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The Case for Medicare for All
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OptimisticOwl Offline
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Post: #101
RE: The Case for Medicare for All
(02-11-2020 10:42 AM)mrbig Wrote:  I feel like my joke of calling tanq a "big boob" after he randomly injected "boob mills" and "boob jobs" into the healthcare discussion was not properly appreciated. Please take a moment to appreciate my wit. One more moment. Ok thanks, you can move back to screaming at each other about Holland (which incidentally, is my son's middle name) and The Netherlands (which incidentally, is a country where I spent a month one summer in law school).

Who is screaming at who? Sometimes I think there is a Quixotic effort to find windmills to tilt at.

I would love to visit Holland/The Netherlands/Europe sometime. You and Lad are lucky people in that respect.

I noted your use of "boob', just didn't think it particularly funny.
(This post was last modified: 02-11-2020 10:59 AM by OptimisticOwl.)
02-11-2020 10:58 AM
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tanqtonic Offline
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Post: #102
RE: The Case for Medicare for All
(02-11-2020 10:30 AM)mrbig Wrote:  69/70/75 - if you can do this without getting overly political, I'd really appreciate it (and I would absorb the information better). What are the primary differences between the Dutch health care system and Obamacare? I ask because I read this and this and this I'm trying to figure out where you think Obamacare went wrong. I mean, Lou Dobbs seems to be a fan (or have been a fan) of the Dutch system (based on the 1st link).

What would be really helpful for me to understand what needs improvement over what we have now is a quick bullet-point list of the major differences between what we have now and the Dutch system and then a separate bullet-point list of the major ways in which our current system falls short of the Dutch system. Hopefully my brain can match the two lists to determine cause-and-effect, but feel free to provide your thoughts as well.

And before tanq accuses me of proposing a government takeover of healthcare with this inquiry, I'm just asking 69/70/75 some questions.

I actually backed off that assertion in my response. I am curious that, given the predicate of the question, what is your personal 'line that should be drawn'. Nothing more, nothing less.
02-11-2020 11:50 AM
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tanqtonic Offline
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Post: #103
RE: The Case for Medicare for All
(02-11-2020 10:33 AM)RiceLad15 Wrote:  
(02-11-2020 10:07 AM)tanqtonic Wrote:  
(02-11-2020 10:05 AM)RiceLad15 Wrote:  
(02-11-2020 09:56 AM)OptimisticOwl Wrote:  
(02-11-2020 09:49 AM)RiceLad15 Wrote:  I'm guessing you mean The Netherlands, and not Holland, right? I assume the region of Holland doesn't has a separate healthcare model as compared to the rest of the country.

Speaking from personal, second-hand experience, my wife was a big fan of the Dutch healthcare system when she lived there for two, non-consecutive years. She found it quick, efficient, and incredibly inexpensive as compared to ours.

Holland

Thank you for posting why I asked my question.

Quote:Holland is a region and former province on the western coast of the Netherlands. The name Holland is also frequently used informally to refer to the whole of the country of the Netherlands.

Yet most of us recognized that Holland was used by #s as referring to the country, as the term is used quite frequently although informally.

I haven't heard anyone use "Holland" to refer to the country itself in years, but have heard Holland used as a reference to the region many, many time. I have been spending a lot of time with Dutch folks for the past 5 years, so that's why I wanted clarification.

Sorry if you and OO are offended for asking for clarification.

And conversely, I have heard references to Holland as a country many times in the last 40 years. Not offended, but pointing out that the reference isnt the bright line distinction that you seemingly imply.
02-11-2020 11:53 AM
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RiceLad15 Online
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Post: #104
RE: The Case for Medicare for All
(02-11-2020 11:53 AM)tanqtonic Wrote:  
(02-11-2020 10:33 AM)RiceLad15 Wrote:  
(02-11-2020 10:07 AM)tanqtonic Wrote:  
(02-11-2020 10:05 AM)RiceLad15 Wrote:  
(02-11-2020 09:56 AM)OptimisticOwl Wrote:  Holland

Thank you for posting why I asked my question.

Quote:Holland is a region and former province on the western coast of the Netherlands. The name Holland is also frequently used informally to refer to the whole of the country of the Netherlands.

Yet most of us recognized that Holland was used by #s as referring to the country, as the term is used quite frequently although informally.

I haven't heard anyone use "Holland" to refer to the country itself in years, but have heard Holland used as a reference to the region many, many time. I have been spending a lot of time with Dutch folks for the past 5 years, so that's why I wanted clarification.

Sorry if you and OO are offended for asking for clarification.

And conversely, I have heard references to Holland as a country many times in the last 40 years. Not offended, but pointing out that the reference isnt the bright line distinction that you seemingly imply.

Looking back, I see that my first reference didn't say "region of Holland, right?" so I can see why you and OO thought I wasn't aware that Holland is sometimes used to refer to the entire country.

Your comment about how there isn't a bright line is precisely why I asked Owl# to clarify, and which seems pretty reasonable. It's like when people use "New York" to only reference New York City, or "Washington" to describe Washington D.C. Sometimes, clarification is helpful.
02-11-2020 12:02 PM
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mrbig Online
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Post: #105
RE: The Case for Medicare for All
(02-11-2020 11:50 AM)tanqtonic Wrote:  
(02-11-2020 10:30 AM)mrbig Wrote:  And before tanq accuses me of proposing a government takeover of healthcare with this inquiry, I'm just asking 69/70/75 some questions.

I actually backed off that assertion in my response. I am curious that, given the predicate of the question, what is your personal 'line that should be drawn'. Nothing more, nothing less.

I'm being a little tongue-in-cheek here.

I don't really have a personal line that should be drawn on the topic of healthcare. I find it an important topic and as I wrote in this thread back in September 2019:
Quote:I just want a system that works primarily to the benefit of patients and providers. What system is that? If patients are happy and providers are happy, the system is probably working reasonably well and reasonably efficiently.

So I'm open to a lot of different ideas that are geared toward increasing quality of care and access to care while decreasing cost of care and complexity in the system.

There was an early discussion of profit/non-profit/not-for-profit that I found interesting, but it was kind of a side discussion. So I was trying to get some feedback on how making certain segments of the health care industry and/or health care insurance industry something more akin to non-profit or not-for-profit might affect quality, access, cost, and complexity.

I'm not favoring any kind of capped or set salaries for providers. My earlier post asking about the non-profit/not-for-profit information was meant to explicitly exclude such things. I like doctors making a lot of money. My 3 best friends at Rice (one of whom I married) all became doctors.
(This post was last modified: 02-11-2020 12:50 PM by mrbig.)
02-11-2020 12:48 PM
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georgewebb Offline
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Post: #106
RE: The Case for Medicare for All
In similar vein to the Holland/Netherlands discussion:
- Using "Great Britain" for "United Kingdom" theoretically overlooks Northern Ireland, but even so, this usage seems perfectly fine to me -- and seemingly to most Britons and British institutions, including government agencies. It seems a bit like referring to, say, a person from Sao Tome & Principe as as Santomean -- a reasonable if not strictly accurate shorthand.
- On the other hand, using "England" for "Great Britain"/"United Kingdom" makes me cringe whenever I hear it. I mean, it's only been 300 years since the English and Scottish governments were united, and 400 years since the monarchies were personally joined.

At the other end of Europe:
- In the 17th and 18th centuries, the Tsars referred to the three "Russias": White Russia (later Byelorussia, now Belarus), Little Russia (Ukraine), and Great Russia (the region most of what is now European Russia). Hence, one of the Tsar's formal titles was "Emperor of all the Russias". In Soviet times, "Great Russian" was still used as an ethnic demonym to distinguish from Ukrainians, Crimeans, Georgians, and so on. Anyway, it is an interesting anomaly that "Great Russia" referred to a subset of what came to be called "Russia", rather than the other way round.
02-11-2020 01:01 PM
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Hambone10 Offline
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Post: #107
RE: The Case for Medicare for All
(02-11-2020 10:30 AM)mrbig Wrote:  69/70/75 - if you can do this without getting overly political, I'd really appreciate it (and I would absorb the information better). What are the primary differences between the Dutch health care system and Obamacare? I ask because I read this and this and this I'm trying to figure out where you think Obamacare went wrong. I mean, Lou Dobbs seems to be a fan (or have been a fan) of the Dutch system (based on the 1st link).

What would be really helpful for me to understand what needs improvement over what we have now is a quick bullet-point list of the major differences between what we have now and the Dutch system and then a separate bullet-point list of the major ways in which our current system falls short of the Dutch system. Hopefully my brain can match the two lists to determine cause-and-effect, but feel free to provide your thoughts as well.

And before tanq accuses me of proposing a government takeover of healthcare with this inquiry, I'm just asking 69/70/75 some questions.

Not trying to speak for 69/70/75... but like you I want something that works. I consider myself an 'expert of sorts' in healthcare finance... but not in the Dutch system (or any other one than ours)

I did a cursory read of the articles. There is lots behind what some of them say that is not verified, but I'm trying to just go with it.

First, it must be noted that The Netherlands is a small country with few places (and thus few people) who don't have easy access to quality care. You can build (and staff) just a few centers and provide service to the entire nation. This matters because as an example... if a provider (not to mention nurses etc etc etc) can see 0-17 patients per day in an inpatient setting or 0-35 patients per day in an outpatient setting, then the goal should be to have 17 or 35 patients for them each day. That's much easier to do in larger population centers.

They are also an extremely homogeneous people and they have a very different approach to things like sex, drugs and 'extreme' activities which are large contributors to outlyers in the 'amount of care needed' categories.

It seems that the Dutch don't have something like Medicare that sets the bar for all costs, but instead has caps and hospitals can do what they want below those caps. I suspect they don't have situations like we do where a single service can have a meaningfully different cost based on where in the country (not to mention where in the system) you recieve it. It also doesn't have a single pooled risk, but it has a risk equalization fund for the INSURERS (as opposed to the insured which is what we used to have, and was blended into Obamacare to handle PEC's and high utilizers). It also seems that from 1940-1970, they were already on this path, at least for the majority of people... so they're literally 50+ years ahead of us.

The biggest problem with the ACA is that it increased demand while doing almost nothing to increase supply. It arguably reduced supply, at least for a number of specialties and areas.

The US has not really promoted healthy lifestyles like Europe has. To the extent that we have, we often have taken it to an extreme which makes it unhealthy.

The ACA thus has also DECREASED rather than increased the desire for healthy living by taking away the financial disincentive to hurt yourself... other than going to your PCP more regularly to catch diseases early... which only helps if you can actually get into your PCP. The welfare programs also encourage (or at least don't discourage) larger families (or earlier families) for those who can least afford it, while the Dutch does not. The subsidy is per family, regardless of size. Because of the legacy issues here, this is where their time/culture makes such a difference.

The ACA should have focused on supply, but that would be good for hospitals and doctors... instead it focused on demand... because they are voters.

The Dutch plan is actually closer to what McCain proposed because of the way the individual subsidies work... there are so many other differences noted above that wouldn't change, I don't want to say it was really 'close' either.

The reason we can't or shouldn't try to emulate what anyone else is doing now is because they were never where we started from... and you somehow must get 'there' from 'here'.

We need to 'punish' poor choices. I suggest higher copays for diseases/injuries of 'choice' and 'family' subsidies.

We need to encourage good choices. High deductible plans do this, but only if you're paying the premium which is also where 'family' subsidies come in

We need to address price transparency. It sounds like it should be simple, but it's not. In the easiest example, we don't want people coming in and treating MUCH healthcare like they're ordering a Subway sandwich.

I understand (but have not experienced) that the standard of care is also an issue for some areas. I'm a little out of my depth here in terms of SOC, but as an obvious example... A 70 yr old with 20% arterial blockage would be treated with medication in most of Europe for little cost, and we would do artherectomy for tens of thousands for little in terms of outcome differential... because that outcome is a voter.... and Medicare (the government) sets most standards.

I also wonder if population ages are meaningfully different. We're an aging population and I'm not sure they are. War babies created boomers in this country, but we lost overwhelmingly men in the US, while Europe lost many women and children as well.
(This post was last modified: 02-11-2020 05:32 PM by Hambone10.)
02-11-2020 05:29 PM
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georgewebb Offline
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Post: #108
RE: The Case for Medicare for All
(02-11-2020 12:48 PM)mrbig Wrote:  
(02-11-2020 11:50 AM)tanqtonic Wrote:  
(02-11-2020 10:30 AM)mrbig Wrote:  And before tanq accuses me of proposing a government takeover of healthcare with this inquiry, I'm just asking 69/70/75 some questions.

I actually backed off that assertion in my response. I am curious that, given the predicate of the question, what is your personal 'line that should be drawn'. Nothing more, nothing less.

I'm being a little tongue-in-cheek here.

I don't really have a personal line that should be drawn on the topic of healthcare. I find it an important topic and as I wrote in this thread back in September 2019:
Quote:I just want a system that works primarily to the benefit of patients and providers. What system is that? If patients are happy and providers are happy, the system is probably working reasonably well and reasonably efficiently.

So I'm open to a lot of different ideas that are geared toward increasing quality of care and access to care while decreasing cost of care and complexity in the system.

There was an early discussion of profit/non-profit/not-for-profit that I found interesting, but it was kind of a side discussion. So I was trying to get some feedback on how making certain segments of the health care industry and/or health care insurance industry something more akin to non-profit or not-for-profit might affect quality, access, cost, and complexity.

I'm not favoring any kind of capped or set salaries for providers. My earlier post asking about the non-profit/not-for-profit information was meant to explicitly exclude such things. I like doctors making a lot of money. My 3 best friends at Rice (one of whom I married) all became doctors.

My gut sense is that:
- Insurance (in the real sense of risk pooling, as opposed to the faux sense in which "insurance" is shorthand for "someone else pays for it") is highly amenable to non-profit operation, and in fact there is a long history of non-profit insurance, dating back to benevolent associations, subscription fire departments, trade guilds and so on.

- For anything that requires capital investment (and the most important such investment of all may be the decades of training that an individual must invest in to become a top-rate doctor), the amount of investment that will occur is highly dependent on the ability of the investors to profit from it. Reduce the profits available to hospital owners, and you'll have fewer, more obsolescent hospitals; to drug and device makers, fewer, less innovative drugs and devices; to doctors, fewer, less talented physicians.
02-11-2020 06:30 PM
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OptimisticOwl Offline
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Post: #109
RE: The Case for Medicare for All
(02-11-2020 06:30 PM)georgewebb Wrote:  - Insurance (in the real sense of risk pooling, as opposed to the faux sense in which "insurance" is shorthand for "someone else pays for it") is highly amenable to non-profit operation, and in fact there is a long history of non-profit insurance, dating back to benevolent associations, subscription fire departments, trade guilds and so on.

For example
02-11-2020 06:35 PM
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Post: #110
RE: The Case for Medicare for All
(02-11-2020 06:30 PM)georgewebb Wrote:  - For anything that requires capital investment (and the most important such investment of all may be the decades of training that an individual must invest in to become a top-rate doctor), the amount of investment that will occur is highly dependent on the ability of the investors to profit from it. Reduce the profits available to hospital owners, and you'll have fewer, more obsolescent hospitals; to drug and device makers, fewer, less innovative drugs and devices; to doctors, fewer, less talented physicians.

SOmething completely lost on many who support the current crop of Democrats. Not saying many on the right are any better, but they're not supporting things that will discourage investment
02-12-2020 10:23 AM
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mrbig Online
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Post: #111
RE: The Case for Medicare for All
I stumbled across this pretty good explainer on the German system when I was (unsuccessfully) trying to explain to a Bernie Bro that Bernie's path wasn't the only path to affordable universal coverage.



03-05-2020 10:31 AM
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Post: #112
RE: The Case for Medicare for All
I've had too many painful discussion with Bernie Bros about how increasing Medicare tax from 3.5% to 5% won't remotely come close to eliminating the 20% copay for Medicare, the 2-6k copays and deductibles for everyone else etc etc etc... how the simple math doesn't remotely work... and if we were arguing over such relatively small amounts, we wouldn't be arguing... and they just don't want to hear it.
03-05-2020 11:48 AM
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