Political Roundtable Part XIII

[montestewart]

bump

Another "bump"...

hmm....

When he said "wiretap," what he meant was that on a windy day, a loose wire hanging from the side of Trump Tower would tap incessantly against a window in his deluxe luxury manse in the sky, thus irritating him. This happened while there was a president (Obama was used generically). There's no story here. Fake news!

[gtn130]

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[sfam]

Just an update on Terrorism, the nature of terrorism operations are changing due to military response.

This demonstrates that the nature of terrorism is evolving. Both Boko Haram and ISIL have changed their tactics in response to military pressure and spread out to surrounding countries. ISIL in particular has also increased attacks and inspired lone actors to carry out attacks in their name across the world. These changes suggest that, despite the ten per cent reduction in deaths from terrorism in 2015, greater international focus on peacebuilding and challenging the drivers of terrorism will be essential for increasing peace. The Global Terrorism Index 2016 outlines the trends of terrorism in 2015, as well as case studies on the deadliest groups and terrorism in OECD countries.

This is just another indication that addressing violent extremism is a constantly moving target. As their safe havens become targeted, their strategy is one of decentralization. The way to address this in addition to identifying bad actors is straight-line peacebuilding to address the local drivers of conflict that drive the radicalization process, strengthening the justice and security environment, and making trusted connections to vulnerable communities and local security forces.

In short, soft power is needed. This was the plan all along. Deny ISIS, Boko Haram and others territory on the ground and then work with allies and partners to reduce or eliminate their decentralized influence.

[sfam]

This is where I'm coming from, too. You need to build the infrastructure to supply the healthcare before you open those floodgates. That includes incentives for people to become doctors (plus nurses, pharmacists, people who fill out and process paperwork for medical records, etc...), and enough schools training them to meet those needs.

You also need to establish a competitive market for everything from MRI machines to antibiotics to the little plastic boxes they dispose needles in. Without driving all of those prices down (and giving suppliers a reason to innovate and increase efficiency) you can't pay for everyone to have quality healthcare in a reasonable time frame.

Insurance isn't really the biggest issue. Cost of healthcare is.

I won't repeat this endlessly, but insurance companies are in fact a huge problem. What other purchase do you have a third party in the middle between the buyer and seller who makes the prices versus quality debate meaningless? This kills the ability to do any kind of meaningful cost control.

There is a bigger risk of a private physician getting sued for not providing complete care, so the drive is instead to perform extraneous procedures. This is the opposite of the Canada story above, where you will get the procedure whether its needed or not. Everyone benefits from extraneas procedures - the doctor, the insurance company, the drug manufacturers and the IT health manufacturers all benefit. The consumer gets "extra" care, but doesn't pay more. Instead, rates keep going up.

You can repeat it endlessly, it doesn't make it true

The reason that physicians are driven to "complete care" is our malpractice environment. Again, one of the cost drivers I listed. U.S. medical liability claims are more than double Canada's (per patient) with at least half of related expenses going to legal costs rather than compensating patients.

I actually pointed this out above. And again, like in many other areas of health care, the Insurance is the crutch that keeps the money flowing for all. Totally agree about liability claims, but the systemic answer has been to enable procedures that don't need to be made. This happens seemlessly due to our drivers around the insurance industry. It is IN THEIR INTEREST to get more tests for more dollars over time. It is folly to think there is no connection here - you brake the connection between buyer and seller, where there is no consequence to either for extraneous costs, and there will be extraneous costs...everywhere - administrative, extra tests, you name it. Because insurance pays for everything, it is in the doctor's interest if they plan on taking that extra vacation to Hawaii.

[FAH1223]

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https://www.facebook.com/RTnews/videos/10155346671359411/

[dckingsfan]

I won't repeat this endlessly, but insurance companies are in fact a huge problem. What other purchase do you have a third party in the middle between the buyer and seller who makes the prices versus quality debate meaningless? This kills the ability to do any kind of meaningful cost control.

There is a bigger risk of a private physician getting sued for not providing complete care, so the drive is instead to perform extraneous procedures. This is the opposite of the Canada story above, where you will get the procedure whether its needed or not. Everyone benefits from extraneas procedures - the doctor, the insurance company, the drug manufacturers and the IT health manufacturers all benefit. The consumer gets "extra" care, but doesn't pay more. Instead, rates keep going up.

You can repeat it endlessly, it doesn't make it true

The reason that physicians are driven to "complete care" is our malpractice environment. Again, one of the cost drivers I listed. U.S. medical liability claims are more than double Canada's (per patient) with at least half of related expenses going to legal costs rather than compensating patients.

I actually pointed this out above. And again, like in many other areas of health care, the Insurance is the crutch that keeps the money flowing for all. Totally agree about liability claims, but the systemic answer has been to enable procedures that don't need to be made. This happens seemlessly due to our drivers around the insurance industry. It is IN THEIR INTEREST to get more tests for more dollars over time. It is folly to think there is no connection here - you brake the connection between buyer and seller, where there is no consequence to either for extraneous costs, and there will be extraneous costs...everywhere - administrative, extra tests, you name it. Because insurance pays for everything, it is in the doctor's interest if they plan on taking that extra vacation to Hawaii.

But sfam, if you truly want to reconnect the buyer and seller, then you wouldn't have single payer, would you?

Again, yes the insurers are a problem - as stated by others before me. But it isn't one of the larger problems. It is actually secondary. And yet you continually make it your premise to move to single payer.

The point is, single payer will still go bankrupt without fixing the underlying issues. Rearranging the chairs on the Titanic get you nowhere.

[dckingsfan]

Interesting that Germany and China were pushing the hardest at the G20 meeting. Clearly frustrated with Trump not giving them a clear path. The final document ended up very weak.

[sfam]

You can repeat it endlessly, it doesn't make it true

The reason that physicians are driven to "complete care" is our malpractice environment. Again, one of the cost drivers I listed. U.S. medical liability claims are more than double Canada's (per patient) with at least half of related expenses going to legal costs rather than compensating patients.

I actually pointed this out above. And again, like in many other areas of health care, the Insurance is the crutch that keeps the money flowing for all. Totally agree about liability claims, but the systemic answer has been to enable procedures that don't need to be made. This happens seemlessly due to our drivers around the insurance industry. It is IN THEIR INTEREST to get more tests for more dollars over time. It is folly to think there is no connection here - you brake the connection between buyer and seller, where there is no consequence to either for extraneous costs, and there will be extraneous costs...everywhere - administrative, extra tests, you name it. Because insurance pays for everything, it is in the doctor's interest if they plan on taking that extra vacation to Hawaii.

But sfam, if you truly want to reconnect the buyer and seller, then you wouldn't have single payer, would you?

Again, yes the insurers are a problem - as stated by others before me. But it isn't one of the larger problems. It is actually secondary. And yet you continually make it your premise to move to single payer.

The point is, single payer will still go bankrupt without fixing the underlying issues. Rearranging the chairs on the Titanic get you nowhere.

You say its minor. I can only tell you from my time in working in HHS, most there saw it as central. Single payer does address this. Without it, there is no baseline, no way of knowing whether you can actually start collecting data across the entire pool to verify that evidence-based treatment works. With a single payer, systemic health care quality and cost controls can be implemented far better. The consumer, as Illuminaire points out above can comment directly on the quality of care in a way that allows the system to adapt. This really isn't possible in the current insurance environment, as the complexity in the system makes it really difficult to come up systemic improvements. In a single payer system there is the possibility for cost transparency, significant reductions in administrative feeds and regular, systemic improvements in care.

In terms of single payer going backrupt, here's a list of 33 developed countries, all of which have either single payer, two tier (with minimum coverage and the ability to buy higher coverage) and insurance mandate similar to Obama care. There is no developed nation that uses the model you advocate other than the US, which has costs

Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014? Insurance Mandate (soon to be removed)

Stating that single payer will go bankrupt whereas private coverage won't, or is somehow cheaper simple doesn't match reality. The US has the most expensive health care in the developed world. We spend more on health care for less results with higher rising costs than virtually anyone else (Obamacare did put a dent rate of increase). Nobody else in the world is charting our course. It could be because, you know, our course sucks.



We pay more than anyone else for really crappy coverage, if you include the entire population. You may be worried about the country going backrupt - our current system has citizens going bankrupt.

[Wizardspride]

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[popper]

I may be misinterpreting something but didn't the Wikileaks documents clearly reveal that the intelligence apparatus is collecting and storing all digital communication on everyone in the country?

[bsilver]

I may be misinterpreting something but didn't the Wikileaks documents clearly reveal that the intelligence apparatus is collecting and storing all digital communication on everyone in the country?

NSA was collecting phone data on US persons until late 2015. The actual content of conversations wasn't collected. The information collected was referred to as meta data - stuff like phone numbers, length of call, etc.

[Wizardspride]

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[dckingsfan]

We pay more than anyone else for really crappy coverage, if you include the entire population. You may be worried about the country going backrupt - our current system has citizens going bankrupt.

Want to address the costs? This is what you should do. This would be tough for any party (or for the parties to get together) - but here is part of what they need to do. Please note: no other country has all these burdens. Put these burdens on single payer and it still goes under

No Employer-based insurance through the tax code (including government) and treat it the same as individual plans

Greatly curtail medical malpractice by limiting remedies

Accelerate drugs available over the counter, don't allow for patent drugs that have already been patented (like mixing two patented drugs together).

Change antitrust laws on drugs and duration of patents

Offer a tax deduction for those providing health care services to indigents

Fix the FDA approval process

Tear down as many regulations as possible - especially the most costly ones

Fix or remove the specialty hospitals certifications

Break the AMA monopoly on medicine and prevention of for-profit healthcare and expand who can deliver care so health providers have to compete for the customer

Where possible, promote telemedicine and other modern delivery systems

Fix or repeal HIPAA

Force health care providers to post prices online (yeah, that one will be tough)

Government promoted health status insurance to deal with pre-existing conditions

Push Health Savings Account spending

Get rid of the limitation to purchase health insurance across state lines

Let individuals pool together to create their own group insurance

Make Medicaid work with the market (negotiate prices, etc.) don't let it get destroyed by deficits

Allow affluent seniors to opt out of Medicare

[gtn130]

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This exchange made me laugh pretty hard. Whatever Conaway was trying to accomplish there just made him look like a complete moron.

[dckingsfan]

Stating that single payer will go bankrupt whereas private coverage won't, or is somehow cheaper simple doesn't match reality.

You are missing the point. I am fine with single payer (actually most systems would work), AFTER we take care of the root causes.

- Single payer does not curtail medical malpractice by limiting remedies
- does not accelerate drugs available over the counter, doesn't allow for patent drugs that have already been patented (like mixing two patented drugs together), doesn't change antitrust laws on drugs and duration of patents, in short - it doesn't affect the price of drugs
- It doesn't affect the FDA approval process which helps drive up the cost of drugs and medical devices
- It will not take care of government negotiating prices
- It will increase the number of regulations from HHS - especially the most costly ones
- It will not help to remove the burdens of specialty hospitals certifications - actually, it will make it more onerous
- It will not break AMA monopoly on medicine to drive down costs
- It will not promote telemedicine and other modern delivery systems
- It will not fix the HIPAA burdens

First you take care of the underlying problems. Otherwise you are still going over the cliff. I like the notion behind ACA - but the implementation sucked for these same reasons.

[dckingsfan]

Anyone listening to the Senate hearings on the Russian Election Interference on CSPAN?

[Wizardspride]

Anyone listening to the Senate hearings on the Russian Election Interference on CSPAN?

I saw it earlier.

It's a mess....

[Wizardspride]

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[dckingsfan]

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Yup. And so even if you are an R - you have to understand that it is eventually coming back at you. That this isn't an R/D thing it as a RUSSIA vs. USA thing.

Want to start the chant now USA, USA, USA...

[sfam]

We pay more than anyone else for really crappy coverage, if you include the entire population. You may be worried about the country going backrupt - our current system has citizens going bankrupt.

Want to address the costs? This is what you should do. This would be tough for any party (or for the parties to get together) - but here is part of what they need to do. Please note: no other country has all these burdens. Put these burdens on single payer and it still goes under

No Employer-based insurance through the tax code (including government) and treat it the same as individual plans

Greatly curtail medical malpractice by limiting remedies

Accelerate drugs available over the counter, don't allow for patent drugs that have already been patented (like mixing two patented drugs together).

Change antitrust laws on drugs and duration of patents

Offer a tax deduction for those providing health care services to indigents

Fix the FDA approval process

Tear down as many regulations as possible - especially the most costly ones

Fix or remove the specialty hospitals certifications

Break the AMA monopoly on medicine and prevention of for-profit healthcare and expand who can deliver care so health providers have to compete for the customer

Where possible, promote telemedicine and other modern delivery systems

Fix or repeal HIPAA

Force health care providers to post prices online (yeah, that one will be tough)

Government promoted health status insurance to deal with pre-existing conditions

Push Health Savings Account spending

Get rid of the limitation to purchase health insurance across state lines

Let individuals pool together to create their own group insurance

Make Medicaid work with the market (negotiate prices, etc.) don't let it get destroyed by deficits

Allow affluent seniors to opt out of Medicare

Yeah, I saw that list. It looks like it has some interesting ideas, but I'm not seeing how people with pre-existing conditions get coverage for prices they can afford in way that addresses costs, that said, I have no idea what "govt promoted health status insurance does to help, maybe it does. But high risk pools and travel across state lines really doesn't impress me. Neither does health savings accounts. Limiting medical malpractice by limiting remedies usually involves screwing those most affected, unless you mean something different. I'm not an expert in healthcare policy, but it seems really complicated to me - something with lots of counter-intuitive aspects that does lend itself to easy answers.

There are probably lots of little things that can be done to improve it - I think it probably makes more sense to evolve what's there if we aren't going to a single payer model.