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PUSH HARD FOR SINGLE PAYER RIGHT NOW

By jazz_music   Apr 19, 10:45pm   5 links   3,295 views   54 comments   watch (1)   quote      

Top down sabotage is coming to the healthcare system. It is urgent that we all fight for Medicare for all, to FIX OBAMACARE, before the Republicans and health insurance CEOs blow up ACA Obama Care --which they will do ASAP remember they want hundred billion tax breaks and they didn't get it yet.

Bernie Sanders

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15   FP   458/464 = 98% civil   Apr 20, 1:52pm  ↑ like   ↓ dislike   quote    

socal2, you seem to equate/confuse profit with expenses

16   socal2   229/231 = 99% civil   Apr 20, 2:11pm  ↑ like   ↓ dislike   quote    

FP says

socal2, you seem to equate/confuse profit with expenses

Profits as a percent of revenue.

https://www.forbes.com/sites/theapothecary/2014/06/27/profits-in-health-insurance-under-obamacare/#3c3a24df3c3a

17   socal2   229/231 = 99% civil   Apr 20, 2:13pm  ↑ like   ↓ dislike   quote    

Lashkar_i_Trumpi says

Yes. It doesn't have shareholders expecting dividends and stock growth.

Unionized government bureacrauts don't have any accountability or incentive to save money and ferret out fraud.

Private Insurer Profits? $13 Billion. Medicare Fraud? $48 Billion
https://www.forbes.com/sites/aroy/2011/03/04/private-insurer-profits-13-billion-medicare-fraud-48-billion-health-reform-priceless/#2f5a3cb42f5a

18   Dan8267   3266/3310 = 98% civil   Apr 20, 2:18pm  ↑ like   ↓ dislike   quote    

Lashkar_i_Trumpi says

Price controls, esp. on ER, absolutely necessary. Should be kept in line with inflation. There is no international shortage of cotton, alcohol wipes, etc. and healthcare provider wage pressure is in line with general wage-earners (that is, not increasing rapidly at all).

There is a reason Health Care costs are exploding annually and it isn't aging population, see Japan

If the economic structures we used weren't so fucked up, health care like any technology would asymptotically decrease in cost to some fixed, low level.

19   curious2   962/962 = 100% civil   Apr 20, 2:29pm  ↑ like (2)   ↓ dislike   quote    

jazz music says

It is urgent that we all fight for Medicare for all, to FIX OBAMACARE...

You don't seem to realize those are opposite goals, and the latter is the slogan of "The Resistance", an Orwellian subversion along the lines of Animal Farm.

Quigley says

One is assistance for paying for medical school for kids of not-wealthy families.

Mexico has a better solution: free medical/dental/vision school for interested students who show ability and potential and agree to work for a year for the government in an underserved area. It creates a plentiful supply of highly capable medical professionals, and thus low prices for excellent quality. It's the best place in North America to go for those services.

Means testing is a bad idea that keeps coming back, in Rin's comments also. Why should you care whether your doctor was born in a log cabin he built himself? "Oh, sorry he misdiagnosed your kid and blinded her for the rest of her life, but he had come from a dirt poor family so we gave him a scholarship, while dissuading better qualified candidates with $60k/year tuition." The idea comes back because it expands the market for expensive tuition: find a way to enable people who can't afford it. It's a lot like Obamneycare in that way: expand Medicaid so that hospital executives can monetize even indigent vagrants at $500k/year each. The idea comes back because marketing can easily distort the inherent sacrifices to look "fair" when in fact it's about maximizing their own power at the expense of everyone else.

The better solution is to reduce the cost. The Mexican system works because they produce so many talented graduates that even the professors can be hired at reasonable salaries. If we had NAFTA for medical/dental/vision, the price would equalize.

Also repeal the Rx requirement, because too many people are scheduling Dr visits for permission to buy junk they saw on TV. Let Darwin Awards take their course. If some schmuck wants to buy the toxic placebo he saw on TV, and wash it down with a can of Pepsi to deter police violence, so be it. You can't save people from themselves, so let people make their own decisions and the smart ones will check expert systems (e.g. RightDiagnosis.com, FKA WrongDiagnosis.com) that cost nothing.

Also, as noted above, emergency services need price controls. That should also be on a fee-for-diagnosis basis, not fee-for-service, which creates terribly perverse incentives. Ideally, emergency medical should be paid by government like Fire&Police, because there is no time for "market" comparisons.

American overpricing relative to other countries, and excess spending especially after age 65, practically began with Medicare's fee-for-service model driving over-utilization. Dan and others have posted a chart showing how American spending leaps above all others starting around Medicare age. Some have noticed the increase becomes most noticeable around age 60, and so they don't blame Medicare, which starts generally at age 65. They don't realize Medicare eligibility extends already to some people under age 65, and the pool expands enough by age 60 to affect the charts. Expanding current Medicare to all, while maintaining current supply restrictions and perverse incentives that increase demand, would increase spending even faster. Here is a chart comparing American medical costs to other countries; notice what happens when Americans become eligible for Medicare, whether due to age or disability (which correlates with age after around 60):

20   rpanic01   159/159 = 100% civil   Apr 20, 4:36pm  ↑ like   ↓ dislike   quote    

We could have a two tier system, one for those that work and one for those that don't. Insurance companies need to go but we also need to talk about at what point do we not keep people alive without getting emotional about it. People should be able to die gracefully and not kept on life support or long term critical care after a certain age.

21   Dan8267   3266/3310 = 98% civil   Apr 20, 4:54pm  ↑ like (1)   ↓ dislike   quote    

curious2 says

Mexico has a better solution: free medical/dental/vision school for interested students who show ability and potential and agree to work for a year for the government in an underserved area. It creates a plentiful supply of highly capable medical professionals, and thus low prices for excellent quality. It's the best place in North America to go for those services.

This is an excellent idea.

curious2 says

Means testing is a bad idea that keeps coming back, in Rin's comments also. Why should you care whether your doctor was born in a log cabin he built himself? "Oh, sorry he misdiagnosed your kid and blinded her for the rest of her life, but he had come from a dirt poor family so we gave him a scholarship, while dissuading better qualified candidates with $60k/year tuition."

Agreed. Talent, not poverty, should be the basis for such scholarships.

22   Straw Man   606/610 = 99% civil   Apr 20, 5:30pm  ↑ like   ↓ dislike   quote    

What do you mean "now"? Less than half a year after losing both Congress and WH to GOP? You absolutely sure this is a good time to push for lefty ideas?

23   TwoScoopsMcGee   1620/1620 = 100% civil   Apr 20, 5:59pm  ↑ like (1)   ↓ dislike   quote    

socal2 says

Unionized government bureacrauts don't have any accountability or incentive to save money and ferret out fraud.

That's why you privatize enforcement. Hey, privatization is always the answer. Let Private Firms pursue Medicare fraud and keep 25% of the haul. Lawyers' profit is a great motivator - and fear of it.

You know how many law firms would love to sue over $20 sprays of Lysol?

I believe the top 5 health insurance companies brought up $30B of their own stock in just two years, hardly suffering.

Whatever we're doing now doesn't work beyond any reasonable doubt, since our costs are astronomical but results mediocre.

Everybody, left and right agrees - only the stupid center of technocrats refuses to see the system they run and benefit from sucks and needed replacement two decades ago.
http://www.weeklystandard.com/insurers-profits-have-nearly-doubled-since-obama-was-elected/article/2005073
http://www.salon.com/2016/10/28/making-a-killing-under-obamacare-the-aca-gets-the-blame-for-rising-premiums-while-insurance-companies-are-reaping-massive-profits/

Whatever the solution, cost controls, at least for ER services, is a big starting point.

"Cost Controls don't work". Funny, works great in Japan. ~1% cost increases on medical care annually, while dealing with an incredibly aged population consisting of many lifelong smokers, and a smaller demographic behind it that has even fewer kids.

24   bob2356   573/577 = 99% civil   Apr 20, 8:06pm  ↑ like   ↓ dislike   quote    

YesYNot says

bob2356 says

We need to decrease the costs of health care

Easier said than done. That was one goal of Obamacare. It should be a goal for a single payer system as well.

Reducing the cost of health care was never a goal of Obamacare. Getting the uninsured health insurance was the goal of Obamacare. There were a lot of smoke and mirrors budget tricks claiming ACA would save money, but they disappear quickly with an honest look at the program.

25   bob2356   573/577 = 99% civil   Apr 20, 8:16pm  ↑ like   ↓ dislike   quote    

socal2 says

FP says

socal2, you seem to equate/confuse profit with expenses

Profits as a percent of revenue.

So do you think that the money health insurance companies spend on marketing polices, billing polices, collecting premiums, paying claims, political lobbying, campaign contributions, salaries, bonuses, legal work, setting rates, negotiating with doctors/hospitals, etc. etc, etc.all comes from the tooth fairy? It all is health care spending. So is the large amounts of money doctors and hospitals spend billing insurance companies. The insurance company profits are the least of it.

26   bob2356   573/577 = 99% civil   Apr 20, 8:27pm  ↑ like   ↓ dislike   quote    

curious2 says

Dan and others have posted a chart showing how American spending leaps above all others starting around Medicare age. Some have noticed the increase becomes most noticeable around age 60, and so they don't blame Medicare, which starts generally at age 65.

You do know that ironbrains vaunted chart isn't anywhere close (like off by a factor of 3 or more) to medicare and HHS spending numbers don't you? I really think that medicare actually knows what they spent no matter what some random unknown source chart ironbrain came up with says. Its public record, go look it up. Here is Kaiser's numbers from 2011 since I still have it on my computer. Not anywhere close to ironbrains mystery chart.

27   curious2   962/962 = 100% civil   Apr 20, 8:44pm  ↑ like (1)   ↓ dislike   quote    

bob2356 says

You do know that ironbrains vaunted chart isn't anywhere close (like off by a factor of 3 or more) to medicare and HHS spending numbers don't you? I really think that medicare actually knows what they spent no matter what some random unknown source chart ironbrain came up with says. Its public record, go look it up.

The chart I linked comes from Carnegie-Mellon via Forbes and elsewhere. It says annual per capita costs, not merely one or two federal components of those costs. I gave up looking up things for you because you remained the same: sarcastic, unappreciative, and toxoplasmotic. You don't even say what chart you're referring to, so maybe you meant a different one from the Carnegie-Mellon chart, and I am definitely not going to waste time trying to read your opiate- and opioid-addled mind. In your paranoia you used to accuse me of being MMR as an alias, which I found very flattering even though we are obviously different people, so who knows what chart you might be imagining now.

Update: I see you updated your comment to add a chart from the Kaiser's HMO empire showing a subset of Medicare spending that "excludes [enrollees] in Medicare Advantage." The Kaiser's chart also excludes Medicaid, other federal and state programs, private insurance, and individual payments. In other words, the Kaiser's chart presents only one subset of annual per capita costs, and thus does not refute the Carnegie-Mellon chart that I had linked.

28   jazz_music   805/806 = 99% civil   Apr 20, 9:40pm  ↑ like   ↓ dislike   quote    

Straw Man says

What do you mean "now"?

Now, after the republican failure to repeal or replace, is not the time to gloat but the time to put forward a popular health care improvement. It shouldn't be too hard to do because the political base is broadened now.

You could listen to the Michael Moore linked above.

Trump's glorious health care promises were empty: everyone sees he's got nothing at all but really really great, trust me, it'll make your head spin nothing. He's got apologists.

Republicans have nothing on the table now, they proposed tax breaks for oligarchs and prayers for sick people and somehow it flopped. --go figure

29   bob2356   573/577 = 99% civil   Apr 20, 10:34pm  ↑ like (1)   ↓ dislike   quote    

curious2 says

The chart I linked comes from Forbes.

Ok I found the forbes link. Very interesting history of the numbers. It's a jumbled mess. A chart taken from of a local newspaper article about a 2010 study of a 2005 study with no peer review or data integrity of any kind done by researchers with no back round in medical. No data sets or methodology are given for either study for anyone to check on. That's very solid professional research.

curious2 says

It says annual per capita costs, not merely one or two federal components of those costs.

There are newspaper articles that say the moon landings are fake and there were WMD in Iraq. The original 2005 Kotlikoff and Hagist article that Fischbeck took his data from is titled Comparing Government Healthcare Costs in Ten OECD Countries. (note that only 5 made the Fischbeck study/chart, the US and the 4 lowest cost countries of the other 9) If you had looked you would have found It's a study of GOVERNMENT spending on health care (note that Fischbeck left out the government part in his study/chart). Want to comment on how much GOVERNMENT health care spending there is in the US before people start using medicare? Most health care in the US is private insurance before age 65, yet the US spending is top of the chart from birth on. The US numbers under 65 are government spending divided by the entire under 65 population, not just the medicaid eligible population making the chart even more distorted. The other 4 countries the population under 65 is almost all government spending. Just in case you didn't catch the implication it drives the US under 65 per capita cost on the chart down relative to the other 4 countries. A lot down.

Might want to give this a glance also before you genuflect before your chart again. http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/

The chart never made any sense to me, the numbers don't even come close to adding up. It seems like the it's true because I believe it should be true crew didn't do any thinking. Still want to stand on this hand or would you like to fold now?

30   bob2356   573/577 = 99% civil   Apr 20, 10:47pm  ↑ like   ↓ dislike   quote    

curious2 says

a subset of Medicare spending that "excludes [enrollees] in Medicare Advantage." The Kaiser's chart also excludes Medicaid, other federal and state programs, private insurance, and individual payments.

Want to do the math and show how medicaid, other federal and state programs, private insurance, and individual payments can triple the per capita cost of basic medicare which takes care of most over 65s? Maybe ironman can help you out since he's so good at math.

31   curious2   962/962 = 100% civil   Apr 20, 10:54pm  ↑ like (1)   ↓ dislike   quote    

32   curious2   962/962 = 100% civil   Apr 20, 11:10pm  ↑ like   ↓ dislike   quote    

jazz music says

time to put forward a popular health care improvement. It shouldn't be too hard to do because the political base is broadened now.

By all means, write to your legislators and President, and I wish you luck with that. You are likely to find it very difficult to make progress because nearly every organization exists for the purpose of increasing its own revenue, and we have reached the point where they're basically butchering and poisoning people for power including revenue. The anecdotes are harrowing, flogging patients to the bitter end even when they've signed advance healthcare directives saying not to do that. The data are even worse. Please do try, but understand what you're up against. The patient population are brainwashed like hostages with Stockholm Syndrome, and the Congress represents the captors trying to maximize ransom. People are addicted to toxic placebos and the higher the price goes, the more "valued" they feel as "beneficiaries" of their insurance programs, which maximize cost-shifting and encourage patients to "get more" at the expense of their neighbors' kids. Well organized and highly educated professionals depend on that gravy train for their yachts, second houses, retirement plans, and fancy cars. Current law enables them to command literally infinite subsidies, and the revenue recipients will not give those up without a fight. You will be denounced as racist or whatever they can imagine to discredit you. And, remember, you're asking the Trump administration to behave nobly and altruistically rather than cutting a deal to make more money. But yes, please try.

bob2356 says

Want to do the math and show how medicaid, other federal and state programs, private insurance, and individual payments can triple the per capita cost of basic medicare which takes care of most over 65s?

You can do the math if you want to challenge the Carnegie-Mellon chart. Medicare spends over $10k/yr per enrollee, and Medicaid spends another $2k/yr per person over 65, so that's $12k/yr just for those two programs. Medi-gap, long term care insurance, and "personal resources" add a lot more.

33   APOCALYPSEFUCK_is_ADORABLE   1207/1207 = 100% civil   Apr 21, 3:19am  ↑ like   ↓ dislike   quote    

FAIL!

A Real Republican Congress would be shooting the old and sick in the face and selling tickets for people to watch them staffer around and die.

Government can be Innovative!

Only TRUMPLIGULA! understands this!

34   YesYNot   1084/1085 = 99% civil   Apr 21, 4:06am  ↑ like   ↓ dislike   quote    

bob2356 says

Reducing the cost of health care was never a goal of Obamacare. Getting the uninsured health insurance was the goal of Obamacare. There were a lot of smoke and mirrors budget tricks claiming ACA would save money, but they disappear quickly with an honest look at the program

Agreed that the primary purpose was to get more people covered by health insurance. A secondary goal, which was taken on in an effort to help finance the first goal was to make health care more efficient. Because there was a huge annual inflation of health care costs prior to Obamacare, you should judge the results by seeing how the annual increases changed under Obamacare. I cannot easily find charts to show this. If you have them, I'd be interested in seeing them.
Republicans primary goal is to lower taxes, particularly on the wealthy. They want to repeal Obamacare as well. This is really a secondary goal, which is there to help finance their primary goal. That doesn't mean that it's not a goal. The only reason that they cannot achieve it is that repealing without a replacement is unpopular, and they cannot agree on a replacement.

35   YesYNot   1084/1085 = 99% civil   Apr 21, 4:24am  ↑ like   ↓ dislike   quote    

curious2 says

Nearly everyone who has looked honestly at the issue finds entrepreneurial over-utilization due to the Medicare fee-for-service payment model, i

I'd agree that fee for service is a major problem, especially when hospitals are run by corporations. People spend hundreds of thousands of dollars on treatments with little hope of any cure in the last 6 months of their lives. IMO, people want every chance that they can get, so they will go for it even when it's not worth it. It's not necessarily good for the patients even if a few people beat the odds.

36   carrieon   15/15 = 100% civil   Apr 21, 5:43am  ↑ like   ↓ dislike   quote    

Federal gov can't run anything right for all? Actually impossible, because too many people. How about Medicaid for all, run independently by each State.

37   TwoScoopsMcGee   1620/1620 = 100% civil   Apr 21, 8:35am  ↑ like (2)   ↓ dislike   quote    

I just visited DailyKos for a few minutes.

All the problems with Obamneycare apparently began late January, 2017. They alternately bash "Trumpcare", while laughing it didn't pass, while blaming the huge premium and deductible increases (yet again, year after year with Obamneycare) on Ryan's plan that didn't pass.

The compounding failures of Obamacare are now laid at Trump's feet.

Alternate Reality.

38   Straw Man   606/610 = 99% civil   Apr 21, 8:39am  ↑ like   ↓ dislike   quote    

jazz music says

Straw Man says

What do you mean "now"?

Now, after the republican failure to repeal or replace, is not the time to gloat but the time to put forward a popular health care improvement.

With what army?

39   curious2   962/962 = 100% civil   Apr 21, 10:04am  ↑ like (3)   ↓ dislike   quote    

YesYNot says

IMO, people want every chance that they can get, so they will go for it even when it's not worth it.

I've seen multiple studies showing people make cheaper decisions when allowed to decide for themselves. It's mainly the hospital executives and other institutional pressures that drive the big ticket over-utilization, while entrepreneurial doctors (including kickbacks from diagnostic labs and other services) drive the routine over-utilization. Religious hospital corporations refuse to follow advance healthcare directives, saying their religion commands them to keep the patient "alive" as long as possible; some hospitals even involve the local police, removing patients involuntarily from their homes and inflicting treatments that the patients had specifically refused. It's a dynamic of cognitive dissonance and conflicts of interest: given a choice among many imperfect options, the natural and institutional tendency is to resolve uncertainty and ambiguity in the direction of self-interest. Institutions that maximize ROI get rewarded, and institutions that fail to maximize ROI get taken over as part of industry consolidation. Reducing hospital infections, for example, can end up costing medical staff their jobs, because the hospital's revenue falls and staff get laid off. Self-interested hospital executives make sure to focus on bringing in the business (I get constant direct mail brochures touting local hospitals), and maximizing the revenue from each sucker that walks in the door.

If you like books, I recommend The Good Nurse. It reports in depth the story of a serial killer who was convicted of murdering dozens of patients. He had probably murdered hundreds, and injured thousands. Hospital executives lied to police in order to cover up his crimes, and enabled him to move on to other hospitals and murder more people. The pattern echoed the Vatican covering up priests who molest children, moving them on to another parish to molest more children. Every single hospital executive who figured out they had a serial killer murdering patients chose to enable him to continue rather than stopping him, and zero hospital executives were ever punished for that. The book notes other, similar stories of serial killers working in hospitals, with murders eventually proved beyond a reasonable doubt. These were not "mercy killings," but actual malicious murders, including patients who had recovered and were about to be discharged to go home to normal lives. I've mentioned this book before, and some defenders of Obamneycare try to fight the example rather than considering the pattern. I don't know what percentage of iatrogenic fatalities result from intentional murder, but the point is the mentality: these instutitions are run by people who would (and did) literally enable a serial killer, even lying to police, for the purpose of protecting and maximizing institutional revenues and thus their own salaries.

40   bob2356   573/577 = 99% civil   Apr 21, 11:36am  ↑ like   ↓ dislike   quote    

curious2 says

From that link: "UPDATE: Chart deemed bogus. See comments. Rest of post altered to reflect that fact, including a big red “X” through the chart." So, commenters on that particular site deemed that chart bogus. It remains at Forbes and elsewhere without retraction.

What facts about the problems of the two studies are wrong? Nice shuffle and jive. What happened to

curious2 says

It says annual per capita costs, not merely one or two federal components of those costs.

It says per capita costs because Fischbeck skipped putting the word government in his study anywhere. And cherry picked his countries. and came up with numbers that aren't even close to what is in the public record. The real question is who paid for Fischbeck 's study and what were the results they wanted to see. This is the part where you say I fucked up. The chart really is only the government costs.

I never saw a retraction for the fake moon landing stories.

41   bob2356   573/577 = 99% civil   Apr 21, 11:50am  ↑ like   ↓ dislike (1)   quote    

curious2 says

You can do the math if you want to challenge the Carnegie-Mellon chart. Medicare spends over $10k/yr per enrollee, and Medicaid spends another $2k/yr per person over 65, so that's $12k/yr just for those two programs. Medi-gap, long term care insurance, and "personal resources" add a lot more.

Meaning you can't begin to come up with anything that supports your claims. You are really saying that the two sources of over 2/3's of the health care spending for over 65's come up to 12k a year and the other third manages to triple that? You really want to try and sell that? Nursing home care last year was 150 billion out of 3.2 trillion. Hell of a big tail wagging that dog. You really do need ironbrain to help you with math.

It's not the Carnegie-Mellon chart. It's a Carnigie-Melllon professor of social sciences chart. He freely admits he did it totally on his own with his own database. It's not like it's some kind of official peer reviewed Carnegie-Mellon research no matter how many times you meaninglessly throw around the school name.

42   bob2356   573/577 = 99% civil   Apr 21, 11:53am  ↑ like   ↓ dislike   quote    

YesYNot says

Agreed that the primary purpose was to get more people covered by health insurance. A secondary goal, which was taken on in an effort to help finance the first goal was to make health care more efficient. Because there was a huge annual inflation of health care costs prior to Obamacare, you should judge the results by seeing how the annual increases changed under Obamacare. I cannot easily find charts to show this. If you have them, I'd be interested in seeing them.

Insurance companies are a big part of the cost of health care. Adding more people to the system doesn't make it cheaper. That's like adding water to drain the swamp.

43   jazz_music   805/806 = 99% civil   Apr 21, 12:11pm  ↑ like   ↓ dislike   quote    

Straw Man says

With what army?

Heheh the army of people that have their eyes opened to looking at no access to health care they can afford because the system is all about maximizing speculator passive gains for doing nothing, ohhh yeaaaaahhhhh.

44   jazz_music   805/806 = 99% civil   Apr 21, 12:13pm  ↑ like   ↓ dislike   quote    

In England's socialized medicine the primary care provider acts as gatekeeper and reasonable balance is achieved between needs and wants and the attendant costs.

45   YesYNot   1084/1085 = 99% civil   Apr 21, 1:00pm  ↑ like (1)   ↓ dislike   quote    

Ironman says

Yes, you normally do... Now how do you explain this chart?

Our system is the most privately run, most non-transparent, and shittiest in the world. It has all of the problems of capitalism and few of the benefits.

46   curious2   962/962 = 100% civil   Apr 21, 1:05pm  ↑ like (1)   ↓ dislike   quote    

bob2356 says

It says per capita costs because Fischbeck skipped putting the word government in his study anywhere.

According to YOUR LINK, he "used total medical expenditures for each country using OECD data."

As for cherry-picking, YOUR LINK says he omitted some of the countries where spending was "in between", meaning they were irrelevant to demonstrating the range of costs. If you can recall math, you might remember that the high and low extremes define the range. Whatever is "in between" does not change the range.

Some of the commenters in YOUR LINK defended the chart, including one who posted anecdotal observation similar to what I've seen among my own neighbors: people becoming eligible for Medicare and then getting surgery that makes them worse off, when their original complaints had been minor. Nobody at your link produced a better chart or better comprehensive data, and meanwhile we see an abundance of reports documenting entrepreneurial over-utilization that makes patients worse off.

Bob, you might feel better simply arguing with yourself. Create a second User account, and switch between accounts each day. You can harangue yourself all day long. At least you would have a better chance of winning. Meanwhile, you're fighting against a chart, without presenting a better one. American per capita spending remains the highest in the world, and at least a third of it (I'd say most) goes to waste, fraud, and abuse, including widely documented entrepreneurial over-utilization to maximize revenue. In California, we see Medicare HMO corporations suing each other like cattle ranchers fighting about poaching cattle, and the battles between them give a glimpse of the enormous revenues at stake. If you don't like the chart that Forbes and others published, then produce a better chart, but remember to use "total medical expenditures for each country" as YOUR LINK says Fischbeck did.

47   YesYNot   1084/1085 = 99% civil   Apr 21, 1:08pm  ↑ like (1)   ↓ dislike   quote    

curious2 says

I don't know what percentage of iatrogenic fatalities result

I read the linked study in full, and can appreciate most of the points. I think that like unwinding Social Security, unwinding Medicare would be very difficult for the same reason. People have paid into the system and are owed huge benefits. To cut off medicare for them would require buying them out in some way, which is essentially paying for the 'unfunded liabilities' today rather than when the bill comes due. I also think that where the rubber meets the road (defining what is catastrophic rather than a predictable expense) is the hard part. Nevertheless, I agree that lack of cost transparency and responsibility takes away any incentive of the customer for reducing costs. This is the major problem with the system. I gave Trump credit for making comments about cost transparency during the election. But, this is an obvious problem without an easy solution. I'll give him or anyone else credit if they can get that implemented.

48   curious2   962/962 = 100% civil   Apr 21, 1:14pm  ↑ like (1)   ↓ dislike   quote    

YesYNot says

People have paid into the system and are owed huge benefits

A big theoretical difference is the actual benefits don't need to cost nearly so much. With already more than a third going to waste, fraud, and abuse (I still say more than 50%), a more efficient system should deliver better results at lower cost.

The problem in the medical sector is not the people who have paid in and are owed benefits. The problem is the pigs at the trough who maximize the cost, including unnecessary and injurious "benefits," and lobby for more of the same. To the extent the two problems are related, it's because patients have become like hostages with Stockholm Syndrome, taking on the perspective of their captors. Patients demand more subsidies rather than lower costs, because that's what their captors/providers tell them is best.

49   Patrick   2082/2082 = 100% civil   Apr 21, 1:20pm  ↑ like (1)   ↓ dislike   quote    

curious2 says

Patients demand more subsidies rather than lower costs, because that's what their captors/providers tell them is best.

This.

50   Straw Man   606/610 = 99% civil   Apr 21, 1:50pm  ↑ like   ↓ dislike   quote    

jazz music says

Straw Man says

With what army?

Heheh the army of people that have their eyes opened to looking at no access to health care they can afford because the system is all about maximizing speculator passive gains for doing nothing, ohhh yeaaaaahhhhh.

You don't have said army at your disposal judging from the results of the last election. So there is nothing to "push" with. Try again after winning. Want me to remind you when the next election is? Hint: it's not "now". Your timing is waaay off.

51   bob2356   573/577 = 99% civil   Apr 21, 1:51pm  ↑ like   ↓ dislike   quote    

curious2 says

According to YOUR LINK, he "used total medical expenditures for each country using OECD data."

Go lower for the comment by the author of the study itself that says it only captures government spending. You are still claiming the study covers all health care spending? How is that? You don't believe the person who wrote the study?

Leaving out private insurance in the US is absurd when comparing to other countries that have only government health care spending. It makes the chart meaningless.

curious2 says

American per capita spending remains the highest in the world,

That's not what the chart is meant to show. It shows American per capiita spending equal to other countries then exploding at 60-65. Put private insurance into the under 65 numbers and pull the bogus numbers out of over 65 it will be a very different chart with very different conclusions.

US health care spending is far higher than other countries at every age. It doesn't just explode at 60 and it doesn't go anywhere near $45,000 a year per capita for 70 year olds. You and Ironbrain screaming the chart shows it's all medicare's fault is absurd. Medicare is a problem but there are plenty of other equally big problems driving up health care spending.

52   bob2356   573/577 = 99% civil   Apr 21, 1:57pm  ↑ like   ↓ dislike   quote    

Ironman says

Yes, you normally do... Now how do you explain this chart??

This is great, this chart actually shows how stupid the other chart is. Thanks for posting it.

53   curious2   962/962 = 100% civil   Apr 21, 4:22pm  ↑ like (2)   ↓ dislike   quote    

bob2356 says

curious2 says

According to YOUR LINK, he "used total medical expenditures for each country using OECD data."

Go lower for the comment by the author of the study itself that says it only captures government spending.

"From a quick perusal of the comments on this and other sites, I find that there is no agreement as to what is wrong with the graph, aside from the comment that it only captures government spending (which implies that it should be a lower bound). I have tracked several of the links that have been proposed to provide results and have found it difficult to extract a single common truth.

The medical expenditure panel survey has 2010 total expenses as being $1.26 trillion."

You seem to have omitted "the comment that", and the conclusion "difficult to extract a single common truth" from your selective quotation. Paul Fischbeck and Dan Munro defended the chart while offering to improve it if others could provide better data. I have likewise invited you to produce a better chart. So far, you presented only partial data, which is what you accuse Fischbeck of doing, and he does not appear to concede that point. Even if, as you contend, his chart shows only government data, then that would not explain the huge disparity between the US and other countries in that age cohort.

This is much ado about very little, as you attack (as usual) without posting a more accurate total. You attack one graph while ignoring the many text links that support the same overall conclusion regarding entrepreneurial over-utilization driving higher costs. The McAllen vs El Paso article reported on a 2:1 disparity attributed to doctors' entrepreneurial over-utilization of Medicare. You seem to react defensively perhaps because your own income depends on your wife's medical practice, and you keep saying the cost problem doesn't result from doctors' salaries. You seem to ignore capital gains from shares in diagnostic lab corporations, in addition to illegal kickbacks from diagnostic labs, for example, in order to say it's all someone else's fault. Maybe you feel guilty because billing is your job and maybe you haven't figured out how to cash in the way many others do. I have tried to be as even-handed as possible, faulting primarily the hospital corporations (the biggest and most lethal revenue recipients, taking 40% of total medical spending for the whole population, and much of that from Medicare), the insurance companies, the drug companies, and doctors. You seem unable to handle the fact that doctors have a role in entrepreneurial over-utilization of Medicare, and so you keep fighting a chart while ignoring the tsunami of information on this point. The bottom line, from your linked source, is that nobody produced a better chart clearly contradicting the first; they debated some few trees, as you do, but not the overall forest.

54   TwoScoopsMcGee   1620/1620 = 100% civil   Apr 21, 6:45pm  ↑ like   ↓ dislike   quote    

curious2 says

It's mainly the hospital executives and other institutional pressures that drive the big ticket over-utilization,

Thanks for your post.

Another one: The revolving door of Nursing Home to C Diff Hospitalization. Contract C Diff, kept in Hospital only a few days, back in Nursing Home. C Diff comes back again, back to Hospital. And then back to the nursing home before the C DIff is wiped out... ready to get it again and spread it to others.

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