Tort costs aren't that big of an element and don't forget that a significant portion of malpractice expense is compensation to receive mitigating medical treatment to deal with malpractice harms. If you have some form of everyone covered, those costs can go away or be reduced.

One of the European countries, Denmark maybe, has dual system. You can be in the everyone system and if you need minor surgery you can end up waiting, you get a primary care doctor and can't change for six months. Consumer pays basically zip beyond taxes. Or you can go to into a private plan and get in faster to that precancerous blemish removed and go to any doctor on the plan. The everyone plan will pay 50% of whatever rate it has set and you or your private plan is responsible for the excess.

The thing about the various flavors other nations use is the price is the price for service. The private providers want to make a profit and can't bolster profit simply by increasing price, they have to figure out how to be more efficient.

We are growing medical school slots. Arkansas has gone from one medical school just three years ago to three now. The school at Arkansas State is now two years old and the private basically for-profit in Fort Smith is wrapping up its first year.

The choke point is residencies and the Federal government has capped how many it will reimburse, the growth that has taken place has been from hospitals funding those spots, most have been in Medicaid expansion states because hospitals in expansion states as a group are doing much better financially.

(05-09-2018 10:42 AM)Owl 69/70/75 Wrote:  

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.
The lack of Medical school SLOTS is what drives up price.
The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Tom, you're the attempted rent taker. You want everybody else to take care of your unique needs, and do it for free. And no system does that.

You thought you were going to be an Obamacare winner. Turns out that your'e a loser. You didn't expect that, so you are pissed. Too bad.

Gently reminding you that personal comments are probably not the intent in this forum.

Actually, the ENTIRE point of health insurance is that it is supposed to protect you from financial ruin in the event of having a medical problem AND its supposed to enable access.

What's the point of having ANY insurance or ANY taxpayer support of the medical system otherwise? If it doesn't exist to actually PAY claims of people with chronic diseases, then why have insurance at all?

(05-09-2018 02:50 PM)Tom in Lazybrook Wrote:  

(05-09-2018 10:42 AM)Owl 69/70/75 Wrote:  

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.
The lack of Medical school SLOTS is what drives up price.
The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Tom, you're the attempted rent taker. You want everybody else to take care of your unique needs, and do it for free. And no system does that.
You thought you were going to be an Obamacare winner. Turns out that your'e a loser. You didn't expect that, so you are pissed. Too bad.

Gently reminding you that personal comments are probably not the intent in this forum.
Actually, the ENTIRE point of health insurance is that it is supposed to protect you from financial ruin in the event of having a medical problem AND its supposed to enable access.
What's the point of having ANY insurance or ANY taxpayer support of the medical system otherwise? If it doesn't exist to actually PAY claims of people with chronic diseases, then why have insurance at all?

Not sure what the gentle reminder stuff is about since you have discussed repeatedly on here your specific issues and how poorly the system responds to them. If you want one set of rules for you and another for everyone else, then I suppose you can want that. But I live in a world where if you open the door, you live with what comes through it. Sorry if you were offended in any way, but I'm sort of mystified as to why.

The entire point of any insurance is to protect you from financial ruin in event of a catastrophic event. But that's not the direction that Obamacare went or the direction that single-payer and single-provider systems go. What they do best is provide the well checkups and other things that keep healthy people better, and they get good results from a cost benefit standpoint because that's the low-hanging fruit. But they're not great with big problems. I'm partial to something like the Singapore approach, where you put so much into a health savings account, and insurance covers you above that.

(05-09-2018 03:42 PM)Owl 69/70/75 Wrote:  

(05-09-2018 02:50 PM)Tom in Lazybrook Wrote:  

(05-09-2018 10:42 AM)Owl 69/70/75 Wrote:  

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.
The lack of Medical school SLOTS is what drives up price.
The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Tom, you're the attempted rent taker. You want everybody else to take care of your unique needs, and do it for free. And no system does that.
You thought you were going to be an Obamacare winner. Turns out that your'e a loser. You didn't expect that, so you are pissed. Too bad.

Gently reminding you that personal comments are probably not the intent in this forum.
Actually, the ENTIRE point of health insurance is that it is supposed to protect you from financial ruin in the event of having a medical problem AND its supposed to enable access.
What's the point of having ANY insurance or ANY taxpayer support of the medical system otherwise? If it doesn't exist to actually PAY claims of people with chronic diseases, then why have insurance at all?

Not sure what the gentle reminder stuff is about since you have discussed repeatedly on here your specific issues and how poorly the system responds to them. If you want one set of rules for you and another for everyone else, then I suppose you can want that. But I live in a world where if you open the door, you live with what comes through it. Sorry if you were offended in any way, but I'm sort of mystified as to why.

The entire point of any insurance is to protect you from financial ruin in event of a catastrophic event. But that's not the direction that Obamacare went or the direction that single-payer and single-provider systems go. What they do best is provide the well checkups and other things that keep healthy people better, and they get good results from a cost benefit standpoint because that's the low-hanging fruit. But they're not great with big problems. I'm partial to something like the Singapore approach, where you put so much into a health savings account, and insurance covers you above that.

My point was that this isn't the Spin Room forum. This is supposed to be about issues. Not the biggest deal, but just gently reminding you that this forum is supposed to be policy based.

(05-09-2018 06:04 PM)Tom in Lazybrook Wrote:  

(05-09-2018 03:42 PM)Owl 69/70/75 Wrote:  

(05-09-2018 02:50 PM)Tom in Lazybrook Wrote:  

(05-09-2018 10:42 AM)Owl 69/70/75 Wrote:  

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.
The lack of Medical school SLOTS is what drives up price.
The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Tom, you're the attempted rent taker. You want everybody else to take care of your unique needs, and do it for free. And no system does that.
You thought you were going to be an Obamacare winner. Turns out that your'e a loser. You didn't expect that, so you are pissed. Too bad.

Gently reminding you that personal comments are probably not the intent in this forum.
Actually, the ENTIRE point of health insurance is that it is supposed to protect you from financial ruin in the event of having a medical problem AND its supposed to enable access.
What's the point of having ANY insurance or ANY taxpayer support of the medical system otherwise? If it doesn't exist to actually PAY claims of people with chronic diseases, then why have insurance at all?

Not sure what the gentle reminder stuff is about since you have discussed repeatedly on here your specific issues and how poorly the system responds to them. If you want one set of rules for you and another for everyone else, then I suppose you can want that. But I live in a world where if you open the door, you live with what comes through it. Sorry if you were offended in any way, but I'm sort of mystified as to why.
The entire point of any insurance is to protect you from financial ruin in event of a catastrophic event. But that's not the direction that Obamacare went or the direction that single-payer and single-provider systems go. What they do best is provide the well checkups and other things that keep healthy people better, and they get good results from a cost benefit standpoint because that's the low-hanging fruit. But they're not great with big problems. I'm partial to something like the Singapore approach, where you put so much into a health savings account, and insurance covers you above that.

My point was that this isn't the Spin Room forum. This is supposed to be about issues. Not the biggest deal, but just gently reminding you that this forum is supposed to be policy based.

And my point was meant as a policy point, if poorly stated as such. Single-payer and single-provider systems are one-size-fits-all approaches. They don't deal well with special needs. See the two recent stories out of UK.

If you want free medical, you're going to get what somebody else decides to let you have, because they control the money. That's why I find it so strange that you are such an advocate.

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  

(05-09-2018 09:14 AM)bullet Wrote:  

(05-08-2018 07:00 PM)Owl 69/70/75 Wrote:  

(05-08-2018 09:49 AM)Tom in Lazybrook Wrote:  

(05-08-2018 09:38 AM)Claw Wrote:  I won't support any of these centralist solutions unless there is an amendment protecting the right to free-market solutions first.

I'd support a free market option for doctors and hospitals, so long as they're really 'free market' solutions. That means that if you're in the free market....no taxpayer subsidies
No NIH, CDC, or other government research grants for hospitals not in the public plan.
No Certificate of Need or HHS funding for hospitals that don't participate
Private doctors should pay the real cost of their internships if they leave the system
Private doctors should pay the real cost of the medical training in they leave the system
Private doctors should have no admitting rights at taxpayer funded hospitals
If the 'private sector' people want to set up a truly 'private' medical system, they're free to attempt to do it. But lets make it truly private. What we have now is that the costs are socialized for the companies/doctors (not the patients) but the profits are part of the free market system.

So what you want to do is create a two tier market with two different groups with wildly differing cost structures? How is the result not inevitably Cadillac care for the rich and crap care for the rest?

Why not do like French Bismarck and you get free med school as long as you commit to work for a salary on the “free” side for a period of, say, 10 years, and after that you are judged to have repaid your debt to society and are free to enter private practice?

Any system needs to look at unnecessary costs. The cost of medical school limits supply, but doesn't cause that much of the cost inflation. More important is using PAs when doctors aren't really needed. We need to look at tort costs (and related CYA testing). We need to look at insurance companies as an inefficient (and often corrupt) middleman. And, of course, drugs.

Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.

The lack of Medical school SLOTS is what drives up price.

The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Its worked very well with Worker's Comp.

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  

(05-09-2018 09:14 AM)bullet Wrote:  

(05-08-2018 07:00 PM)Owl 69/70/75 Wrote:  

(05-08-2018 09:49 AM)Tom in Lazybrook Wrote:  

(05-08-2018 09:38 AM)Claw Wrote:  I won't support any of these centralist solutions unless there is an amendment protecting the right to free-market solutions first.

I'd support a free market option for doctors and hospitals, so long as they're really 'free market' solutions. That means that if you're in the free market....no taxpayer subsidies
No NIH, CDC, or other government research grants for hospitals not in the public plan.
No Certificate of Need or HHS funding for hospitals that don't participate
Private doctors should pay the real cost of their internships if they leave the system
Private doctors should pay the real cost of the medical training in they leave the system
Private doctors should have no admitting rights at taxpayer funded hospitals
If the 'private sector' people want to set up a truly 'private' medical system, they're free to attempt to do it. But lets make it truly private. What we have now is that the costs are socialized for the companies/doctors (not the patients) but the profits are part of the free market system.

So what you want to do is create a two tier market with two different groups with wildly differing cost structures? How is the result not inevitably Cadillac care for the rich and crap care for the rest?

Why not do like French Bismarck and you get free med school as long as you commit to work for a salary on the “free” side for a period of, say, 10 years, and after that you are judged to have repaid your debt to society and are free to enter private practice?

Any system needs to look at unnecessary costs. The cost of medical school limits supply, but doesn't cause that much of the cost inflation. More important is using PAs when doctors aren't really needed. We need to look at tort costs (and related CYA testing). We need to look at insurance companies as an inefficient (and often corrupt) middleman. And, of course, drugs.

Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.

The lack of Medical school SLOTS is what drives up price.

The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Look at a hospital bill. Doctor's costs are an infinitesimal part of the bill. There are costs that can be driven out there, but its not the biggest factor.

The insurance industry is a middleman that is adding little value. That needs to be re-worked.

(05-10-2018 08:02 AM)bullet Wrote:  

(05-09-2018 10:32 AM)Tom in Lazybrook Wrote:  

(05-09-2018 09:14 AM)bullet Wrote:  

(05-08-2018 07:00 PM)Owl 69/70/75 Wrote:  

(05-08-2018 09:49 AM)Tom in Lazybrook Wrote:  I'd support a free market option for doctors and hospitals, so long as they're really 'free market' solutions. That means that if you're in the free market....no taxpayer subsidies
No NIH, CDC, or other government research grants for hospitals not in the public plan.
No Certificate of Need or HHS funding for hospitals that don't participate
Private doctors should pay the real cost of their internships if they leave the system
Private doctors should pay the real cost of the medical training in they leave the system
Private doctors should have no admitting rights at taxpayer funded hospitals
If the 'private sector' people want to set up a truly 'private' medical system, they're free to attempt to do it. But lets make it truly private. What we have now is that the costs are socialized for the companies/doctors (not the patients) but the profits are part of the free market system.

So what you want to do is create a two tier market with two different groups with wildly differing cost structures? How is the result not inevitably Cadillac care for the rich and crap care for the rest?
Why not do like French Bismarck and you get free med school as long as you commit to work for a salary on the “free” side for a period of, say, 10 years, and after that you are judged to have repaid your debt to society and are free to enter private practice?

Any system needs to look at unnecessary costs. The cost of medical school limits supply, but doesn't cause that much of the cost inflation. More important is using PAs when doctors aren't really needed. We need to look at tort costs (and related CYA testing). We need to look at insurance companies as an inefficient (and often corrupt) middleman. And, of course, drugs.

Tort is not an issue. When there's a limit for damages capped at less than a week's salary for some hosptial corp CEO's that's not really much of a cost.
The lack of Medical school SLOTS is what drives up price.
The insurance industry appears to be nothing more than a rent taker, that provides zero value to the system.

Look at a hospital bill. Doctor's costs are an infinitesimal part of the bill. There are costs that can be driven out there, but its not the biggest factor.
The insurance industry is a middleman that is adding little value. That needs to be re-worked.

But insurance company profits on health insurance are very low. And insurance does add value by providing a relatively efficient market for administering payment for care. The insurers basically run Bismarck, and that gets the best results of any approach. But, of course, that is done in markets that are set up to guarantee competition.

The big profits in health care are in Pharma, but that's also where the huge financial risks are. You can spend many millions on testing, only to determine that you don't have a viable treatment. What needs to take place in Pharma is some leveling of the playing field between what we pay and what the rest of the world pays. But that means that the rest of the world has to come up, it can't all be the US going down, or else you starve research. I'd make it a violation of US law for any country to negotiate a price that does not include a pro rata share of R&D costs (with exceptions for third world countries), I'd cut off all aid to any country that does so, and I'd provide for patent termination for any company that enters into such a deal. Of course, then the problem would be reverse engineered ripoffs, and that would take some additional steps to address. For any country to allow that would be a violation of US law, as above, and any company that did it would be prohibited from doing business in the USA.

The median health insurer has a profit margin of 4% to 5% serving as an intermediary.
The nature of the business is such that rising costs aren't really that bad of a thing as long as the consumer is remaining in the system. I'll take 4% of $5000 over 4% of $1000 every day.

I've not seen anyone seriously propose that the US adopt a single provider system, in general single provider systems are rarely chosen. The UK system is one of the few and if they hadn't been recovering from so many hospitals and clinics being destroyed and the economy in shambles and unlike much of Europe didn't already have a framework of public health available to most if not all the population to build upon. They had remained classically free market longer then veered far more socialist than most of the regional nations.

The Fourth Amendment makes single provider essentially impossible in the US because the cost of taking just the hospitals would be a staggering number beyond the ability of most of us to imagine.

Any discussion of the UK's NHS is a red herring because it practically impossible for the US to ever adopt a similar system.

https://www.realclearhealth.com/articles...10785.html

Apparently US is looking at negotiating on drug "theft" by the Europeans and Canadians.

"The USTR report states:
In order to promote affordable healthcare for Americans and the innovation to preserve access to the cutting-edge cures and therapies, USTR has been engaging with trading partners to ensure that U.S. owners of IP have a full and fair opportunity to use and profit from their IP.
The report also makes clear that the Trump administration is working to “ensure robust IP systems and reduce market access barriers to pharmaceutical products and medical devices.” The goal? To ensure “trading partners contribute their fair share to the research and development of new cures and therapies.”

Perhaps most importantly, the report highlights the administration’s concerns regarding unfair uses of compulsory licenses — i.e., foreign governments stealing patents from America’s biopharmaceutical companies. It’s the threat of compulsory licensing that forces American companies to sell their products at price-controlled levels in foreign markets, again, driving up costs for Americans. The reason why drugs are so cheap in Canada, for instance, is because if an American company refuses to sell its medicine in Canada at the artificially set, government-mandated price, the Canadian government will just take the patent."

(05-10-2018 09:06 AM)bullet Wrote:  https://www.realclearhealth.com/articles...10785.html
Apparently US is looking at negotiating on drug "theft" by the Europeans and Canadians.
"The USTR report states:
In order to promote affordable healthcare for Americans and the innovation to preserve access to the cutting-edge cures and therapies, USTR has been engaging with trading partners to ensure that U.S. owners of IP have a full and fair opportunity to use and profit from their IP.
The report also makes clear that the Trump administration is working to “ensure robust IP systems and reduce market access barriers to pharmaceutical products and medical devices.” The goal? To ensure “trading partners contribute their fair share to the research and development of new cures and therapies.”
Perhaps most importantly, the report highlights the administration’s concerns regarding unfair uses of compulsory licenses — i.e., foreign governments stealing patents from America’s biopharmaceutical companies. It’s the threat of compulsory licensing that forces American companies to sell their products at price-controlled levels in foreign markets, again, driving up costs for Americans. The reason why drugs are so cheap in Canada, for instance, is because if an American company refuses to sell its medicine in Canada at the artificially set, government-mandated price, the Canadian government will just take the patent."

And I think we simply make that practice a violation of US law.

Trump expected to take on Pharmacy Benefit Managers.
http://www.businessinsider.com/trump-spe...ers-2018-5