Political Roundtable Part XIII

[dckingsfan]

Military spending is ridiculous too. I don't think we should be the world's police.

But I work in health care so I am more familiar with it and I think the current course simply won't work. Sfam's "solving" comment seemed to be implying that our health care woes could be solved by funding. We are already overspending on health care.

To be clear, I think our health care woes get solved the same way the rest of the developed world does it - removing insurance and drug companies as the primary driver of costs, and instead go to a single payer where basic health care is a right.

But if we're talking about taking away health care for poor folks in order to fund extraneous military expenditures that won't reduce violent extremism, its an easy call.

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government and more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

The question of if single payer would be the answer is in how it is written. If it is written like the ACA or implemented like the VA it would be an abject failure.

But to get competition, you would also have to take away the tax breaks for corporations and unions (healthcare being tax deductible) and I don't see that happening either (as well as the carveouts for the pharma industry).

We are in a fine mess.

[Zonkerbl]

I wouldn't say US healthcare is low quality. It's very high quality for people who have insurance.

[dckingsfan]

To be clear, I think our health care woes get solved the same way the rest of the developed world does it - removing insurance and drug companies as the primary driver of costs, and instead go to a single payer where basic health care is a right.

But if we're talking about taking away health care for poor folks in order to fund extraneous military expenditures that won't rteduce violent extremism, its an easy call.

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government are more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

Unfortunately there is nothing in your statement that fits with actual reality. There is no country you can point to across the world where this works as you say. Literally the rest of the developed world has gone to single payer and almost everyone in the developed world has better health care than the US for less cost. Health insurance should be for top-up care like Aflac, which would solve your advanced treatment problem.

Sign me up for Canada health care. Like Now. Or the UK's. Or Germany's. Or Sweden's. Or Japan's. Or Singapore's.

I would agree to this if we could agree that the US would fund no more than 50 percent of all outlays on entitlements.

If you are referring to the Sanders plan, we can't afford it. The Sanders plan covers more than typical insurance plans abroad. The Sanders plan would charge no premiums, require no out-of-pocket spending and would pay for services like dental care and long-term nursing home stays. It would just bankrupt us sooner.

Also, Medicare pays doctors and hospitals higher prices than single-payer systems do in other countries.

Making a single payer American health care system significantly cheaper would mean more than just cutting the insurance companies out. It would mean more than reducing the high administrative costs of the American system.

We would need to cut the cost of drugs (remember how you wanted to help those in other countries that are less fortunate? This is the number one way we do this by underwriting the cost of drugs abroad).

It would also require paying doctors and nurses substantially lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of American hospital stays, like private patient rooms.

If we want to be honest with the Americans (and not the, "you can keep your doctor" stuff). We would need a plan forwarded by whichever party wanted to be honest (and then most likely the minority party for a while).

[tontoz]

To be clear, I think our health care woes get solved the same way the rest of the developed world does it - removing insurance and drug companies as the primary driver of costs, and instead go to a single payer where basic health care is a right.

But if we're talking about taking away health care for poor folks in order to fund extraneous military expenditures that won't rteduce violent extremism, its an easy call.

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government are more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

Unfortunately there is nothing in your statement that fits with actual reality. There is no country you can point to across the world where this works as you say. Literally the rest of the developed world has gone to single payer and almost everyone in the developed world has better health care than the US for less cost. Health insurance should be for top-up care like Aflac, which would solve your advanced treatment problem.

Sign me up for Canada health care. Like Now. Or the UK's. Or Germany's. Or Sweden's. Or Japan's. Or Singapore's.

Sure you can have Canada healthcare. It will be cheap and work fine, until it is time to use it.

Then you will wait weeks to see a doctor. After he finally sees you (assuming you actually get in) then it will be a few more weeks until you get treatment, assuming that treatment is even available.

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.

When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.

https://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.html

[nuposse04]

I wouldn't say US healthcare is low quality. It's very high quality for people who have insurance.

Basically all my preceptors in clinical rotations thus far have said something to the effect "America is a great place to have an acute condition, but a horrible country to have a chronic condition compared to the rest of the industrialized world". The disdain that is actively spewed to insurance companies is at times hilarious. Also lamenting how they get compensated at a fraction of what they use to for medicare patients.

My OBGYN preceptor was probably an example of your statement though. She definitely had more "give-a-damn" for patients with private insurance they government. Was kind of disgusting to watch to be frank.

[dckingsfan]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

[Zonkerbl]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

Ooh, Ezra Klein.

[dckingsfan]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

Ooh, Ezra Klein.

hehehe - I know.

[tontoz]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

Ooh, Ezra Klein.

hehehe - I know.

Surprising to see some good points in there.

In general, Americans don’t use more health care than citizens of other countries. But we pay a lot more for the health care we do get.

The dirty truth about American health care is that it costs more not because insurers are so powerful, but because they’re so weak.

[DCZards]

To be clear, I think our health care woes get solved the same way the rest of the developed world does it - removing insurance and drug companies as the primary driver of costs, and instead go to a single payer where basic health care is a right.

But if we're talking about taking away health care for poor folks in order to fund extraneous military expenditures that won't reduce violent extremism, its an easy call.

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government and more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

The question of if single payer would be the answer is in how it is written. If it is written like the ACA or implemented like the VA it would be an abject failure.

But to get competition, you would also have to take away the tax breaks for corporations and unions (healthcare being tax deductible) and I don't see that happening either (as well as the carveouts for the pharma industry).

We are in a fine mess.

Correction: Unions don't provide healthcare coverage nor do they receive tax breaks for it. Employers provide the coverage for union members and get the tax break for it.

[dckingsfan]

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government and more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

The question of if single payer would be the answer is in how it is written. If it is written like the ACA or implemented like the VA it would be an abject failure.

But to get competition, you would also have to take away the tax breaks for corporations and unions (healthcare being tax deductible) and I don't see that happening either (as well as the carveouts for the pharma industry).

We are in a fine mess.

Correction: Unions don't provide healthcare coverage nor do they receive tax breaks for it. Employers provide the coverage for union members and get the tax break for it.

Union members are not taxed on their healthcare benefits. So, yes - they get a tax break.

Vs. if they had to pay taxes before they purchased insurance. Remember the Cadillac portion of the ACA and the visceral reaction from unions

[Zonkerbl]

Watch on YouTube

[sfam]

Single payer is not the answer. Canada has single payer and their medical services are terrible compared to ours. They don't even have access to a lot of the advanced treatments we have here and wait times are outrageous.

Less government are more competition is the better option. There is a reason why medical costs have been going up while the costs of Lasik and cosmetic procedures have been coming down.

Unfortunately there is nothing in your statement that fits with actual reality. There is no country you can point to across the world where this works as you say. Literally the rest of the developed world has gone to single payer and almost everyone in the developed world has better health care than the US for less cost. Health insurance should be for top-up care like Aflac, which would solve your advanced treatment problem.

Sign me up for Canada health care. Like Now. Or the UK's. Or Germany's. Or Sweden's. Or Japan's. Or Singapore's.

I would agree to this if we could agree that the US would fund no more than 50 percent of all outlays on entitlements.

If you are referring to the Sanders plan, we can't afford it. The Sanders plan covers more than typical insurance plans abroad. The Sanders plan would charge no premiums, require no out-of-pocket spending and would pay for services like dental care and long-term nursing home stays. It would just bankrupt us sooner.

Also, Medicare pays doctors and hospitals higher prices than single-payer systems do in other countries.

Making a single payer American health care system significantly cheaper would mean more than just cutting the insurance companies out. It would mean more than reducing the high administrative costs of the American system.

We would need to cut the cost of drugs (remember how you wanted to help those in other countries that are less fortunate? This is the number one way we do this by underwriting the cost of drugs abroad).

It would also require paying doctors and nurses substantially lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of American hospital stays, like private patient rooms.

If we want to be honest with the Americans (and not the, "you can keep your doctor" stuff). We would need a plan forwarded by whichever party wanted to be honest (and then most likely the minority party for a while).

It would also involve significant reductions and risk and insurance costs on the part of the doctors. So its not all bad for them. Many health care systems are doing horrific in the US market. The fact that insurance companies are making BANK is not improving personal health or our systems' health. Ideally, a single payer system would cover basic health care and allow for a premium insurance model.

[DCZards]

Correction: Unions don't provide healthcare coverage nor do they receive tax breaks for it. Employers provide the coverage for union members and get the tax break for it.

Union members are not taxed on their healthcare benefits. So, yes - they get a tax break.

Vs. if they had to pay taxes before they purchased insurance. Remember the Cadillac portion of the ACA and the visceral reaction from unions

Very few union members have the high-end (or Cadillac) healthcare benefits that the ACA wanted to tax. Not changing much by dropping that as a tax break.

[dckingsfan]

Correction: Unions don't provide healthcare coverage nor do they receive tax breaks for it. Employers provide the coverage for union members and get the tax break for it.

Union members are not taxed on their healthcare benefits. So, yes - they get a tax break.

Vs. if they had to pay taxes before they purchased insurance. Remember the Cadillac portion of the ACA and the visceral reaction from unions

Very few union members have the high-end (or Cadillac) healthcare benefits that the ACA wanted to tax. Not changing much by dropping that as a tax break.

For those that aren't taxed it is still a tax break...

[sfam]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

This says that drug companies and device manufacturers drive costs, but its clear insurance companies are the enablers. They brake the normal market dynamics between buyer and seller. Their metric isn't healthy patients, and often they don't care as long as claims are made. I spent some time in the early 2000s working with a research organization inside HHS looking for ways to reduce preventable deaths. I was doing community of practice type things between various groups, but got to go on a number of the research trips to health care systems around the country including Childrens Hospitals, and got to talk to a number of health professionals including CFOs. The most illuminating was a CFO of a hospital system in Florida explaining that if they reduce preventable deaths, their income goes down. The health care systems that make the most insurance money from heart attack treatments are the ones that require the patient to come back and take up bed space. Healthy ones bring in less money.

There are lots of ways the incentives are all screwed up. This is why its so difficult to come up with innovations. Rating doctors is a great example of this. In the states that try it, a highly rated doctor usually means they don't take high risk patients. Poorly rated doctors may provide better care, but they don't reject a hard luck case. The end result is poor information for consumers.

[tontoz]

It would also involve significant reductions and risk and insurance costs on the part of the doctors. So its not all bad for them. Many health care systems are doing horrific in the US market. The fact that insurance companies are making BANK is not improving personal health or our systems' health. Ideally, a single payer system would cover basic health care and allow for a premium insurance model.

Tell that to the people in Canada who routinely come here for treatment, or have to wait indefinitely to get treatment in Canada.

My mom has already gone through two successful treatments of proton therapy, each lasting several weeks, for cancer. Proton therapy is an alternative to radiation therapy with far fewer side effects. She got treatment only 90 minutes from her home.

Good luck getting proton therapy in Canada. I doubt they have a proton machine in the entire country.

[Wizardspride]

Read on Twitter

[dckingsfan]

The WSP on the cost of Healthcare.
https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/?utm_term=.b1267d8fcc83

This says that drug companies and device manufacturers drive costs, but its clear insurance companies are the enablers. They brake the normal market dynamics between buyer and seller. Their metric isn't healthy patients, and often they don't care as long as claims are made. I spent some time in the early 2000s working with a research organization inside HHS looking for ways to reduce preventable deaths. I was doing community of practice type things between various groups, but got to go on a number of the research trips to health care systems around the country including Childrens Hospitals, and got to talk to a number of health professionals including CFOs. The most illuminating was a CFO of a hospital system in Florida explaining that if they reduce preventable deaths, their income goes down. The health care systems that make the most insurance money from heart attack treatments are the ones that require the patient to come back and take up bed space. Healthy ones bring in less money.

There are lots of ways the incentives are all screwed up. This is why its so difficult to come up with innovations. Rating doctors is a great example of this. In the states that try it, a highly rated doctor usually means they don't take high risk patients. Poorly rated doctors may provide better care, but they don't reject a hard luck case. The end result is poor information for consumers.

Drug companies, device manufactures and healthcare employees. Not just Drug companies and device manufactures. In fact, labor is the biggest component.

And no, it isn't clear that the insurance companies are the drivers, in fact anything but. They are the whipping boy but didn't actually commit the crime. And it has stuck because we need a bad guy for people to point at...

Since you did some research for HHS, have you checked outstanding work they did on EMS systems. Where did the breakdown of the procedures come from? Yep, government. It wasn't insurance companies that were the enabler - it was/is the federal government.

Who gave the drug companies the carveouts with the inability for Medicare/Medicade to negotiate with those drug companies (and same for the ACA btw)? Yep, your federal government.

Again, I would be open to a single payer. But you would have to fix the underlying issues for it to work. But, if you fix the underlying issues - either system would work.

That was why the ACA was such a waste.

[dckingsfan]

It would also involve significant reductions and risk and insurance costs on the part of the doctors. So its not all bad for them. Many health care systems are doing horrific in the US market. The fact that insurance companies are making BANK is not improving personal health or our systems' health. Ideally, a single payer system would cover basic health care and allow for a premium insurance model.

Tell that to the people in Canada who routinely come here for treatment, or have to wait indefinitely to get treatment in Canada.

My mom has already gone through two successful treatments of proton therapy, each lasting several weeks, for cancer. Proton therapy is an alternative to radiation therapy with far fewer side effects. She got treatment only 90 minutes from her home.

Good luck getting proton therapy in Canada. I doubt they have a proton machine in the entire country.

You might want to show that healthcare companies are one of the lowest margin groups out there. So much for making huge bank.