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#202 Mar 20 2013 at 8:00 PM Rating: Excellent
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Smasharoo wrote:
Admittedly, there's a whole bunch of Democratic ideas that people far prefer over the Republican counterparts. Health care was just one of them

I thought it was free stuff for poors? That's Medicaid, right?

Also Obamaphones.
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#203 Mar 20 2013 at 8:04 PM Rating: Excellent
Smasharoo wrote:
Firstly - I just read the original post and WTH? Surely, surely .... the resources and time spent on the looney venture of NY Soda could have been spent on something worthwhile like ... healthcare, help for the homeless, better roads, hospitals, infrastructure.

Olympics...


If you refer to London 2012 - worthwhile, it had a feelgood factor for the country and has given us a little legacy. It also regenerated an entire area of London.

What will be the legacy of NY Soda Prohibition?
#204 Mar 20 2013 at 8:05 PM Rating: Good
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For one it wouldn't have cost anywhere near an Olympics.
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#205 Mar 20 2013 at 8:22 PM Rating: Good


gbaji wrote:
Do you understand that before our government started mandating health coverage levels, and insurance, and medicare requirements into our health care market, everyone but the absolutely destitute could afford health care.
You've said this a million times, and been wrong a million times.

Unless, of course you can prove it.

Which you can't.
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#206 Mar 20 2013 at 8:36 PM Rating: Default
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Belkira wrote:
Insurance companies are there to make money. They are not going to go out of business as long as health care costs are so high.


Huh? Of course they can. The only reason they're not going out of business with health costs this high is because government mandates create guaranteed business for them. Flipped around, the reason health costs have been able to rise this high is because of the government mandates. If people had to pay for their health insurance directly out of their pockets today, health insurance would cost half as much as it does right now. Probably less than that.

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With a single payer system, you don't have that problem.


High prices? Of course you do. You just hide it in a huge government program is all. In the same way that health cost will rise when you hide the cost from consumers by making their employers pay for most or all of it behind the scenes, they will also rise when you further hide that cost from consumers by making it something funded by their tax dollars instead.

What drives prices up is when the consumer is not the one footing the bill out of his own pocket. He has no need to bargain for the best price, and the seller thus has no reason to keep prices low in order to get his business. If I wanted to double the cost of food, I'd institute a mandatory food insurance program in the US. This is not really an arguable aspect of the issue, it's fact that costs are higher because of this. Thus, mandating yet more requirements will not serve to make costs drop, but will increase them even more.

Similarly, single payer will not do so either. There will be even less demand to keep prices low under such a system. Well, until funds are strained that is, but then cost savings will not come in the form of lower prices for care, but less care. There is nothing better at keeping prices low than free market competition. How on earth can someone think that by making the market less free, we can somehow decrease costs?
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#207 Mar 20 2013 at 8:39 PM Rating: Default
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Friar Bijou wrote:


gbaji wrote:
Do you understand that before our government started mandating health coverage levels, and insurance, and medicare requirements into our health care market, everyone but the absolutely destitute could afford health care.
You've said this a million times, and been wrong a million times.

Unless, of course you can prove it.

Which you can't.


Huh? Talk to anyone who was an adult in the 50s and 60s. Ask them about health care costs and about health insurance costs. Basically, everyone could afford basic health care. You paid as you went and it was relatively inexpensive. Insurance covered major medical costs (hospitalizations and operations and whatnot). It was also relatively inexpensive because it only covered rare and expensive things. It's like you're asking me to prove that people managed to live prior to television, when quite obviously they did.
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#208 Mar 20 2013 at 8:48 PM Rating: Excellent
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I didn't mean you wouldn't have high health care prices, I have no idea what sort of prices you would have. I meant you won'5 have for-profit companies denying coverage to people who need it the most.

My post was badly worded again, sorry. I blame the small screen on my phone.

Edited, Mar 20th 2013 9:50pm by Belkira
#209 Mar 20 2013 at 8:52 PM Rating: Default
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someproteinguy wrote:
The biggest problem I see is that Americans are willing to pay obscene amounts of money on end of life care. Extending life by a year or two at a cost that may well exceed what the spend the rest of their life. I fear it's simply an underlying cultural thing, we're not very cost-conscious on medical decisions and we don't do a good job of shopping around or comparing treatment options or costs. We have the ability to treat, why would we turn it down? It's not going to matter what kind of health system we have, as long as we cling to life we're going to be paying for it either way. Just a cultural thing I guess.


Honestly though, that's because of government funded stuff as well (medicare specifically). It's funny, but medicare will continue to pay for a nearly infinite series of life extending treatments. You know what it wont cover (or not sufficiently)? Hospice. Oh. It'll pay for the nurse care and medicines, but not for the room and other related care (which is by far the larger cost). So you are literally better off spending hundreds of thousands of government dollars on procedure after procedure and long expensive hospital stays than saying "F-it" and just taking some pain meds while you wait to die.

If people were limited in terms of total costs rather than type of treatments covered, they'd make very different choices.

Quote:
I don't know if I'll have the guts to just to go before I run up a giant bill, but I hope I do when the time comes.


You likely wont have much choice. Not unless you actually commit suicide or something. Cause you don't get to spend your money the way you want, but the government takes your money and then tells you how it can be spent. So there's your freedom issue right there.
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#210 Mar 20 2013 at 8:54 PM Rating: Excellent
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gbaji wrote:
Honestly though,
Would be a nice change of pace.
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#211 Mar 20 2013 at 9:10 PM Rating: Default
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Belkira wrote:
I didn't mean you wouldn't have high health care prices, I have no idea what sort of prices you would have. I meant you won'5 have for-profit companies denying coverage to people who need it the most.


No. You'll have the government doing it instead. The difference is that the for profit organizations do what they need to do to earn a profit. So if people pay them money for insurance, they kinda have to deliver on what they promised, or they don't make money. Once the government has your money, it can change the terms and conditions of what you get however it wants, and you really don't have much say in it.

The problem with government run health care is the same basic problem of pension type systems. They are not investment driven, but rely utterly on current funding to pay for current costs. So you pay for 50+ years of your working life for those people who were receiving care while you were working. But when you need the care, that's being paid for by the current crop of taxpayers. Taxpayers who may find it in their best interest to cut the care you receive in order to reduce the costs coming out of their pockets. And when you're in that condition, you'll be in the minority and more or less at the whim of the younger majority.

You have zero recourse in that situation. You get whatever care the government says you get. With a privately funded system, you pay into your own health care, either via some kind of account, or insurance (or both). Since you've got a contract with the insurance provider, they're required to provide you the coverage agreed upon in the contract. And if they fail to uphold that contract, you can turn to the government and courts to force them to. Also, you get to decide what care and treatment you want based on what you can afford and what you want to spend money on. If you've invested your own money into your own account, and you choose not to spend it, you can hand it to your children and grandchildren instead. You can't do that with money you paid into medicare, so you have no reason to even think in terms of cost. I'll point out that you do *not* have a contract with the government. It can change the terms anytime it wants to and you're just out all the money you've paid into the system all your life. Also you have no real power to choose what is provided and what isn't, and there's no cost savings to you if you chose a less expensive alternative. And there's nowhere to go if the government makes that decision, cause you know, it's the government. So it's basically worse all the way around.


My issue is that actual health costs *will* rise over time absent competitive forces keeping them low. This is not a guess or speculation, it's a market fact. It can't not increase relatively speaking over time. At some point, those costs will rise to the point of unsustainability. At that point, the cost per "unit" of heath care wont or cant go down, so what must give is the quantity or quality of care. Which means that you wont get what you will feel you've paid for. It's not a matter of "if", but a matter of "when". And I suppose who happens to be in the generation that gets screwed by this.



Edited, Mar 20th 2013 8:14pm by gbaji
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#212 Mar 20 2013 at 9:20 PM Rating: Good
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gbaji wrote:
someproteinguy wrote:
The biggest problem I see is that Americans are willing to pay obscene amounts of money on end of life care. Extending life by a year or two at a cost that may well exceed what the spend the rest of their life. I fear it's simply an underlying cultural thing, we're not very cost-conscious on medical decisions and we don't do a good job of shopping around or comparing treatment options or costs. We have the ability to treat, why would we turn it down? It's not going to matter what kind of health system we have, as long as we cling to life we're going to be paying for it either way. Just a cultural thing I guess.


Honestly though, that's because of government funded stuff as well (medicare specifically). It's funny, but medicare will continue to pay for a nearly infinite series of life extending treatments. You know what it wont cover (or not sufficiently)? Hospice. Oh. It'll pay for the nurse care and medicines, but not for the room and other related care (which is by far the larger cost). So you are literally better off spending hundreds of thousands of government dollars on procedure after procedure and long expensive hospital stays than saying "F-it" and just taking some pain meds while you wait to die.

If people were limited in terms of total costs rather than type of treatments covered, they'd make very different choices.

Quote:
I don't know if I'll have the guts to just to go before I run up a giant bill, but I hope I do when the time comes.


You likely wont have much choice. Not unless you actually commit suicide or something. Cause you don't get to spend your money the way you want, but the government takes your money and then tells you how it can be spent. So there's your freedom issue right there.



The GoP calls those death panels when ever there is talk of limiting treatment after a certain point. Also you can refuse treatment at any time and ask to be made comfortable. Hospice will come to your home or loved ones home.

Edited, Mar 20th 2013 11:21pm by RavennofTitan
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#213 Mar 20 2013 at 9:29 PM Rating: Excellent
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gbaji wrote:
You likely wont have much choice. Not unless you actually commit suicide or something.

Well, at least Oregon gives me the freedom to do that if I so choose. Smiley: lol


Edited, Mar 20th 2013 8:30pm by someproteinguy
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#214 Mar 20 2013 at 10:55 PM Rating: Good
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someproteinguy wrote:
The biggest problem I see is that Americans are willing to pay obscene amounts of money on end of life care. Extending life by a year or two at a cost that may well exceed what the spend the rest of their life. I fear it's simply an underlying cultural thing, we're not very cost-conscious on medical decisions and we don't do a good job of shopping around or comparing treatment options or costs. We have the ability to treat, why would we turn it down? It's not going to matter what kind of health system we have, as long as we cling to life we're going to be paying for it either way. Just a cultural thing I guess.

I don't know if I'll have the guts to just to go before I run up a giant bill, but I hope I do when the time comes.
That's really not the biggest problem I see with your system. Studies show that, specifically when it comes to healthcare, every $1 spent on prevention saves $19 in trying to cure an illness that's gone too far. Your system wildly skews people away from receiving preventative, or early intervention care, except for the tiny minority of wealthy Americans. THAT is probably why your overall healthcare GDP costs twice as much as any other OECD nation, for the same or worse results.
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#215 Mar 21 2013 at 7:53 AM Rating: Good
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Your system wildly skews people away from receiving preventative, or early intervention care, except for the tiny minority of wealthy Americans. THAT is probably why your overall healthcare GDP costs twice as much as any other OECD nation, for the same or worse results.

No, it's mostly end of life care. There have been hundreds of studies, we don't need to guess.
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#216 Mar 21 2013 at 8:03 AM Rating: Excellent
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I heard that when they hit 70, elderly Brits just walk into the North Sea, so as to not be a burden on anyone.
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#217 Mar 21 2013 at 8:10 AM Rating: Excellent
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I heard instead of Taps, they play Yakkity Sax at funerals.
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#218 Mar 21 2013 at 8:13 AM Rating: Good
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I heard that when they hit 70, elderly Brits just walk into the North Sea, so as to not be a burden on anyone.

Nah, that's just what happens to anyone who spends more than a day in Aberdeen.
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#219 Mar 21 2013 at 11:21 AM Rating: Default
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someproteinguy wrote:
gbaji wrote:
You likely wont have much choice. Not unless you actually commit suicide or something.

Well, at least Oregon gives me the freedom to do that if I so choose. Smiley: lol


Ironically, I was in Oregon last weekend, visiting my dad, who's in Hospice. 3 years or so of cancer treatments wasn't a problem financially because that's all nearly 100% paid for. Medicare pays for pain medications and someone to administer them, but not for any of the other costs related to caring for someone who can't get out of bed by himself. Know what else doesn't pay for Hospice care? VA benefits. Well, they do, but the application process is typically longer than the time you've got left, and they don't reimburse.

Course, my dad's an ornery cuss, and 90 days (is that just like a stock estimate?) will probably end out being more like a year. But then the benefits will still only pay about 1/3rd of the cost per month, so that's not necessarily a good thing.


Oh. Just wanted to say: Portland is a dump. Salem is beautiful though.
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#220 Mar 21 2013 at 11:53 AM Rating: Decent
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Ironically, I was in Oregon last weekend, visiting my dad, who's in Hospice. 3 years or so of cancer treatments wasn't a problem financially because that's all nearly 100% paid for. Medicare pays for pain medications and someone to administer them, but not for any of the other costs related to caring for someone who can't get out of bed by himself. Know what else doesn't pay for Hospice care? VA benefits. Well, they do, but the application process is typically longer than the time you've got left, and they don't reimburse.


Sorry about your father (I assume, unless you want him dead).
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#221 Mar 21 2013 at 12:44 PM Rating: Decent
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Smasharoo wrote:
Ironically, I was in Oregon last weekend, visiting my dad, who's in Hospice. 3 years or so of cancer treatments wasn't a problem financially because that's all nearly 100% paid for. Medicare pays for pain medications and someone to administer them, but not for any of the other costs related to caring for someone who can't get out of bed by himself. Know what else doesn't pay for Hospice care? VA benefits. Well, they do, but the application process is typically longer than the time you've got left, and they don't reimburse.


Sorry about your father (I assume, unless you want him dead).


Thanks. No, I reconciled with him years ago. He was always a tough parent, and that's difficult to deal with as a child, but you actually kinda appreciate it as you get older. What responsibility I do possess, and my work ethic, I largely got from him. Poor housekeeping and eternally being 15 minutes late I got from my mom (but I'm working on that. Really!).

It's an interesting experience because he's relating stories about himself and his life that he never told us before. Like the time his ship (LSD Comstock) hit a buoy while he was in the rear steering compartment. The buoy got caught in the propeller and broke some things, causing said compartment to start flooding. The other two guys in there disappeared, but he was told to stay at his post. Which he did until told he could leave, at which point the water was up to his neck. Apparently, the commander and captain were relieved for that incident. He also got to witness the one and only nuclear depth charge test. And I found an old newspaper clipping from his (apparently tiny and news short) hometown about him being on one of the ships involved in some big amphibious landing exercise which would be filmed for footage in the exciting up and coming film "South Pacific".

The only time he got emotional was when talking about a friend of his from the war (not sure how they met, but they were into power boats here in town later on), named Frank something, who'd been at Chosin and later became Sergent Major of the Marine Corps (at least according to him, but he could have gotten that wrong). Lots of information and we're trying to get as much as we can. That side of my family is not as well known as my mom's side, mostly because they all live in Missouri or thereabouts, so any information is good.
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#222 Mar 21 2013 at 1:02 PM Rating: Good
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gbaji wrote:
Huh? Talk to anyone who was an adult in the 50s and 60s. Ask them about health care costs and about health insurance costs. Basically, everyone could afford basic health care. You paid as you went and it was relatively inexpensive. Insurance covered major medical costs (hospitalizations and operations and whatnot). It was also relatively inexpensive because it only covered rare and expensive things. It's like you're asking me to prove that people managed to live prior to television, when quite obviously they did.
Lol, of course crappy insurance that only covers things you probably won't need is cheap. I bet i could get really cheap tornado, or earthquake insurance here in NJ too.
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#223 Mar 21 2013 at 1:21 PM Rating: Excellent
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Rachel9 wrote:
gbaji wrote:
Huh? Talk to anyone who was an adult in the 50s and 60s. Ask them about health care costs and about health insurance costs. Basically, everyone could afford basic health care. You paid as you went and it was relatively inexpensive. Insurance covered major medical costs (hospitalizations and operations and whatnot). It was also relatively inexpensive because it only covered rare and expensive things. It's like you're asking me to prove that people managed to live prior to television, when quite obviously they did.
Lol, of course crappy insurance that only covers things you probably won't need is cheap. I bet i could get really cheap tornado, or earthquake insurance here in NJ too.
gjabi is stuck in a leave it to beaver episode.

Health care in the 50's and 60 and especially back in the day of 'house calls' is irrelevant. This is a different time. Life expectancy had increased since the 40's (it's plateauing now). Diseases and medical technologies have changed considerably. Also, house calls are a very inefficient way to distribute health care. Considering the advances in transportation, they were on the way out - with our without government intervention.

Regardless of all that, health care in the 50's and 60's was nothing to brag about for most.

My dad broke his arm as a boy in the 40's. They were a farm family and couldn't afford much in the way of health care nor even quick transport to a hospital. He eventually got the arm set, but it had already started healing improperly. It's been a bit weird all his life. His little sister died of the flu. Both my parents ended up with false teeth in their twenties because of no access to dental care.

So yeah, you used to be able to trade a goat for a self-taught doc to pull an aching tooth, but this is a very very different time gbaji.


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#224 Mar 21 2013 at 1:43 PM Rating: Default
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Rachel9 wrote:
gbaji wrote:
Huh? Talk to anyone who was an adult in the 50s and 60s. Ask them about health care costs and about health insurance costs. Basically, everyone could afford basic health care. You paid as you went and it was relatively inexpensive. Insurance covered major medical costs (hospitalizations and operations and whatnot). It was also relatively inexpensive because it only covered rare and expensive things. It's like you're asking me to prove that people managed to live prior to television, when quite obviously they did.
Lol, of course crappy insurance that only covers things you probably won't need is cheap. I bet i could get really cheap tornado, or earthquake insurance here in NJ too.


That's what insurance is all about though. Covering things that you will probably not need, but that if you do would be too expensive to deal with out of your own pocket. If you are covering things that happen all the time, you should not be using insurance to pay for it because all you're doing is making it more expensive. If you stop and think about how insurance works, you'll see that I'm right.

Comprehensive health insurance is inherently foolish.
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#225 Mar 21 2013 at 1:48 PM Rating: Default
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Elinda wrote:
Regardless of all that, health care in the 50's and 60's was nothing to brag about for most.


But that's about advancements in medicine, which has very little to do with how we pay for it. We managed to have significant advances in medical treatment over the first half of the 20th century, all prior to the passage of medicare (early 60s), much less the HMO act (mid 70s). There's no reason to assume that the health "care" would suffer if we used a direct pay method (and some argument that it might improve faster). What would change would be how much it would cost.

Quote:
My dad broke his arm as a boy in the 40's. They were a farm family and couldn't afford much in the way of health care nor even quick transport to a hospital. He eventually got the arm set, but it had already started healing improperly. It's been a bit weird all his life. His little sister died of the flu. Both my parents ended up with false teeth in their twenties because of no access to dental care.


Which is exactly what would happen today if you didn't take someone to a doctor to get their arm set. The difference is that the cost to get a broken arm set today is much higher relatively speaking than it was in the 40s. So we're worse off in that regard.
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#226 Mar 21 2013 at 2:03 PM Rating: Decent
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gbaji wrote:
Rachel9 wrote:
gbaji wrote:
Huh? Talk to anyone who was an adult in the 50s and 60s. Ask them about health care costs and about health insurance costs. Basically, everyone could afford basic health care. You paid as you went and it was relatively inexpensive. Insurance covered major medical costs (hospitalizations and operations and whatnot). It was also relatively inexpensive because it only covered rare and expensive things. It's like you're asking me to prove that people managed to live prior to television, when quite obviously they did.
Lol, of course crappy insurance that only covers things you probably won't need is cheap. I bet i could get really cheap tornado, or earthquake insurance here in NJ too.


That's what insurance is all about though. Covering things that you will probably not need, but that if you do would be too expensive to deal with out of your own pocket. If you are covering things that happen all the time, you should not be using insurance to pay for it because all you're doing is making it more expensive. If you stop and think about how insurance works, you'll see that I'm right.

Comprehensive health insurance is inherently foolish.
Okay, well while you're paying $500 for a prescription, i'll pay my $2 copay.

I'm pretty sure my family's total health care costs would be 2x higher than our total income if not for insurance. Instead it's like <1%. That sucks that you don't have good health insurance though. I wish everyone did!
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#227 Mar 21 2013 at 2:53 PM Rating: Excellent
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gbaji wrote:
someproteinguy wrote:
gbaji wrote:
You likely wont have much choice. Not unless you actually commit suicide or something.

Well, at least Oregon gives me the freedom to do that if I so choose. Smiley: lol


Ironically, I was in Oregon last weekend, visiting my dad, who's in Hospice. 3 years or so of cancer treatments wasn't a problem financially because that's all nearly 100% paid for. Medicare pays for pain medications and someone to administer them, but not for any of the other costs related to caring for someone who can't get out of bed by himself. Know what else doesn't pay for Hospice care? VA benefits. Well, they do, but the application process is typically longer than the time you've got left, and they don't reimburse.

Course, my dad's an ornery cuss, and 90 days (is that just like a stock estimate?) will probably end out being more like a year. But then the benefits will still only pay about 1/3rd of the cost per month, so that's not necessarily a good thing.


Oh. Just wanted to say: Portland is a dump. Salem is beautiful though.

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

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? Smiley: wink), 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. Smiley: disappointed
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#228 Mar 21 2013 at 3:00 PM Rating: Good
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gbaji wrote:
Elinda wrote:
Regardless of all that, health care in the 50's and 60's was nothing to brag about for most.


But that's about advancements in medicine, which has very little to do with how we pay for it. We managed to have significant advances in medical treatment over the first half of the 20th century, all prior to the passage of medicare (early 60s), much less the HMO act (mid 70s). There's no reason to assume that the health "care" would suffer if we used a direct pay method (and some argument that it might improve faster). What would change would be how much it would cost.

Quote:
My dad broke his arm as a boy in the 40's. They were a farm family and couldn't afford much in the way of health care nor even quick transport to a hospital. He eventually got the arm set, but it had already started healing improperly. It's been a bit weird all his life. His little sister died of the flu. Both my parents ended up with false teeth in their twenties because of no access to dental care.


Which is exactly what would happen today if you didn't take someone to a doctor to get their arm set. The difference is that the cost to get a broken arm set today is much higher relatively speaking than it was in the 40s. So we're worse off in that regard.
No it wouldn't happen today. A kid can get to a hospital and get an arm set without it being a tremendous burden on the family.

The reality is it's not 1950 - and it never will be again. I don't care how awesome you think you're thinking is, but you can't predict what the healthcare system would be like now if 70 years ago things had been done differently. It's stupid to base any argument on that sort of conjecture.

Economically speaking, healthcare is a highly restricted market. It's specialized. It's technological. It's geographically limited, etc, etc. But mostly it simply doesn't work in your world of perfect supply and demand - it can't. When someone is forced to make an immediate life-saving decision the whole notion of 'value' becomes skewed. The supplier, because of the constraints of maximizing profit, really has no choice but to exploit the individuals desire to stay alive.

Go back to your desk now Beaver.
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#229 Mar 21 2013 at 6:54 PM Rating: Good
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Smasharoo wrote:
Your system wildly skews people away from receiving preventative, or early intervention care, except for the tiny minority of wealthy Americans. THAT is probably why your overall healthcare GDP costs twice as much as any other OECD nation, for the same or worse results.

No, it's mostly end of life care. There have been hundreds of studies, we don't need to guess.

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
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#230 Mar 21 2013 at 8:39 PM Rating: Good
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Once you hit 65 or become disable, you get medicare.
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#231 Mar 21 2013 at 9:14 PM Rating: Good
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#232 Mar 22 2013 at 3:31 AM Rating: Decent
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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?

Well, culturally, we usually throw grapefruit at these people. There is safety net government insurance for the elderly. None of them have no insurance or money to pay the bills per se. Which is part of the problem, in some ways. One of the primary reasons end of life care is so expensive is that it's billed at a rate for services that assumes a default rate of 30%, what other care has. While Medicare is slow to pay claims at times, providers will usually get their money, and the default rate for most end of life care is close to 0%.
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#233 Mar 22 2013 at 7:25 AM Rating: Good
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Smasharoo wrote:
Well, culturally, we usually throw grapefruit at these people.
I'm not wasting grapefruit when there are perfectly good rocks around.
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#234gbaji, Posted: Mar 22 2013 at 3:40 PM, Rating: Sub-Default, (Expand Post) Again, you're confusing what you pay out directly with the actual "cost" of the care. The cost is easily 2-3 times higher than it should be if the providers of the care had to sell the care directly to customers. Surely you understand that it can't be cheaper for everyone? Every dollar of direct cost less than the actual cost paid by you is a dollar more than the actual cost paid by someone else in the system. This dynamic works when there are significant random probabilities involved (how many people out of a thousand will require hospitalization, for example). It does not work when the probabilities are somewhat non-random and set (how many people will get a cold this year, or need a flu shot, or have a check up). In the latter case, you can shift the direct cost burden from healthy people who can afford to pay more for their care than they're getting to sick people who cannot, but the side effect of doing this is that the total costs increase for everyone across the board.
#235 Mar 22 2013 at 3:49 PM Rating: Default
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Elinda wrote:
No it wouldn't happen today. A kid can get to a hospital and get an arm set without it being a tremendous burden on the family.


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.

Quote:
The reality is it's not 1950 - and it never will be again. I don't care how awesome you think you're thinking is, but you can't predict what the healthcare system would be like now if 70 years ago things had been done differently. It's stupid to base any argument on that sort of conjecture.


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

Quote:
Economically speaking, healthcare is a highly restricted market. It's specialized. It's technological. It's geographically limited, etc, etc. But mostly it simply doesn't work in your world of perfect supply and demand - it can't. When someone is forced to make an immediate life-saving decision the whole notion of 'value' becomes skewed. The supplier, because of the constraints of maximizing profit, really has no choice but to exploit the individuals desire to stay alive.


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.

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#236 Mar 22 2013 at 4:07 PM Rating: Good
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And even if you personally are still paying less, collectively we are paying the full price.
Yes, that's true. It's a better deal for those who use it often. Which goes against what you said previously.

Edited, Mar 22nd 2013 6:09pm by Rachel9
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#237 Mar 22 2013 at 4:18 PM Rating: Excellent
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gbaji wrote:
So instead of paying say $6k/year for complete comprehensive coverage, what if they paid $1k/year for just major medical insurance? They could then pay me the $5k/year difference directly, which would more than cover my regular yearly medical costs (even without accounting for the cost difference if everyone paid directly rather than through insurance).

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.
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#238 Mar 22 2013 at 4:59 PM Rating: Default
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Rachel9 wrote:
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And even if you personally are still paying less, collectively we are paying the full price.
Yes, that's true. It's a better deal for those who use it often. Which goes against what you said previously.


I'm not sure how it does, but let me ask you what happens when you get a better deal the more you use something. In a market sense, and when the total cost is shared by the whole group. Let me put it another way with a simple example:

Let's pretend that you and 9 other people realize that some days you forget to bring a lunch, and don't have cash on hand for lunch, so you decide to pool your money for lunch. Everyone pays say $100/month into a lunch fund and everyone is free to use the funds to purchase a lunch for him or her self as needed. It can be as cheap or expensive as they want. Also, if the total cost for all lunches ends out being higher than the total amount paid into the fund, you'll all just pay more equally to make up the difference. Given this system, obviously those who eat out for lunch every day and buy expensive lunches get the better deal than those who only draw on the lunch fund occasionally and are frugal with their choices. But that's the problem. When you were all just buying lunches out of your own pocket, you made frugal choices. But now, each person feels its in their own best interest to get as much lunch value for their lunch fund dollars. It wont be long before everyone will buy lunch every single day, and buy the most expensive lunch possible. End result is that the cost to each person for the fund will increase dramatically over time. And all the while, there will be people insisting that if we all just make smart choices, we can keep the costs of the fund down and make it do what it was supposed to do (just cover the rare case when someone didn't have a lunch to eat).

Obviously, I'm not comparing lunch directly to health care, but the same principle applies. If you are paying $X/month for health insurance, you're going to tend to use it for everything related to health, even if before you might have chosen a less expensive option. So you get sick and have a cough. Before, you'd just buy over the counter medicine and stay home for a few days, but now? Why not go get checked out and get a prescription for stronger medicines? Worse, in the analogy I used, I just mentioned 10 people, but what if everyone working in an area paid into a lunch fund instead of just a small handful? What do you think the vendors selling lunch nearby would do with their prices? They'd increase them, right? Same deal with health care. If I know that most of my customers are going to pay the same co-pay whether I'm charging $50 or $500, I may as well charge $500, right? And the nasty thing about that is since I'm charging $500, the folks without insurance can't afford it, which forces them to go out and get insurance, thus making the whole situation worse.


What I'm trying to get people to understand is that the entire system is more or less designed to cause costs to rise over time. The "best for me" market forces, which usually act to drive prices down cause the reverse in this case because of how we're paying for health care. Because we're putting our money into a fund from which everyone can draw, the pressure is to use it more often to get a better bargain, and for vendors to charge us more for what we're getting. These combined to massively increase total health care costs and make the whole system unwieldy. I don't think you realize just how much of an effect this has. Everything from medical equipment, to medicine, to overhead is jacked up in terms of price, purely because the way we're doing things, those prices can be jacked up without affecting demand. And in any sort of market, if people can raise prices without affecting demand they always will. The correct answer isn't more government mandates on demand (which is what Obamacare essentially does), but the exact opposite. Remove the mandated demand and force the market to sell its product to the consumers directly. Then watch the price for health care drop like a stone.
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#239 Mar 22 2013 at 5:04 PM Rating: Default
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Jophiel wrote:
gbaji wrote:
So instead of paying say $6k/year for complete comprehensive coverage, what if they paid $1k/year for just major medical insurance? They could then pay me the $5k/year difference directly, which would more than cover my regular yearly medical costs (even without accounting for the cost difference if everyone paid directly rather than through insurance).

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.

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#240 Mar 22 2013 at 5:08 PM Rating: Good
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I'm assuming they don't pay you cash back for the employer paid portion though, right?


Of course they do, idiot. There's no cash back of the employee contribution you don't pay.
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gbaji wrote:
I'm assuming they don't pay you cash back for the employer paid portion though, right?

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.
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#242 Mar 22 2013 at 6:42 PM Rating: Good
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Quote:
I'm not sure how it does
because you said this:
Quote:
That's what insurance is all about though. Covering things that you will probably not need, but that if you do would be too expensive to deal with out of your own pocket. If you are covering things that happen all the time, you should not be using insurance to pay for it because all you're doing is making it more expensive.
This isn't really true in this case. The more you use it, the more you benefit. Of course it's also beneficial to those who put in more than they take, for exactly this reason; as a safety net.


Quote:
Obviously, I'm not comparing lunch directly to health care, but the same principle applies.
Not really. Even if it does drive prices up (which seems reasonable enough), it'll still be cheaper if everyone uses it excessively. Why? Because it's cheaper to prevent a problem than to fix it. I'm sure you can find plenty of diseases that can be prevented, or cured early on for a few dollars, but by the time they are a real problem cost tens, or hundreds of thousands of dollars to treat. Even if the price of each individual thing goes up, the overall cost will be lower.
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#243 Mar 22 2013 at 8:19 PM Rating: Default
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Rachel9 wrote:
Quote:
I'm not sure how it does
because you said this:
Quote:
That's what insurance is all about though. Covering things that you will probably not need, but that if you do would be too expensive to deal with out of your own pocket. If you are covering things that happen all the time, you should not be using insurance to pay for it because all you're doing is making it more expensive.
This isn't really true in this case. The more you use it, the more you benefit. Of course it's also beneficial to those who put in more than they take, for exactly this reason; as a safety net.


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.


Quote:
Quote:
Obviously, I'm not comparing lunch directly to health care, but the same principle applies.
Not really. Even if it does drive prices up (which seems reasonable enough), it'll still be cheaper if everyone uses it excessively.


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.

Quote:
Why? Because it's cheaper to prevent a problem than to fix it. I'm sure you can find plenty of diseases that can be prevented, or cured early on for a few dollars, but by the time they are a real problem cost tens, or hundreds of thousands of dollars to treat. Even if the price of each individual thing goes up, the overall cost will be lower.


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
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#244 Mar 22 2013 at 11:14 PM Rating: Good
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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.
Yes, but as you have explained, most people go in expecting (hoping) to lose. They get insurance anyway though, because without it, they risk losing everything. If they get some expensive disease, and have no insurance, they are screwed. They will have no choice but to sit back and die. Obviously most people don't want to take that risk, so they get insurance. This helps pay for the medical care of others, and ensures they do not die to a curable disease, should they get unlucky.
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we have to test every single person for every single possible illness every single year for this to work.
Okay buddy.

Edited, Mar 23rd 2013 1:19am by Rachel9
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#245 Mar 23 2013 at 12:01 AM Rating: Good
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You got to remember gbaji is just a greedy sob that would rather keep a few dollars in taxes then give a **** 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.
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#246 Mar 23 2013 at 2:56 AM Rating: Good
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RavennofTitan wrote:
a greedy sob that would rather keep a few dollars in taxes then give a **** about anyone else, like any other rep.
And you're just a bleeding heart liberal communist who would rather a few do all the work so the rest of society can suckle at the teat of those who produce with the sweat of their brows, just like every other democrat.

See how easy it is to sling mud rather than understand issues? See how easy it is to generalize about others and not be correct? If you want to ad hominem gbaji, well, you go right ahead. But let's not generalize about everyone, k?
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#247 Mar 23 2013 at 6:38 AM Rating: Excellent
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That may not get cheering crowds to jump to their feet, but it does have the virtue of being true.
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.
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#248 Mar 23 2013 at 9:14 PM Rating: Decent
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I understand the issue perfectly. Doesn't change the fact that at any given moment factors out of your control can **** you over and you will be at the mercy of the hand outs people hate so much.
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#249 Mar 25 2013 at 3:35 PM Rating: Default
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Rachel9 wrote:
Quote:
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.
Yes, but as you have explained, most people go in expecting (hoping) to lose. They get insurance anyway though, because without it, they risk losing everything. If they get some expensive disease, and have no insurance, they are screwed.


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.

Quote:
They will have no choice but to sit back and die. Obviously most people don't want to take that risk, so they get insurance. This helps pay for the medical care of others, and ensures they do not die to a curable disease, should they get unlucky.


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.


Quote:
Quote:
we have to test every single person for every single possible illness every single year for this to work.
Okay buddy.


So you agree? Great!
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#250 Mar 25 2013 at 4:11 PM Rating: Excellent
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gbaji wrote:
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.

Because anecdotes are data, a story I've heard many times. My wife's grandfather was a plantation manager way back in the day. In those times the plantation provided health care for all of their employees. Costs were going up, and it was becoming a strain on the budget. His solution was to add a $5 charge for each visit (think 1950's...), prior to this all visits had been free. It apparently saved them a lot of money and helped his career out, if stories are to be believed.

That being said, I don't see how you don't offer some kind of checkup as part of the program, at least for the elderly and the young, immunizations should be covered regardless. One optional free visit a year perhaps? I don't know, maybe we can just skype or e-mail these days for many things. Still there's some stuff that is nice to nip in the bud.

gbaji wrote:

So you agree? Great!

I approve, we could always use more money. Smiley: grin

Edited, Mar 25th 2013 3:12pm by someproteinguy
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#251 Mar 25 2013 at 4:21 PM Rating: Excellent
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someproteinguy wrote:
His solution was to add a $5 charge for each visit (think 1950's...)

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