Trump as tragicomedy

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Xan
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Re: Trump as tragicomedy

Post by Xan » Tue Jul 31, 2018 10:09 am

MangoMan wrote:
Tue Jul 31, 2018 9:50 am
There is currently a lawsuit by the Attorneys General of 12(?) states to eliminate the pre-existing conditions clause of the ACA. Personally, while I think the ACA was a big, expensive lie and added thousands of needless regulations to healthcare, the elimination of pre-existing conditions was the one good thing to come out of it. But there is no doubt that this drives up the cost for everyone else. Socialism at its finest, and I hate Socialism, but it was a necessary evil.
If your insurance covers pre-existing conditions, then it isn't insurance. Maybe it's some kind of cost-sharing scheme, or maybe it's welfare, but we should be honest about it.
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Re: Trump as tragicomedy

Post by ochotona » Tue Jul 31, 2018 10:14 am

Xan wrote:
Tue Jul 31, 2018 10:09 am
If your insurance covers pre-existing conditions, then it isn't insurance. Maybe it's some kind of cost-sharing scheme, or maybe it's welfare, but we should be honest about it.
This is not a political question... if health insurance doesn't cover people with pre-existing conditions, what good is it? Everyone gets a pre-existing condition eventually. If you're only covered for things not likely to cause you expense, why insure those risks?
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Re: Trump as tragicomedy

Post by Xan » Tue Jul 31, 2018 10:18 am

ochotona wrote:
Tue Jul 31, 2018 10:14 am
Xan wrote:
Tue Jul 31, 2018 10:09 am
If your insurance covers pre-existing conditions, then it isn't insurance. Maybe it's some kind of cost-sharing scheme, or maybe it's welfare, but we should be honest about it.
This is not a political question... if health insurance doesn't cover people with pre-existing conditions, what good is it? Everyone gets a pre-existing condition eventually. If you're only covered for things not likely to cause you expense, why insure those risks?
You insure against the risk of developing a condition.
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Re: Trump as tragicomedy

Post by ochotona » Tue Jul 31, 2018 10:32 am

Desert wrote:
Tue Jul 31, 2018 10:22 am
I'm not crazy about the ACA either, but it's irresponsible to simply kill it without any substitute in mind. I think it's time to end the private health insurance system in our country and go to single payer. The present system with insurance companies and government both involved brings the worst of both worlds, unfortunately. But as long as insurance companies are raking in the profits, it will be politically difficult to change the system.
It's not about politics. It's about the wrong system in place to serve patients.

There is much less cooperation among the disparate private rent-seeking providers than there is among the disparate private rent-seeking providers in electrical power generation, transmission, and retail for example. And the outcomes for people's health are much worse. And electrical outcomes are pretty spectacular. The lights pretty much stay on.

So why is that?
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Re: Trump as tragicomedy

Post by Xan » Tue Jul 31, 2018 10:43 am

I've found that insurance other than catastrophic is largely a joke. They claim to save you a lot of money, but when you go self-pay, you save that money anyway, often more.

A family member told me recently that his son needed an elbow popped back in. He paid the hospital some $350 at the time of service while they figured out what the bill would be. The bill was $3200 or so (highway robbery), but their policy is that self-pay patients get 90% off. NINETY PERCENT. So the hospital now owes him $30.

Insurance is useful in case we get cancer or something and rack up millions of dollars in bills. Other than that, self-pay is much better all the way around. I really don't know why they killed catastrophic insurance: it's the only useful kind.
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Re: Trump as tragicomedy

Post by ochotona » Tue Jul 31, 2018 10:45 am

MangoMan wrote:
Tue Jul 31, 2018 10:36 am
Desert wrote:
Tue Jul 31, 2018 10:22 am
I'm not crazy about the ACA either, but it's irresponsible to simply kill it without any substitute in mind. I think it's time to end the private health insurance system in our country and go to single payer. The present system with insurance companies and government both involved brings the worst of both worlds, unfortunately. But as long as insurance companies are raking in the profits, it will be politically difficult to change the system.
You want to give the government more control over health care?! Because they've proven in the past how everything they do becomes less expensive and more efficient? There has to be a better way than the current, but I'm pretty sure making the govt the CEO is not the answer. If you don't believe me, ask one of our Canadian members.
I agree, we don't want to give the government more control. But we need a profit-based system with groundrules crafted to narrow the vast existing territories for rip-off, abuse, and non-transparency.
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Re: Trump as tragicomedy

Post by Xan » Tue Jul 31, 2018 11:51 am

MangoMan wrote:
Tue Jul 31, 2018 10:49 am
Xan wrote:
Tue Jul 31, 2018 10:43 am


Insurance is useful in case we get cancer or something and rack up millions of dollars in bills. Other than that, self-pay is much better all the way around. I really don't know why they killed catastrophic insurance: it's the only useful kind.
Probably because most people aren't members of this forum or MMM or whatever. You and I could self-insure a minor hospital surgical procedure or colonoscopy, but none of my employees, their friends, or family members could.
Even if their insurance premiums were greatly reduced?

Maybe that's the part I'm missing: these people all have insurance provided by their employer, and I never have. Having employers provide insurance is one of the worst all-round parts of this whole mess.
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Re: Trump as tragicomedy

Post by ochotona » Tue Jul 31, 2018 12:04 pm

Xan wrote:
Tue Jul 31, 2018 11:51 am
Maybe that's the part I'm missing: these people all have insurance provided by their employer, and I never have. Having employers provide insurance is one of the worst all-round parts of this whole mess.
Agreed. It was a WW-2 era kluge that turned into a system, and you can tell it's screwed-up by looking at the outputs. More spend per capita by a factor of two over other developed nations, and worse outcomes. But the entrenched rent-seeking participants don't want change.
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Re: Trump as tragicomedy

Post by Kriegsspiel » Tue Jul 31, 2018 1:07 pm

MangoMan wrote:
Tue Jul 31, 2018 10:49 am
Xan wrote:
Tue Jul 31, 2018 10:43 am


Insurance is useful in case we get cancer or something and rack up millions of dollars in bills. Other than that, self-pay is much better all the way around. I really don't know why they killed catastrophic insurance: it's the only useful kind.
Probably because most people aren't members of this forum or MMM or whatever. You and I could self-insure a minor hospital surgical procedure or colonoscopy, but none of my employees, their friends, or family members could.
I feel like the surgical procedures are the things you SHOULD want to insure, and insurance companies would be equipped to handle. It's the things that you know you're gonna need/need RIGHT NOW (colonoscopies, birth control, diabetes medicine) that don't really need to be bought through insurance.

I mean, if we applied some actuarial science to health insurance, I'm guessing they'll find out that there's pretty much a 100% chance that a diabetic needs insulin, and that a 50 year old is going to get a colonoscopy. And if an insurance company wouldn't give you fire insurance if there was a 100% chance they'd have to pay out for it, why would a health insurance company? If someone came to an insurance company with a pre-existing condition like diabetes, why shouldn't either a) they pay for their own insulin, or b) they pay a higher premium to cover it, amounting to the same thing?
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Re: Trump as tragicomedy

Post by ochotona » Tue Jul 31, 2018 5:50 pm

Not insurance... but we need human life cycle health care financing for women and men coupled with highly competitive reverse auction features! Call it what you want, that is what we need
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Re: Trump as tragicomedy

Post by Kriegsspiel » Tue Jul 31, 2018 9:19 pm

ochotona wrote:
Tue Jul 31, 2018 5:50 pm
Not insurance... but we need human life cycle health care financing for women and men coupled with highly competitive reverse auction features! Call it what you want, that is what we need
Like, unlimited financing? Do we keep throwing money at people until the end of their life cycle, or do we need death panels to let us know when to stop throwing good money after bad. How much is a human life worth, anyway, and are they all worth the same?
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Re: Trump as tragicomedy

Post by Xan » Tue Jul 31, 2018 9:35 pm

Kriegsspiel wrote:
Tue Jul 31, 2018 9:19 pm
ochotona wrote:
Tue Jul 31, 2018 5:50 pm
Not insurance... but we need human life cycle health care financing for women and men coupled with highly competitive reverse auction features! Call it what you want, that is what we need
Like, unlimited financing? Do we keep throwing money at people until the end of their life cycle, or do we need death panels to let us know when to stop throwing good money after bad. How much is a human life worth, anyway, and are they all worth the same?
Also, why do we not have this financing for, say, food? Housing? Why not everything!
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Re: Trump as tragicomedy

Post by moda0306 » Tue Jul 31, 2018 10:35 pm

Xan wrote:
Tue Jul 31, 2018 9:35 pm
Kriegsspiel wrote:
Tue Jul 31, 2018 9:19 pm
ochotona wrote:
Tue Jul 31, 2018 5:50 pm
Not insurance... but we need human life cycle health care financing for women and men coupled with highly competitive reverse auction features! Call it what you want, that is what we need
Like, unlimited financing? Do we keep throwing money at people until the end of their life cycle, or do we need death panels to let us know when to stop throwing good money after bad. How much is a human life worth, anyway, and are they all worth the same?
Also, why do we not have this financing for, say, food? Housing? Why not everything!
Why not food, basic housing & healthcare?

Like really why not?

Maybe they should be subsidized or guaranteed? Our government facilitated the genocidal capture of 2.3 billion acres of land and resources to basically be given to a relative few for them to market to others. It's not outside the realm of reason to suggest a basic floor on human dignity and survival as a sort of "citizen's dividend."

Although I agree with you that liberals should get more comfortable asking the questions about where the limits stop on government healthcare. Seems to me many other countries have found a decent balance.

I'd prefer similar benefit levels but perhaps less of a patchwork system. A 65+ senior has a lot of healthcare protection compared to a pre-Obamacare 60-year-old. I think there are ways we could level out benefits a bit.
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Re: Trump as tragicomedy

Post by boglerdude » Wed Aug 01, 2018 1:52 am

I hear a lot of trash talked about the NHS, but they seem to take very good care of alcoholics. As in the documentary, Louis Theroux: Drinking To Oblivion
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Re: Trump as tragicomedy

Post by Kriegsspiel » Wed Aug 01, 2018 10:14 am

moda0306 wrote:
Tue Jul 31, 2018 10:35 pm
Xan wrote:
Tue Jul 31, 2018 9:35 pm
Kriegsspiel wrote:
Tue Jul 31, 2018 9:19 pm


Like, unlimited financing? Do we keep throwing money at people until the end of their life cycle, or do we need death panels to let us know when to stop throwing good money after bad. How much is a human life worth, anyway, and are they all worth the same?
Also, why do we not have this financing for, say, food? Housing? Why not everything!
Why not food, basic housing & healthcare?

Like really why not?

Maybe they should be subsidized or guaranteed?
We can't even pay for the stuff government does now.

Although, I could probably agree we could do something like that, if Americans were willing to accept a standard of living much lower than the current one.
Our government facilitated the genocidal capture of 2.3 billion acres of land and resources to basically be given to a relative few for them to market to others. It's not outside the realm of reason to suggest a basic floor on human dignity and survival as a sort of "citizen's dividend."
What is your point?
Although I agree with you that liberals should get more comfortable asking the questions about where the limits stop on government healthcare. Seems to me many other countries have found a decent balance.
I think Megan McArdle has done a good job showing that other countries with socialized medicine aren't doing that great and are running into problems, or will shortly. Government-run healthcare is such a recent phenomenon that skepticism is prudent.
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Re: Trump as tragicomedy

Post by Kriegsspiel » Wed Aug 01, 2018 10:19 am

Desert wrote:
Wed Aug 01, 2018 7:57 am
Regarding Canada, I think their system is far superior to ours, just looking at outcomes and spending per person.
Didn't Canada's Supreme Court rule that it was a human rights violation to force their citizens to rely solely on their nationalized healthcare?
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Re: Trump as tragicomedy

Post by flyingpylon » Wed Aug 01, 2018 11:19 am

Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.

Besides, I thought this thread was about Trump?
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Re: Trump as tragicomedy

Post by Maddy » Wed Aug 01, 2018 11:53 am

flyingpylon wrote:
Wed Aug 01, 2018 11:19 am
Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.
Ding! Ding! Ding!
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Re: Trump as tragicomedy

Post by moda0306 » Wed Aug 01, 2018 12:26 pm

flyingpylon wrote:
Wed Aug 01, 2018 11:19 am
Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.

Besides, I thought this thread was about Trump?
Isn't one of the main ideas behind single-payer to actually engage a negotiation framework that allows for universal coverage AND lower prices, rather than one or the other?

And yes it was about Trump... we meander around here.
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Re: Trump as tragicomedy

Post by Xan » Wed Aug 01, 2018 1:00 pm

flyingpylon wrote:
Wed Aug 01, 2018 11:19 am
Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.

Besides, I thought this thread was about Trump?
As my earlier anecdote noted, by opting out of the insurance system, you can save 90% off the sticker price, no questions asked. That sounds like a way to get around the exorbitant prices.
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Re: Trump as tragicomedy

Post by moda0306 » Wed Aug 01, 2018 5:57 pm

Xan wrote:
Wed Aug 01, 2018 1:00 pm
flyingpylon wrote:
Wed Aug 01, 2018 11:19 am
Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.

Besides, I thought this thread was about Trump?
As my earlier anecdote noted, by opting out of the insurance system, you can save 90% off the sticker price, no questions asked. That sounds like a way to get around the exorbitant prices.
I grazed back... where is this anecdote? Are you really saying that you think folks can regularly offer care providers 10% of their insurance-reimbursed rates with cash and they'll accept your offer?

I think I must be misinterpreting.
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Re: Trump as tragicomedy

Post by D1984 » Wed Aug 01, 2018 6:16 pm

moda0306 wrote:
Wed Aug 01, 2018 5:57 pm
Xan wrote:
Wed Aug 01, 2018 1:00 pm
flyingpylon wrote:
Wed Aug 01, 2018 11:19 am
Perhaps we should be asking why we allow the health care industry to operate like a giant cartel instead of debating the best way to pay their exorbitant prices.

Besides, I thought this thread was about Trump?
As my earlier anecdote noted, by opting out of the insurance system, you can save 90% off the sticker price, no questions asked. That sounds like a way to get around the exorbitant prices.
I grazed back... where is this anecdote? Are you really saying that you think folks can regularly offer care providers 10% of their insurance-reimbursed rates with cash and they'll accept your offer?

I think I must be misinterpreting.
I think it was back when he talked about having an elbow re-set for around $300 instead of circa $3000.

I would like to add a couple of points, though:

One, you will basically never get 90% off the price an insurer (BCBS, Medicare, etc) would pay...the 90% he got off was likely off the ridiculous "chargemaster" price which is a pie in the sky price that only the uninsured get soaked with.

Two, the plural of anecdote is not data; just because Xan got a good price as a cash-paying patient does not mean most people will; in fact, as per the chargemaster example noted above, the uninsured usually get hit with the WORST prices. The local hospital system in my city has essentially a monopoly and their charges to uninsured patients are as follows: If you make the poverty level or less, free or nominal; if you make from 100% of the FPl to 200% of FPL, prices are based on a sliding scale from almost nothing to roughly what BCBS of Georgia would pay; if you make one cent above that you pay the FULL chargemaster rate, no ifs, ands, or buts (with the singular exception that certain imaging services get 10% or 15% off the chargemaster price). oh, and even if the hospital does discount its prices due to your being poor enough, the doctors who work on you can (and generally do) still charge the full amount.

Three, every other country that has health care prices lower than ours (which is pretty much....all of them) has the government directly or indirectly negotiate prices; this is true whether the system in single provider (UK, Spain, New Zealand, plus Hong Kong as far as hospital care is concerned); single-payer (Canada, Taiwan, South Korea), or some form of private or nonprofit universal coverage (Germany, Netherlands, Japan, Israel, Switzerland, etc) or a hybrid of single-payer and private non-profit (France). Strangely enough, none of them rely on patients acting as cost-control kamikazes and trying to negotiate rates with providers themselves. They all have lower prices (see the IFHP reports if you don't believe me) as a result. Funny how that works.
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Re: Trump as tragicomedy

Post by Maddy » Wed Aug 01, 2018 6:22 pm

moda0306 wrote:
Wed Aug 01, 2018 5:57 pm
I grazed back... where is this anecdote? Are you really saying that you think folks can regularly offer care providers 10% of their insurance-reimbursed rates with cash and they'll accept your offer?
I regularly get 40 percent off the sticker price from an orthopedist for paying cash on the barrelhead. He says that's about the same discount the insurance companies are getting. My one other experience with discounts comes from my participation in a health care sharing ministry. They are associated with a company (the Karis Group) that negotiates bills on behalf of member-patients--mostly major stuff. From what I've heard, they routinely get much larger discounts than that.
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Re: Trump as tragicomedy

Post by ochotona » Wed Aug 01, 2018 9:30 pm

What D1984 said. Basically, we're suckers but we think we live in this great utopia. Sorry about the thread drift.
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Re: Trump as tragicomedy

Post by Xan » Wed Aug 01, 2018 9:45 pm

D1984 wrote:
Wed Aug 01, 2018 6:16 pm
One, you will basically never get 90% off the price an insurer (BCBS, Medicare, etc) would pay...the 90% he got off was likely off the ridiculous "chargemaster" price which is a pie in the sky price that only the uninsured get soaked with.
This was the ridiculous "chargemaster" price that NOBODY pays. If you don't have insurance, you get 90% off. If you do have insurance, you'll get 90% off. Insurance is just there for... Well I don't know what!
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