Trumpcare

[dust]

Ummm...

 

The debate over American healthcare isn't about life expectancy.

 

The debate is over the funding model, and more fundamentally over the question of who decides which people get what care -- in essence, who controls the healthcare delivery system and, by extension, who controls the people.

 

No, it's not, but maybe it should be.

 

If you lot focused more on what's best for the health/wellbeing of the population rather than some conspiratorial ideas about "who controls the people", things likely wouldn't be so shit. (Yes, comparatively, your healthcare system is "so shit".)

 

The model is different among European nations, but in no instance that I'm aware of are citizens complaining about being controlled by their government through manipulation of healthcare. Don't get me wrong, there are major problems in any and every nation, but the UK NHS for example is living proof that a socialist health system can be effective and mostly free from corruption.

Edited April 12, 2017 by dust

[Brian]

No, it's not, but maybe it should be.

 

If you lot focused more on what's best for the health/wellbeing of the population rather than some conspiratorial ideas about "who controls the people", things likely wouldn't be so shit. (Yes, comparatively, your healthcare system is "so shit".)

 

The model is different among European nations, but in no instance that I'm aware of are citizens complaining about being controlled by their government through manipulation of healthcare. Don't get me wrong, there are major problems in any and every nation, but the UK NHS for example is living proof that a socialist health system can be effective and mostly free from corruption.

NHS problems 'at their worst since 1990s' - BBC News

NHS problems 'completely unacceptable', admits Jeremy Hunt

Financial problems 'now endemic' in NHS England, says King's Fund

Today's NHS - our current challenges | myhealthlondon

[Three challenges and a big uncertainty for the NHS in 2015

The real problem destroying the NHS? Jobsworths who want to please politicians more than patients

My personal favorite...

Nearly 1,200 people have starved to death in NHS hospitals because 'nurses are too busy to feed patients'

 

Yep, just magnificent!

 

Remove the log from your own eye before worrying about the mote in mine, OK?

Edited April 12, 2017 by Brian

[Gerry]

Who thinks the British NHS is the model to be emulated?

Edited April 12, 2017 by Gerry

[Gerry]

Ah, yes. Efficiency.

 

Washington is famous for its efficiency.

 

EDIT​: The debate isn't about efficiency, either. It is about wielding control. The "efficiency" issue will arise later, without debate, when the central government starts deciding who gets which treatment.

Can you look at the German and French system which is managed by private insurance companies in accordance with State laws?  The "central government starts deciding who gets which treatment" is a straw dog.  I am more fearful of insurance companies making HC choice for me as a means to the end, their profit margin.

[dust]

NHS problems 'at their worst since 1990s' - BBC News

NHS problems 'completely unacceptable', admits Jeremy Hunt

Financial problems 'now endemic' in NHS England, says King's Fund

Today's NHS - our current challenges | myhealthlondon

[Three challenges and a big uncertainty for the NHS in 2015

The real problem destroying the NHS? Jobsworths who want to please politicians more than patients

My personal favorite...

Nearly 1,200 people have starved to death in NHS hospitals because 'nurses are too busy to feed patients'

 

Yep, just magnificent!

 

Remove the log from your own eye before worrying about the mote in mine, OK?

 

Oho. I never used a word like "magnificent". I said that there are major problems here.

 

But you see, even with all of the problems, the NHS is STILL superior to the American alternative. According to this, and this or this, over 0.1% of the US population die yearly from preventable errors, compared to 0.01% of the UK population. And I'm thinking that this is even worse for the US considering that the UK has universal care, while there are millions of Americans who never even see a hospital.

[dust]

Who thinks the British NHS is the model to be emulated?

 

The only other system I have direct of experience is the Chinese... so my opinion is only based on studies/figures. And these change year by year. Each system has its pros and cons, each year studies find different things to praise and to criticise.

But I think the NHS is in the running for one of the best.

[MooNiNite]

  I am more fearful of insurance companies making HC choice for me as a means to the end, their profit margin.

 

Then you have no economic sense. In a free market efficiency and the most helpful product is what generates the most income. It's called competition.

 

If there was a product that was more helpful than what the existing health insurance companies are offering, then that is called opportunity. 

 

Who is going to monitor the market if a government controls it? The government themselves? How do you not understand the problem......

[Brian]

Oho. I never used a word like "magnificent". I said that there are major problems here.

 

But you see, even with all of the problems, the NHS is STILL superior to the American alternative. According to this, and this or this, over 0.1% of the US population die yearly from preventable errors, compared to 0.01% of the UK population. And I'm thinking that this is even worse for the US considering that the UK has universal care, while there are millions of Americans who never even see a hospital.

Here's the thing...

 

When you hear people -- news commentators or politicians or "Progressives" on Internet forums, for instance -- talk about wanting "universal healthcare in the US," most people think that were is a huge portion of the population who is being denied necessary medical treatment because they can't afford to pay for it. We do have problems here, and people do sometimes fall through the cracks, but what these people are really advocating for is a complete takeover of the healthcare delivery system by the Federal government.

 

We currently have Federal programs which cover the elderly (Medicare), the indigent (Medicaid), the military veteran (Veteran Affairs) & the disabled (a combination of Medicaid, SSI, VA, et al). In addition to that, every State in the Union has a department of public health which provides medical services on a sliding scale (meaning the cost is adjusted according to one's ability to pay -- including all the way down to zero) to residents of their respective States. In addition to that, every emergency department in every hospital in the country provides emergency services to anyone who shows up regardless of their ability to pay. In addition to that, every pharmaceutical company has a program to provide medications at reduced or no cost to those who need the assistance. In addition to that, there are lots and lots of private charities which provide or fund medical services.

 

Right now, more than 2/3rds of all US medical expenditures come from "taxpayer money" in one form or another. This is up from nearly none of it sixty years ago. The problems in the US which have emerged over the last half-century or so are not because government is not sufficiently involved in healthcare...

 

OK, now imagine this -- imagine that Brussels announced that the EU was going to fix the European healthcare crisis by taking over the entire European healthcare system -- no more UK system, German system, French system, Turkish system or Danish system, just one big centralized "one size fits all" system which would be entirely managed by the Ministers in Brussels. Think the citizens of those countries would be cheering in the streets? Or do you think the French and the Germans would say, "Thanks but we think we would rather run our own healthcare systems"?

[Gerry]

 

We do have problems here, and people do sometimes fall through the cracks, but what these people are really advocating for is a complete takeover of the healthcare delivery system by the Federal government.

No that is not true, well I guess mostly not true.  I'm sure about Germany and France, their system is as properly called private as it is governmental.  The payments flow through government.  I am certain if I would call that the management of the care services are implemented via private non-profit insurance companies.  Medicare is more of a "run by the federal government" establishment than the UHC in those countries.

 

There are however vast differences in many aspects of their HC implementations that would not work in America without a complete overhaul.  They incomes of doctors is a whole different thing "over there"

 

What I believe is wrong in what you said is how they implement their HC delivery system.

[Gerry]

 

OK, now imagine this -- imagine that Brussels announced that the EU was going to fix the European healthcare crisis by taking over the entire European healthcare system -- no more UK system, German system, French system, Turkish system or Danish system, just one big centralized "one size fits all" system which would be entirely managed by the Ministers in Brussels. Think the citizens of those countries would be cheering in the streets? Or do you think the French and the Germans would say, "Thanks but we think we would rather run our own healthcare systems"?

Of course that is not going to work for them because the EU is not the strong central force DC is in America.  It is the damnable Constitution we have.   We need to be rid of it Brian and form an EU style of localized governance is regional authorities.

 

Are you with me brother?

[Gerry]

Oho. I never used a word like "magnificent". I said that there are major problems here.

 

But you see, even with all of the problems, the NHS is STILL superior to the American alternative. According to this, and this or this, over 0.1% of the US population die yearly from preventable errors, compared to 0.01% of the UK population. And I'm thinking that this is even worse for the US considering that the UK has universal care, while there are millions of Americans who never even see a hospital.

Well, maybe.  I think if you talk to Brits they love their HC system until they talk about it a bit.  When they dig down into the weeds, I think they are not as happy.

 

Ten years ago we sailed from England to Boston and made the acquaintance of a british couple who were in their late 60's.  [That is my age now.]  I heard "we love it but..." in different ways, but the big thing even then was how "the new comers", the immigrants were getting the same perks as true Brits.

[Gerry]

 

which provides medical services on a sliding scale (meaning the cost is adjusted according to one's ability to pay -- including all the way down to zero)

Actually tht is not how this works. 

 

"A man without insurance walked into an ER.....  Or was in a car crash  ...  or had a heart attack .... or had stage 4 cancer that had not been diagnosed....."

 

Such people get, and got, billed in full  What did they do?  They defaulted on their obligations, and most likely ended up in bankruptcy. Their economic status is irrevocably destroyed.  How did/do the hospitals deal with this?  They pass the cost onto the insured patients by increasing the cost of services.  It is the insured having to pay for the uninsured.  You know, $5.000 asprins....

 

I would like to see any program where the "cost is adjusted according to one's ability to pay".  That this was not true before the ACA, with insurance companies driving up the total costs of HC to both the society and the individual, is why the ACA made some sense.  Under Bush 2 those increase were reaching into the 80% per year category.

[Brian]

Of course that is not going to work for them because the EU is not the strong central force DC is in America.  It is the damnable Constitution we have.   We need to be rid of it Brian and form an EU style of localized governance is regional authorities.

 

Are you with me brother?

No, it is exactly not the Constitution. It is over a century of politicians and federal judges progressively ignoring the Constitution.

 

Personally, I think the Articles of Confederation were sufficient and would argue for the viewpoint of anti-Federalism if we had a do-over.

[Gerry]

Then you have no economic sense. In a free market efficiency and the most helpful product is what generates the most income. It's called competition.

Really? You expect that dog to be a winner?  Pre-ACA under the free market efficiencies of the insurance companies rate of medical cost were rising 80% plus.  Those fee market forces create hundreds of policies with loop holes the Ins. Co. could deny services, limit coverage, place life time limits on coverage.  The only thing that improved under that system was the CEO compensation packages.

 

Any one who thinks that is the way to go should be .....

[MooNiNite]

Really? You expect that dog to be a winner?  Pre-ACA under the free market efficiencies of the insurance companies rate of medical cost were rising 80% plus.

 

Pre-ACA? How much pre-ACA? Why dont you look at rate increases during ACA and now? lol. 

[Gerry]

A different topic....  One thing that the founding fathers should have set into the original Constitution.. Automatic Con-cons  every 50 years.  Con-cons with no previously elected official participation.  Then the resultant adjustment to the documents should be put to the people in a vote. Election with each change voted on like a referendum.  A nation wide election and 50% of the national vote wins the day on any point.

 

If you served as a representative to the con-con you could never be eligible for any elected post [national or local] for life.

[Gerry]

Pre-ACA? How much pre-ACA? Why dont you look at rate increases during ACA and now? lol. 

34% under ACA.

Edited April 12, 2017 by Gerry

[Brian]

Actually tht is not how this works. 

 

"A man without insurance walked into an ER.....  Or was in a car crash  ...  or had a heart attack .... or had stage 4 cancer that had not been diagnosed....."

 

Such people get, and got, billed in full  What did they do?  They defaulted on their obligations, and most likely ended up in bankruptcy. Their economic status is irrevocably destroyed.  How did/do the hospitals deal with this?  They pass the cost onto the insured patients by increasing the cost of services.  It is the insured having to pay for the uninsured.  You know, $5.000 asprins....

 

I would like to see any program where the "cost is adjusted according to one's ability to pay".  That this was not true before the ACA, with insurance companies driving up the total costs of HC to both the society and the individual, is why the ACA made some sense.  Under Bush 2 those increase were reaching into the 80% per year category.

Pick a State, any State -- Google something like "indigent healthcare in Massachusetts":

https://www.benefits.gov/benefits/benefit-details/1282

 

Or Ohio:

http://www.needhelppayingbills.com/html/ohio_free_community_clinics.html

http://medicaid.ohio.gov/FOROHIOANS/CoveredServices.aspx#61544-emergency

 

New Mexico?

https://www.sjcounty.net/departments/hthruz/health

http://www.lincolncountynm.gov/services/indigent_health_care/index.php

http://www.currycounty.org/programs/indigent-board/

etc.

 

North Carolina?

http://www.ncmedsoc.org/legacysecure2013/pages/ncms_library/detail.jsp?pitem_id=252

http://ncafcc.org/

https://www.ncdhhs.gov/divisions/orh

 

 

You see the pattern...

 

Now, this is not to say that these systems and programs are perfect or are completely comprehensive, but neither are the Federal programs being touted as the solutions! Did Medicare pay for your root canal this week? So why is the push for demanding an unconstitutional (read: "illegal") Federal Universal Healthcare System instead of shoring up the existing, constitutional (read: "legal") programs? That's a really good question and I've been repeating the correct answer over & over! The intent isn't really to "fix the healthcare system in America" but to control the healthcare system in America. Just try taking that as a working premise and then view all the news and debate on this topic through this lens for a few weeks.

[Gerry]

Not that this makes my argument, and not that it covers the full ACA period.

Also not the best quality.  Look at 200 - 2003;  The percent arguments about Bush-2 probably reflect that.  I have not stored the articles about this on my hard drive, and I might be willing to search for that later.

 

What should be of interest is the data from 2009 - 2012  [source]

[dust]

When you hear people -- news commentators or politicians or "Progressives" on Internet forums, for instance -- talk about wanting "universal healthcare in the US," most people think that were is a huge portion of the population who is being denied necessary medical treatment because they can't afford to pay for it. We do have problems here, and people do sometimes fall through the cracks, but what these people are really advocating for is a complete takeover of the healthcare delivery system by the Federal government.

 

We currently have Federal programs which cover the elderly (Medicare), the indigent (Medicaid), the military veteran (Veteran Affairs) & the disabled (a combination of Medicaid, SSI, VA, et al). In addition to that, every State in the Union has a department of public health which provides medical services on a sliding scale (meaning the cost is adjusted according to one's ability to pay -- including all the way down to zero) to residents of their respective States. In addition to that, every emergency department in every hospital in the country provides emergency services to anyone who shows up regardless of their ability to pay. In addition to that, every pharmaceutical company has a program to provide medications at reduced or no cost to those who need the assistance. In addition to that, there are lots and lots of private charities which provide or fund medical services.

 

I do get that (the Medicare etc stuff, the emergency care).

 

Certainly, I do not mean to suggest that American healthcare is some kind of brutal wasteland where only the richest survive. As is obvious from those world maps I posted earlier, America has never been #1 but has always been near the top. Yes, of course, your healthcare is still preferable to that of many other countries. And America is and has been at the forefront of medical research for a long time, and there are procedures/treatments for which a person would be most fortunate to find themselves in an American hospital.

 

But with all those caveats, it still appears that the American approach isn't working as well as the approach of many other nations.

 

Really, your health system doesn't bother me on a personal level. I have no vested interest in it. Entirely up to your people. I'm not trying to convince you to change it (as if the few Americans on this forum could instigate such change!) as much as I'm just arguing in favour of a system that is free at the point of use. It's abused a little over here, it's not perfect, but I still think it's a good way to do things.

 

 

Right now, more than 2/3rds of all US medical expenditures come from "taxpayer money" in one form or another. This is up from nearly none of it sixty years ago. The problems in the US which have emerged over the last half-century or so are not because government is not sufficiently involved in healthcare...

 

OK, now imagine this -- imagine that Brussels announced that the EU was going to fix the European healthcare crisis by taking over the entire European healthcare system -- no more UK system, German system, French system, Turkish system or Danish system, just one big centralized "one size fits all" system which would be entirely managed by the Ministers in Brussels. Think the citizens of those countries would be cheering in the streets? Or do you think the French and the Germans would say, "Thanks but we think we would rather run our own healthcare systems"?

 

Well, based on the current climate I think the French and Germans would basically take control of the whole thing and be very happy about it

 

The British, on the other hand (assuming we were staying in), no... many would not be so happy. But I would wait and see what the plan looked like.

Edited April 12, 2017 by dust

[Geof Nanto]

I’ve browsed the last few pages of discussion here and that got me doing a little of my own research.

(Incidentally, I live in a country with a universal health care insurance system, namely Australia.)

 

Detailed OECD health statistics are available here.

What strikes me is how similar outcomes are for all OECD countries. For me the most significant feature is how rapidly health care costs as a percentage of GDP are escalating in all countries.

The similarities got me thinking about what actually most effects health outcomes.  

 

I then checked how income effects life expectancy, especially in the USA as the only significant developed country without universal health care.

 

Firstly, across all countries, the Preston curve indicates that individuals born in richer countries, on average, can expect to live longer than those born in poor countries. However, the link between income and life expectancy flattens out. This means that at low levels of per capita income, further increases in income are associated with large gains in life expectancy, but at high levels of income, increased income has little associated change in life expectancy. In other words, if the relationship is interpreted as being causal, then there are diminishing returns to income in terms of life expectancy.”

 

The Association Between Income and Life Expectancy in the United States, 2001-2014

 

Interestingly, it isn’t so much access to health care that impacts on life expectancy as much as lifestyle and place of residence….

 

“In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.”

 

My conclusion…..

 

This is complex issue with a multitude of causal factors at work but basically in all developed countries health care systems are rapidly escalating into areas of diminishing returns in terms of expenditure versus health outcomes.  What we are seeing is both a rapid escalation of life-style related illness and an unwillingness to accept illness and early death as a natural part of the variation of outcomes within any population.  For me these are the main issues, as all developed countries have excellent conventional health care systems.   

[Brian]

Not that this makes my argument, and not that it covers the full ACA period.

Also not the best quality. Look at 200 - 2003; The percent arguments about Bush-2 probably reflect that. I have not stored the articles about this on my hard drive, and I might be willing to search for that later.

 

What should be of interest is the data from 2009 - 2012 [source]

The most significant change in the healthcare system (both products and services) over those decades (and extending it back to the 1960s) has been steadily increasing Federal involvement in the system. Perhaps other nations don't experience this phenomenon but anything Washington starts paying for or meddles in suffers from market distortion. Hammers, tuition, insurance policies, asthma meds, highways, you name it.

[Gerry]

Search:  indigent healthcare in Massachusetts

 

What do I get is the medicaid requirements.  This does not have anything to do with the uninsured.

 

Ok: found this list

 

Where do these facilities get their funding.

 

Also found this

 

I notice the geographic spread.

 

I also found this

 

MassHealth is basically the consumer branch of the Massachusetts Department of Health and Human Services. In the words of its mission statement, MassHealth “provides comprehensive health insurance – or help in paying for private health insurance—to more than one million Massachusetts children, families, seniors, and people with disabilities.” In addition, MassHealth is the second largest insurer in the state. However this description of MassHealth sounds, the truth is that the question has no easy answer, since benefits and services under MassHealth are often changing with rising costs and changing client needs.

 

This system was used as a model for the nationwide healthcare plan known also as the “Patient Protection and Affordable Care Act” or “Obamacare.” In that sense it is a system that covers all insured persons within the state

This is why MA has such a low number of uninsured.  My tax dollar at work.

 

look at this

 

And this

 

This for me shows the problem most clearly  [i could not post the chart.  I do not know how to manage scale of posted graphs]

 

 

Also consider

[Gerry]

Can anyone tell me if it is possible to scale graphs/images in this software.  Since I need a url, and I cannot just upload size adjusted images, Even I could careless about my last post.

[Brian]

Search: indigent healthcare in Massachusetts

 

What do I get is the medicaid requirements. This does not have anything to do with the uninsured.

 

Ok: found this list

 

Where do these facilities get their funding.

 

Also found this

 

I notice the geographic spread.

 

I also found this

This is why MA has such a low number of uninsured. My tax dollar at work.

 

look at this

 

And this

 

This for me shows the problem most clearly [i could not post the chart. I do not know how to manage scale of posted graphs]

 

 

Also consider

In 1981, medical expenses caused 8% of US bankruptcies. By 2009, that had increased to 62%. This is clearly a problem -- we are talking roughly 0.2% of Americans each year. So...

 

What changed so significantly during those three decades???