Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
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01-10-2017, 01:22 AM
RE: Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
(30-09-2017 05:57 PM)Popeyes Pappy Wrote:  
(30-09-2017 02:32 PM)Dom Wrote:  There are no figures available (that I can find) about how much money the tax system loses every year due to unpaid medical bills. I bet it's staggering, but the insurance companies and the congressmen in their pockets don't want you to see that. That money would make a very good start for setting up an efficient system.

I understand that Switzerland has the model system - functioning best. Why re-invent the wheel?

The first hit I got when I Googled it was $41 billion for unpaid and charitable combined in 2013 and increasing by 4-5% a year. Call it $50 billion for 2017 if those numbers are real. That's a little less than 1.5% of total US healthcare expenditures.

There are about 28 million in the US this year without healthcare insurance coverage. That's about 8.6% of the population. Subtract 1.5 from 8.6 and you are looking at a 7.1% increase in healthcare spending by adding all the uninsured to the pool. That's about $242 billion. Nearly 5 times the savings you would realize from zeroing out unpaid bills.

Per capita healthcare spending in Switzerland is about 73% of the US. If we could get to that level of spending we would save about $682 billion in 2017. We could probably afford that, but getting there is hard. Gross revenues for health insurance providers in about $480 billion a year. Even if we zeroed that out we'd be $200 billion short of what we need to reach the savings we would need to reach Swiss per capita levels, and we can't just zero out that expense no matter how much we would like to. For one thing at least some of those people would be needed on the government side to process payments. If we did do any with health insurance completely we would put 2.5 million people out of work overnight. That's a 35% increase in unemployment. That alone would have serious repercussions for the economy in general.

2.5 million people losing they're jobs is better considering the alternative is millions of people without health insurance or unable to afford to preventive care, rationing they're medications because they can't afford to buy enough of it, rising premiums and deductibles under a rapacious profit driven system.

The more one asserts their own unquestioned preconceived beliefs, the more demanding I will be for empirical evidence for I will accept nothing else in place of it
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01-10-2017, 03:24 AM
RE: Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
(30-09-2017 01:28 PM)Popeyes Pappy Wrote:  ...
Our per capita healthcare costs are much higher than most other developed countries
...

It's not the costs that are higher... it's the prices.

(30-09-2017 01:28 PM)Popeyes Pappy Wrote:  ...
A single payer system sounds great, but if we just throw all the people who don't currently have coverage into the pool without reducing costs per capita spending is going to go up not down.
...

That's kinda the whole point of centralised purchasing ... reducing costs.

A general rule of thumb in total cost of service (TCS) models is that preventative costs vs. incident costs (good design + ongoing maintenance vs. detection/diagnosis/repair/recover/restore) is about 1:90.

A system focused on profit will veer towards making money from the latter.

(30-09-2017 01:28 PM)Popeyes Pappy Wrote:  ...
Here is a question for those of you living in countries with single payer healthcare system. How long did it take your country to implement your system? I'm betting it didn't happen overnight. I'm betting it was rolled out over years.

National Health Service Act 1946 - received Royal Assent on 6 November 1946.
Launched - 5 July 1948.

It was a phased rollout (as opposed to a big bang) - Aneurin Bevan launched the NHS at Park Hospital in Manchester (now the Trafford General Hospital).

Yes, there will be a cost in creating it. Here's what needs to happen...

[Image: itil-overview-59-638.jpg?cb=1360416966]

But the good news is that the prototype is already up and running in the form of Medicare.

(30-09-2017 05:57 PM)Popeyes Pappy Wrote:  ...
If we did do any with health insurance completely we would put 2.5 million people out of work overnight. That's a 35% increase in unemployment. That alone would have serious repercussions for the economy in general.

There will still be need for administrators for the new service (some people will transition) and health insurance companies will still need staff for other insurance services they provide (some will re-align) and yes, some will be left out in the cold when the profiteers start cutting costs when they're shareholders start complaining.
And when the CEOs' children complain about not getting a new car every year.

In your calculations, don't forget to include the productivity gains in all sectors derived from a healthier work-force.

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01-10-2017, 10:17 AM
RE: Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
(01-10-2017 03:24 AM)DLJ Wrote:  It's not the costs that are higher... it's the prices.

Unfortunately, that's just not true. The high cost of providing services are a major driving factor in the high prices consumers are charged for healthcare in the US. Let's take a look at what I said in my first post in this thread.

(30-09-2017 08:00 AM)Popeyes Pappy Wrote:  The reasons for the high cost of healthcare here are numerous, but some of the main driving factors are:

High cost of education
Overly complicated administrative requirements
Defensive medical practices which include overuse of expensive diagnostics
Fee for service billing
High cost of medications
High cost of using a middleman (insurance companies) to pay for services

The only one on that list that probably falls into your explanation is the high cost of medication. Even drug prices here aren't driven by profit margins as many believe. According to Stern NYU 2016 gross margins in the pharmaceutical segment were 14.19%. Pharmaceuticals account for about 10% of US healthcare expenditures. If we removed pharmaceutical profits from the equation completely it would only result in a maximum 1.4% reduction in our healthcare cost.

There are other factors that come into play like the insane compensation packages many executives receive, but even those costs have less of an effect on the bottom line than many believe. Most of the value of those compensation packages are in stock, and those stocks cost the companies nothing unless they are buying it back the stock in order to give it to the executives. Stock grants only affect the bottom line of investors and the people receiving them.

Education costs drive up prices. A doctorate at our local university is going to cost about $240,000. A 4 year nursing degree runs $120,000. At a good school you'd be looking at $400,000 for a doctorate and $200,000 for a nursing degree. Many of our medical professionals leave school with tens or even hundreds of thousands of dollars of debt for their education costs. That debt has to be paid back, and the only way to pay it back is charge consumers more for their services. That's a problem these same people in countries with single payer systems don't have. Fixing our education system is a whole separate problem, and it is probably every bit as hard to fix as fixing our healthcare system.

The administrative requirements of the US healthcare system are way more complicated than most other countries. This results in having to use a lot more people to process the paperwork, and that drives up costs. The two main driving factors here are government regulations and fee for service billing practices. HIPAA compliance alone is a nightmare for both healthcare and insurance providers. As far as fee for service goes there were 16 separate line items on my bill from my last annual physical. There could be tens or even hundreds on the bill for something like a bypass surgery. It takes a lot of manpower on both the invoicing and payment sides to process that kind of paperwork.

Defensive medical practices may be the single most expensive part of the US healthcare system. By some estimates, unnecessary diagnostics and procedures account for as much as 30% of US healthcare costs. Part of that is due to the fact that US doctors are generally more specialized than doctors in other countries. We are far more likely to be referred to a specialist for even minor medical problems than you are. When we are we pay for two doctors visits. Other part of this is our doctors are trying to keep from getting sued. Patients in the US are far more likely to receive expensive diagnostics like MRI's than you are. Even when our doctors are pretty sure they know what is wrong they order more tests than you are likely to get just to be sure.

Malpractice insurance is a real expense for US healthcare providers. For a general practitioner those premiums aren't astronomical. Mainly because they are going to send people with serious conditions to a specialist, but anesthesiologists and gynecologists malpractice premiums are high. One figure I saw said the average malpractice insurance premium for a gynecologist in the US is $36,000 a year. That's a lot of vagina probing in a year just to pay your malpractice premium.

Once again I'm all for a single-payer system. I just believe implementing a single payer system in the US is a lot harder than just saying let's do what the Swiss do. There are a lot of moving parts that need to be considered in order to make the transition to a single-payer system successful. Unfortunately, I have very little confidence that our government has either the cajones or the skills to pull it off successfully.

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01-10-2017, 10:18 AM
RE: Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
Double post...

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05-10-2017, 12:05 PM
RE: Lindsey Graham On Repealing ACA: 'I had no Idea what I was doing.'
(30-09-2017 02:32 PM)Dom Wrote:  
(30-09-2017 01:28 PM)Popeyes Pappy Wrote:  I understand all that, Dom. As I said earlier I believe the ACA was a good start. I believe we should go to a single payer system where everyone has access to healthcare. I simply don't believe we can afford that without reducing costs as we go. Our per capita healthcare costs are much higher than most other developed countries, and a lot of people here don't currently have access to decent healthcare because they can't afford it. A single payer system sounds great, but if we just throw all the people who don't currently have coverage into the pool without reducing costs per capita spending is going to go up not down.

It has taken us generations to dig the health care hole we are currently in. It may take us generations to climb back out without risking completely crashing the system or worse the economy as a whole.

Here is a question for those of you living in countries with single payer healthcare system. How long did it take your country to implement your system? I'm betting it didn't happen overnight. I'm betting it was rolled out over years.


There are no figures available (that I can find) about how much money the tax system loses every year due to unpaid medical bills. I bet it's staggering, but the insurance companies and the congressmen in their pockets don't want you to see that. That money would make a very good start for setting up an efficient system.

I understand that Switzerland has the model system - functioning best. Why re-invent the wheel?

Having been in and out of hospitals over the last few years thanks to complications of diabetes, I have watched all of this from the inside. I am on Medicare. Houston is in Harris County, whose Harris County Hospital District is a close as a model health care system as you can get . Houston has one of the most amazing collection of hospitals in the world, and trains thousands of doctors and nurses. For many years it ran pretty well. But thanks to efforts from the US Congress to undermine ACA, and the Texas legislature HCHD is now running $85 million a year deficits. The GOP sabotage of the medical systems is causing insurance prices to rise rapidly as the Insurance companies do not want to be left holding the bag when government assurances they will not be stuck with massive bills due to undermining or repeal of ACA. The state legislature is hostile to ACA because taxes! Taxes! Taxes! Since nobody can say if or when the GOP manages to engineer ACA's demise or not, it can be stated that the problems with ACA will not be fixed by an obdurant and ignorant GOP congress.

There are a lot of good people in the HCHD and poor citizens of Harris County get good health care out of this system. But it's slowly coming apart at the seams due to the war on Obamacare by the GOP.

The problem now is, nobody has an inkling what the future holds. The GOP has a stranglehold on politics in Texas, and they have no sympathy or competence in this arena. We will see massive hikes in insurance costs, which the insurance industry tells us is due totally to the unsureness of how this will all play out in the future. Which of course the GOP will blame on ACA.

Kakitocracy in action. The wrong people in the wrong place, doing the wrong things, for the wrong reasons.

And the day will come when the mystical generation of Jesus, by the supreme being as his father in the womb of a virgin will be classed with the fable of the generation of Minerva in the brain of Jupiter
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