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Sorry to hear about him, here's to hoping it's more like a year.

Portland isn't much to write home about. You can catch the tram down from the hill the VA hospital is on. The ride down is free. If it's a clear day you can snag some nice pics of Mt. Hood (it is quite nice at sunrise). At that point you've pretty much hit the highlight of town. There some other things, but nothing to really write home about, and not a whole lot the average tourist would stumble on. Unless you're the left wing fringe hippie type (you are right? ), then it's like one of those revered utopian places or something. Best part is the ease of access to what's in the area. Skiing, hiking, fishing, ocean, gorge, etc. are all a short trip away. Just as a case in point thingy, we have relatives in town this week, and we met them at the Oregon Coast for a couple of days.

Also, the VA here is a pain at paying bills. Took us over a year to get them to cover a simple invoice.

Ok.
Is this end of life care for all Americans, or Just the people who have managed to qualify and hang on to health insurance when they get to the point of being extremely frail? What happens with the extremely frail elderly who turn up at Emergency rooms in hospitals, who have no insurance and no money to pay the bills?

Oh, and commiserations on your father, gbaji. I hope your relationship with him is good, and I hope he dies peacefully and in as little pain as possible.


Edited, Mar 21st 2013 9:04pm by Aripyanfar

Check. (no, don't check your facts, I meant I was ticking off a box.)

I'm not wasting grapefruit when there are perfectly good rocks around.

The only thing that's changed is the getting to a hospital part of the equation. That has nothing to do with less expensive care.



Exactly how it would be? Of course not. But predictions based on fairly well understood economic concepts? Yes, we can.



We're not talking about immediate life-saving decisions though. We're talking about all the stuff included in "comprehensive health coverage" specifically in contrast to "major medical coverage". Major medical includes all the life threatening stuff. The delta between that and comprehensive health coverage is specifically all the stuff that isn't life threatening, isn't necessarily that rare, and ultimately isn't necessarily that expensive.

How much should it cost to get a sprained ankle examined and bandaged? How much to set a broken arm? How much to diagnose an ear infection? How much to administer a flu shot? How much for a checkup? These are things that general practitioners can do easily and cheaply, yet the total cost for doing so has risen to ridiculous levels, such that if you don't have insurance, you're going to get hit with a serious bill. These are also things that doctors used to handle in their own offices and charged very reasonable prices for. I just think that people are so used to the way things are today that they can't fathom how much less expensive things were back then relatively speaking. Most of those services I listed didn't cost much more than the price of a new pair of shoes prior to the rise of the HMO. Today? Hundreds of dollars if paid out of pocket.



Dirtiest thing said on TV back then:

Ward, I think you were a little hard on the beaver last night.

My company gives me the cash back in my paycheck if I don't use their insurance (which I don't; we use Flea's). Sounds like you should go chain yourself to HR's desk until they give you a better deal.

I'm assuming they don't pay you cash back for the employer paid portion though, right? Just the part they take out of your paycheck to pay your portion. The difference is that my health care is 100% employer paid. Which, as I've pointed out, is mere semantics, but it does create the unusual situation you describe. Also, there's no way for me to break the insurance up anyway. I'd like to have insurance that pays out if I contract a major illness, or need a hospital stay for some reason, but I think it's a waste of money to have it pay out for minor ailments and illnesses. Sadly, I'm not able to do that, and under Obamacare it's now illegal for the company to deny me comprehensive coverage anyway.

So negative progress going on here.

No, I get paid extra out of the employer's portion. Above and beyond the amount I'm not paying by just not opting into it. I essentially make money by not entering into my company's insurance.

I'm sorry. I wasn't clear enough. My statement was in reference to your claim that this went against something I'd said previously. I have never said that insurance doesn't benefit those who make the most use of it. Quite the opposite, my argument is that this is one of the problems with insuring things that are not both rare and expensive. Insuring the ordinary is a problem because it becomes the means to do something you do regularly, thus amplifying the increased total cost for insurance itself. It always costs more for the whole group to insure themselves then the insurance will pay, thus always being a losing proposition for the group as a whole. It's only a winning proposition for those within the group who "win" the lottery by having something bad happen to them which is then covered by the insurance. Everyone else loses, and the group overall loses. It's one of those situations where each individual, pursuing their own advantage, hurts the whole, and in the long run, themselves. It just doesn't seem like it at the time.

It's gambling. The house always wins, the gamblers as a group always lose. While individual gamblers can win, it's at the cost of a whole lot of other gamblers losing, with the balance being more loss than gain. Gambling makes sense only if you can win a significant amount of money to make it worth while. So everyone plays the lottery (for example) knowing that their odds are low, but the prize is worth taking a relatively inexpensive shot. Comprehensive health insurance is like telling every single gambler that they'll just take $20 from them every day and pay them $19 in winnings. No more, no less. It's a guaranteed loss for everyone. We're just paying the overhead for the insurance for no real reason at all. It's stupid as hell.




No, it wont. It will become progressively more expensive the more people use it, in exactly the same way you'll lose more money if you "gamble" $20 in the system I mentioned above. Every time you use it, you are paying a percentage of the cost to the insurance company (for profit and overhead). You're paying them to be a middle man. That's it. And the more people who pay this way, the more inelastic the demand becomes and thus the higher prices will become in addition to the cut the insurance company is taking. It's lose/lose. Again, I'm just talking about comprehensive care, not major medical style insurance.



This is a myth though. It doesn't work that way, never has worked that way, but some politicians and pundits will claim it does because it's politically advantageous for them to get you to think this is true. It cannot be less expensive in the long run. I know this flies in the face of what you've been told, but you've been told a lie. Well, not really a lie, they just only tell you half of the true.

It is true that if someone who contracts a major illness had gone to a doctor earlier and the illness had been detected and treated, the total cost would be much lower. But that's for that one person, after the fact. The problem is that since we can't know ahead of time which one person out of 10,000 will be in the early stages of this sort of illness in any given year, we have to test every single person for every single possible illness every single year for this to work. The cost to do that is vastly higher than the cost to treat the one person who will get sick.

Think about what percentage of people each year contract an illness that costs say $100,000 to treat. Now think about how much it would cost to test everyone ahead of time for that illness. If 1% of all the people in the country will get sick with that in a given year, the cost to test for it would need to be $100 to break even on cost. Guess what? The odds are likely lower than that and the costs higher. It's a nice sounding theory, and it does sell well when some charming politician says it from a podium, but in the real world it simply does not work. We really are better off waiting for people to get sick and then treating them, then trying to detect when people will get sick ahead of time.

That may not get cheering crowds to jump to their feet, but it does have the virtue of being true.

Edited, Mar 22nd 2013 7:21pm by gbaji

You got to remember gbaji is just a greedy sob that would rather keep a few dollars in taxes then give a crap about anyone else, like any other rep. What most of these people fail to understand is you are at all times only one bad day away from needing the very programs and government spending they rail against.

The more that you go out of your way to insist something is true, the more I'm inclined to believe that it is indeed false.

Yes. Which is why insuring against the rare and expensive things makes perfect sense. I've never argued against that at all. My issue is with comprehensive health insurance. That specifically adds a whole bunch of things that are not rare and are not particularly expensive (or shouldn't be). I keep telling you that I'm making a distinction between "major medical" which covers the rare/expensive treatments and comprehensive which adds in things like checkups, minor treatments, minor prescriptions, etc, but then when arguing against what I'm saying, you keep bringing up cases where major medical insurance is what's needed.



Absolutely. But that's major medical insurance. The problem is with comprehensive insurance. That's all I'm arguing against. The reason a simple doctor visit for a bad cold, or ear infection, or sprained ankle costs hundreds of dollars instead of tens of dollars is because we pay for it with insurance, and that separates the consumer from the seller, which is always a bad thing to do. When it's cash coming out of your pocket, you'll spend some effort finding the best value for your dollars. When you buy insurance ahead of time, and the co-pay is the same regardless of how much the product actually costs, you don't. Thus, the provider will raise their prices over time. The insurance company will cover it and pass it on to the buyers of their insurance. And 20 years later you'll wonder why no one can afford to buy health insurance.


The wrong answer to that condition is to just mandate that everyone buy it, thinking it'll lower costs. It wont. It will increase costs even more because now the industry has absolutely no reason to keep costs low since every customer is required to buy their product.




So you agree? Great!

Sure, but $5 in the 1950's was worth, like, $165,000 today.