and it was destroyed by voters, who made it clear that an oversimplified dislike for public employees made law is no way to go about running a state. From a 2011 article in regards to issue 2 and Kasich, http://www.washingtonpost.com/blogs/the-fix/post/issue-2-falls-ohio-collective-bargaining-law-repealed/2011/11/08/gIQAyZ0U3M_blog.html
“This was a thrashing in Ohio — a huge overreach by extremist Republicans and an enormous victory for average working families,” said Steve Rosenthal, a longtime Democratic labor strategist. “A sleeping giant may have been awoken in the process. In Ohio nearly 30 percent of the vote in 2012 will come from union households. There is enormous energy coming off this victory.”
Exactly how Ohio will vote in the upcoming presidential election is still unknown, but you better believe Kasich will be handing Obama the state if he follows Rick Scott's lead. As for Pennsylvania and Colorado, well I'm doing research as we speak 
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EPT
