(03-29-2013 12:45 PM)RobertN Wrote:  

(03-29-2013 07:36 AM)Rebel Wrote:  Once more for the people with reading comprehension issues, "Obamacare won't be fully implemented until January 2014".

Btw Robs, in what up is down, blue is red world is increasing premiums and deductibles "saving me money"?

Hey dumb ****, I was ralking about increased tax. I also realize that I am going to have to pay for insurance next year(or pay the tax). I have no idea how much it will cost at this time.

I hope it hurts like hell. We can ralk about it next year.

(03-29-2013 01:44 PM)Hambone10 Wrote:  Generally true... and I agree 100%.... but have to throw the monkey wrenches in there.... and honestly, why "universal healthcare" and Obamacare are different animals.

Good discussion, Ham. I'll do my best:

(03-29-2013 01:44 PM)Hambone10 Wrote:  Guy shows up at the ER unconcious from an intentional OD... no idea what he would choose, so how do you decide? If he disagrees after the fact, who pays? If he "wants to die" and the doctor thinks he is mentally unstable, what should happen?

According to the law, they have to try and save him, no matter the cost.

I believe you answered your own question here. It is accepted in this scenario he has relieved himself of his right to choice due to the circumstances. The fact that it was an intentional overdose would not be known until after the fact in many cases anyway, and is not as material. If unconscious or not lucid enough to decide then, absent a family member who could help as in present cases like this, hospital has to do what it has to do; they can choose w/o liability as long as they follow a path of proper protocol that will hold up under scruitiny (malpractice laws could still apply, for instance).

(03-29-2013 01:44 PM)Hambone10 Wrote:  This is where the "doctors office visit" and the hospitalization diverge... and where the rules change... and where insurance and public healthcare should separate... like they do for dentists... But we want continuity of care, meaning we want the hospital to involve the doctor in the decisions... so it can't. Another issue is we have to staff hospitals 24/7, while doctors offices can refuse patients and schedule hours. An ER can refuse you treatment, but they have to run some basic tests at least to determine that you aren't sick.

So maybe we look at adjusting that as you suggest, to heck with the continuity foir continuity's sake. And I did say hospitals can charge the true costs, so figure it out and charge it. No problem there. Same as getting stuck in the middle of nowhere in your car and ahving to go to the nearest garage because the more iefficient one is impractical or impossible to get to due to time/location/cost of transport; or in a boat at sea during a hurricane helicopter rescue. You take the help that comes.

(03-29-2013 01:44 PM)Hambone10 Wrote:  This is why it is so tough. Who decides whether you go to the ER or the doctor's office? The rules are complex and the people making the decisions aren't qualified to do so.

You do, or your family/relatives/legal guardians do. People become aware that they have to take responsibility for themselves. The key difference is you have aVERY strong cost savings incentive that does not presently exist in the syetem. To wit: your insurance premium goes to the insurance company whether you ever go to the doctor or get a prescription or not. That is where the inefficiency is in the system. I believe you pointed out previously the issue is we are all paying $10,000/yr for only $4000/yr of care.

Of course, there will always be difficult situations no matter what your system is in a country this large, but I think people like to think these things are more complicated than they really are or have to be. A large part of the complication is the whole system of insurance/government intrusion and over-regulation and lack of any pricing information or consideration involved in the process until way way after the fact.

(03-29-2013 01:44 PM)Hambone10 Wrote:  We currently accomplish about a 70/30 split. I think we should do as you suggest and that would cover 90% of situations.... the 10% would still be a problem, but at least it is only 10%. The reason I don't like Obamacare is that it makes the situation more like 50/50. It's the absolute wrong direction. It's not entirely without merit... It just doesn't address the dichotomy of care and the "requirement" to treat.

And that is the main thrust of why I posted my scenario agaisnt yours as I did. No one could dispute we'd be far, far better off only having to worry about 10% of the difficult situations rather than 30% or as you suggest 50% under Obaminationcare.

As has happened over time in every other country that has nationalized healthcare, deaths and sickness will go up, waiting lines will increase, other people will tell you what you can and cannot spend your money on (as you pointed out, this has been going on for years since Medicare and Medicaid set all the reimbursement levels, and their payment schedules drive almost all the pricing and kickbacks behind the scenes even for those who have great insurance, as you and I know from experience).

At least my solution actually reduces cost, dramatically reduces waste, incentivizes efficiency from all parites involved, increases freedom, reduces incentive for all people to overuse facilities and services, leaving them to be utilized by only the truly sick and chronic needful, which further drives costs and problems down.

No doubt there would always be people who have chronic diseases and illnessess (as there are today) that would forever be using all their HSA dollars every year and be into their catastrophic policies every year. It's a little concept called "Insurance" that uses these things called "actuaries" to help evaluate and projects costs and liabilities. Then you just do the math and charge the actual costs for the services provided. (I know a good little private university of students who like math a whole lot in Houston, TX that could help, do you?)!

With competition and computers providing information, you change the mindset of the consumer to re-involve them in most of their decisions in healthcare raher than one of a rat in a maze that has to figure out arbitrary rules, many of which are counter-intuitive like we have today.

People poor or not make complicated decisions every day involving how to handle the complexities of the system they're in to maximize "what they get." Why do we pretend they cannot figure out how to take care of their healthcare dollars if given the chance? If there's money in it for them, they will learn how to maximize their benefit no matter how poor they may or may not be. But today, there is no incentive for them but to grab as much as they can whether they need it or not. That's pretty dumb, and Obamacare will make it even worse because it does nothing to change that mindset.

The underlying principle that has to be accepted is that Healthcare, like everything else, costs money, and there is nothing wrong with that.

ETA: typos, a bit more info.

Sure it costs. But it is driving up the costs of health care.
It's supposed to be a benefit to people for universal health care.
It's neither a benefit or universal by any means.

Great comments Good.

I think it starts with the government wanting to "muddy the waters" about where money is going. By the time you take adminstrative expense at the government level, and administrative expense for compliance with the government at the local and insurance level... not to mention the "how much care are we getting for how much cost"... I think there would be a revolution against, and not BY government on healthcare.

The challenge in clarity on medicine is that much care cannot be refused for a variety of reasons... and the ability to pay, or the willingness of the government to pay the actual costs, PARTICULARLY when time is of the essence and doctors aren't "efficiency experts"... is still the problem.... because if I don't know if I'm going to get paid at all on say on average, 10% of my cases, then that could be 500% of my profit margin... not to mention that I don't really know if it will be 8% or 12% of my cases for any period.


I believe in universal healthcare....

I think I would augment your system as follows, and I believe the data exists to determine this sort of thing:

a) Emergency, life saving care would be covered for all. No fault care. No choices. No frills. The doctors do what they feel they must to save your life and no more. Once you are stable, the care ends. If you end up with a scar down the middle of your face or losing your lower half, tough crap... you're alive. The government could estimate this expense and fund it out of medicare/medical school training ground/charity. End the Obamacare backhanded tax and go to a straightforward and more honest increase in medicare premiums. Hospitals would NEVER be out of pocket for emergency care, other than "elective" charity or as an income tax write-off.

b) There is a list of other covered procedures for all. Nothing else is covered. We could set this bar anywhere we had to to make the numbers work, but included in this would have to be many of the tests required to determine if your life is in danger... like echochardiograms etc... This is essentially what the doc-in-the-boxes at CVS and other places are... plus the "fillers" at the emergency room. Let's say for example, $50 for a physical. This list could change every year on the whims of Congress if it had to... because there is a book with the procedure codes and the hospitals can tell you what they cost. If you want, create a panel in every state that can decide on any "special cases" and have that money come out of a state fund, perhaps funded by sin taxes on smoking or whatever.

c) BETTER emergency care or better care for other procedures would be optional, at private cost of either insurance or cash upfront or with a bond ensuring that you would pay eliminating the need for deceptive pricing. The doctors would get the $50 from medicare, plus another $20 from the person or the insurance for the "better" care.

d) Additional coverage for things beyond the scope of the list or emergency care can be paid by cash, through charity, through insurance... or you go without.

You'd still have some problems with prescriptions where the generic is $4, but the dr proscribes one that costs $400. I think this would be a relatively small number compared to everything else, and not all drugs for the same problem are the same (not just $50 nexium vs $4 omaprazole but $4 omaprozole vs $30 pantoprazole).

I think you'd have a lot more clarity... and with a lot more clarity, people would be better able to vote on things like healthcare reform. The government doesn't want clarity because if you knew what it really costs, you wouldn't buy it. It's the car salesman telling you the GPS only costs you an extra $10/month,,, before you realize you just spent $6,000 for a $99 Garmin.

Yes, the increased costs coming 1-1-14 will indeed hurt.

But this is what happens when children up to age 26 are carried by their parents and about 25mm uninsured people are dumped into the system. SOMEONE HAS TO PAY FOR IT.

All I know from my PCP is their office (8 doctors) plans to NOT accept any new patients. Don't ask me how they can do this, but that is what he told me. Of course, my costs still go up to cover all the changes voted in in 2010 by Pelosi and her band of fools.