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Kirk W

Where will healthcare go in the near future?

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Good article and subsequent comments for discussion on the matter. Thanks for posting Kirk.

 

 

Cyber security issues aside for the moment; having health care records easily accessible in a safe and secure platform that is accepted by all doctors so RV'ers can visit a dr in any of the states they travel would be helpful. Also it could discourage misuse of med's which seems to be a hot button for many. I believe some pharmacys currently share databases on patient prescriptions? If Dr's could share history and in the extreme a computer like IBM Watson could assist in diagnoses.

 

Deregulate health care .Though well intended HIPPA is one example: it is interpreted in many different ways with many trying to adhere to the letter of the law instead of the spirit of the law; which I believe was to prevent unauthorized use of an individuals health history for insurance coverage, credit approvals, employment hiring or other legal maneuvers. In my personal experience caring for elderly family members medical providers following the letter of the law where HIPPA was concerned resulted in delayed, inadequate or just plain rude and unkind care. Kind of like dealing with robots instead of human beings.

 

I would like to see ALL health care providers post their fees ie: http://www.ocotillointernalmedicine.com/affordable-cash-pay-plans/ giving patients an opportunity to compare and shop for their own care and chose the services they want not have to take a "package" deal.

 

Separating health care from employment could have far reaching benefits helping to prevent people from staying in jobs they don't like and or are not preforming well in just for their health care coverage. This could come about with pre-existing conditions coverage and maybe improve customer service, productivity and improved well being with more people in jobs they love.

 

Health savings accounts for everyone instead of employer health care puts the issue of health care on the front burner for everyone to prepare for in advance of getting sick or starting a family etc. I remember in grade school to encourage savings habits (and of course future customers) a local bank opened free accounts for kids and we brought our pennies to school once a month and would watch our savings book grow. I don't know that is done anywhere anymore? But good habits started young never hurt.

 

Bottom line it is human nature to resist change and that resistance can prevent needed change to assimilate the inevitable. ie as our life expectancy has increased subsequent services haven't adjusted to absorb the change ie social security should have started minimal adjustments a long time ago to ease into the increased life expectancy tables*** but nobody wants to confront that sensitive issue.

 

***the average American life expectancy back in 1935 when SS was enacted was 61.7 years and in the USA rose in 2012 to 78.8 years.

(17.1 years more that need to be assimilated somehow)

 

"According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life." SOURCE: http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/#2bd28f7b4781

Edited by JM

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We need a robust discussion on end-of-life and latter in life care. Lots of testing (mammography, colonoscopy, PSA, etc) are unnecessary after 80, because even if cancer detected, not treating is often a better way to go. We all die in the end, why not enjoy a good quality of life rather than trying to fight a losing battle with surgeries, chemo, radiation, etc?

 

BTW - ACA is not a failure. It has GREATLY reduced the number of uninsured in this country, not to mention how many people have been able to GET insurance because of scraping the pre-existing conditions and lifetime limits. It does need to be tweeked as we go forward.

Edited by Barbaraok

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The Great Recession enabled ObamaCare. Now the law’s failure makes reform possible.

 

Will we soon have major changes in our healthcare system? How might it effect the RV community?

 

Obamacare did what it was supposed to do, provide health insurance for millions of Americans who didnt have health insurance. The problem with health care these days, is that there are no controls on the price of health care, just look at the examples of the Epi-Pen and Daraprim, and I am sure there are hundreds of other examples. Then there are the vast difference in the cost of other health care services from facility to facility. Until we get the cost of health care under control, there can be no health insurance reform that will work.

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Obamacare did what it was supposed to do, provide health insurance for millions of Americans who didnt have health insurance. The problem with health care these days, is that there are no controls on the price of health care, just look at the examples of the Epi-Pen and Daraprim, and I am sure there are hundreds of other examples. Then there are the vast difference in the cost of other health care services from facility to facility. Until we get the cost of health care under control, there can be no health insurance reform that will work.

 

The price issues you cite are largely due to Congress forbidding Medicare from negotiating the price of prescription drugs when the Part D program was authorized. For many years Medicare, because of its size, has acted as the principal negotiating agent between insurance companies and the healthcare industry. When Medicare decides what it will pay for a particular procedure, it "drives" what the private insurance industry agrees to pay. Since that doesn't happen with drugs, the industry is free to pretty much charge what it wants.

Edited by docj

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Separating health care from employment could have far reaching benefits helping to prevent people from staying in jobs they don't like and or are not preforming well in just for their health care coverage. This could come about with pre-existing conditions coverage and maybe improve customer service, productivity and improved well being with more people in jobs they love.

 

 

 

You may not be aware that the coupling of health insurance to employment began when post-WWII wage controls exempted health care premiums paid by employers. As a result it became a way to provide an increased benefit to employees without violating wage control regulations. Another example of how we have a crazy quilt of health insurance policies and procedures that wasn't designed in any logical way.

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The Great Recession enabled ObamaCare. Now the law’s failure makes reform possible.

 

Will we soon have major changes in our healthcare system? How might it effect the RV community?

 

Very easy for people to propose that all insurance needs to do is pay for basics and for catastrophic expenses; the author of this article proposes defining ~$5k/person as the threshold for "catastrophic" expenses. Everyone else is expected to use HSA's to save for expenses less than the catastrophic level.

 

That's all very simple if your family has the wherewithal to allocate $5-15k/yr to an HSA. Since many members of Congress are millionaires and all earn at least ~$175k this doesn't seem like too much of a burden. It seems only reasonable that people should save for rainy days.

 

But, even if you're an upper middle class family earning $75-100k/yr with a couple of kids putting $500-1000/mo (or more) into an HSA that's quite hit on their disposable income. Now, imaging doing the same on an income of ~$50k and you begin to understand why high deductibles and HSAs are a very regressive approach for providing health insurance.

 

My wife and I volunteer in Corpus Christi at a free medical clinic for uninsured and underinsured people residing in the Coastal Bend are. Most of our clients are working folks who make too much to qualify for Medicaid and too little to qualify for the subsidized premiums under ACA. We currently provide primary care for <1,000 area residents. Our clients aren't freeloaders; they are working people who simply are trying to survive. If they don't get care from us, they end up in local hospital emergency rooms after they get much sicker.

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You may not be aware that the coupling of health insurance to employment began when post-WWII wage controls exempted health care premiums paid by employers. As a result it became a way to provide an increased benefit to employees without violating wage control regulations. Another example of how we have a crazy quilt of health insurance policies and procedures that wasn't designed in any logical way.

 

Richard Nixon's wage and price controls have also had a negative effect on health care costs as well.

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We seem to be skating dangerously close to politics with some of our opinions on what is or should be, so I'll choose not to respond to some comments that I'd prefer to disagree with. While I read quite a lot on the subject and much of it from people I trust, I can only state facts on the things which I have personal experience with. Very little of that has any connection to the present debate. It is a fact that the issue is historically a new issue, and no sort of insurance or government coverage existed 100 years ago. The first such healthcare plans came into existence when some hospitals began to offer prepaid care plans in the 1920's. Prior to that, all healthcare needs were on a "fee for service" system since we live in a capitalistic society. What we have isn't perfect but it has come a long way. Hopefully things will continue to be improved in the future.

 

 

We need a robust discussion on end-of-life and latter in life care.

No question that this is an area that needs serious study and work. In observing the late in life experiences of both of my parents, there is little doubt that my dad had more medical expenses in his last 5 years than the rest of his life, combined. With my mother it wasn't quite as dramatic, but close.

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Kirk, you want to avoid politics but you post an article by Gottlieb (a long time republican health care advocate) with the American Enterprise Institute?

 

Come on man..................

 

As others pointed out just the title proclaiming ACA a failure signals this was any kind of fair analysis.

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I didn't even respond this AM when I first read the article because it is so riddled with falsehoods, obviously partisan talking points and in violation of forum rules. But for the original author (and forum moderator??????!!!!!!!!!!!) to come on and chide others for pointing out problems. That is a bridge way to far.............Shame!!!

Edited by Daveh

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The Great Recession enabled ObamaCare. Now the law’s failure makes reform possible.[/size]

 

Will we soon have major changes in our healthcare system? How might it effect the RV community?

 

Kirk, the article you link to is from the American Enterprise Institute, an organization similar to the Mercatus Center which you quoted in another thread. Both of these groups are conservative organizations with definite health care "agendas".

 

That's ok as long as you recognize where they're coming from, but in this thread and your other one ("Healthcare Openness Project"), you seem to take these articles as fiat, rather than the opinions they are.

 

Please stop cherry picking.

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He knows where they come from. Kirk is the best at answering general Rving issues and technical issues but not these issues where he is beholden to conservative partisan rhetoric rather than discussion of the issues.

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Kirk, you want to avoid politics but you post an article by Gottlieb (a long time republican health care advocate) with the American Enterprise Institute?

 

Come on man..................

 

As others pointed out just the title proclaiming ACA a failure signals this was any kind of fair analysis

True, I did post it looking for thoughts about where it may go from here, knowing that it is a risky subject. It does come from AEI but was reprinted from the Wall Street Journal. I'm not endorsing any of the positions in it, or any of the other stories around, but am interested in what direction we may see the issue take. Political debates are not bad of themselves, but unfortunately most of us find it very difficult to keep our emotions out of such debates and thus my remark. Only history will say accurately just how good or bad the present laws are, as mostly at present we get what our sources choose to feed to us.

 

. It appears that more change is coming and that was the intended subject. The word of caution was not for myself so much as to avoid the thread being locked for crossing the forums rules.

Edited by Kirk

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True, I did post it looking for thoughts about where it may go from here, knowing that it is a risky subject. It does come from AEI but was reprinted from the Wall Street Journal. I'm not endorsing any of the positions in it, or any of the other stories around, but am interested in what direction we may see the issue take. Political debates are not bad of themselves, but unfortunately most of us find it very difficult to keep our emotions out of such debates and thus my remark. Only history will say accurately just how good or bad the present laws are, as mostly at present we get what our sources choose to feed to us.

 

Kirk, while your intentions may have been good, I think that using these articles as "conversation starters" does endorse a point of view.

 

Since you're a Moderator (Weekend or not), you really shouldn't be leading these types of discussions.

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Okay, I will jump back into these dangerous waters and suggest this article, written by a known liberal reporter, is a much better dispassionate analysis of where we may end up in the next 2-4 years on Obamacare. His position, and this is confirmed by some conservative health analysts, is that the Republicans now find themselves in the position of the dog that finally caught the car. The scenario he believes most likely to occur is that Congress will immediately pass the flashy repeal but then will kick the can done the road leaving things essentially as they are (perhaps with different names and mechanisms ie. credits instead of subsidies). Just last week I read a conservative guy on twitter say some Republican house aides thought they should handle the issue by pushing it out 4 years to the next president. I don't think any of this considers the one big factor here and that isTrump can sway opinion and he is unpredictable (that was intended as a factual rather than political statement--hope it worked).

 

http://nymag.com/daily/intelligencer/2017/01/repeal-and-delay-is-forever.html

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We need a robust discussion on end-of-life and latter in life care. Lots of testing (mammography, colonoscopy, PSA, etc) are unnecessary after 80, because even if cancer detected, not treating is often a better way to go. We all die in the end, why not enjoy a good quality of life rather than trying to fight a losing battle with surgeries, chemo, radiation, etc?

 

BTW - ACA is not a failure. It has GREATLY reduced the number of uninsured in this country, not to mention how many people have been able to GET insurance because of scraping the pre-existing conditions and lifetime limits. It does need to be tweeked as we go forward.

 

As a retired health care professional, I want to thank Barb for bringing this up. This was an industry hot button for at least the last half of my 42 year career - especially for the more conscientious providers. Failing to recognize and take reasonable approaches to end of life care and related decisions is a major driver of higher costs, economic hardships for patients and families, and increased suffering in this country. Other countries have done a far better job in this arena than the United States.

 

I think that, before the country can come to a consensus about the best course for healthcare and its financing, we will have to evaluate and possibly shift a major paradigm in our national culture. In grad school in the early '80s, our health care policy professor asked a well-known congressman to come speak to us. Although I won't mention any names here for reasons demonstrated above, something he said hit me so hard that I've never forgotten it - and, to me at least, it's completely non-partisan. He said, "The problem with health care finance in this country is that we think of health care as a right but fund it like a privilege." All the fighting over how to fund health care is going to remain just that - fighting - until some broader philosophical issues are resolved.

 

Rob

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"The problem with health care finance in this country is that we think of health care as a right but fund it like a privilege." All the fighting over how to fund health care is going to remain just that - fighting - until some broader philosophical issues are resolved.

 

 

 

Thanks for posting this. I agree with the statement, and will take it a step further. We consider it a right, without responsibility. We make poor lifestyle choices, eat poorly, drink alcohol to excess, use tobacco, lead a sedentary existence, then demand to be treated at the expense of others when we develop expensive ailments as a result of our actions.

 

I also agree that there are no easy answers.

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Thanks for posting this. I agree with the statement, and will take it a step further. We consider it a right, without responsibility. We make poor lifestyle choices, eat poorly, drink alcohol to excess, use tobacco, lead a sedentary existence, then demand to be treated at the expense of others when we develop expensive ailments as a result of our actions.

 

I also agree that there are no easy answers.

 

 

As Paul Harvey use to say, "Self government without self discipline wont work".

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I liked the quote also but interpreted it differently.

 

I don't think the general debate is never honest because we don't openly talk about the consequences of whether we agree that health care is a right or privilege. I would reword the quote to say that in the US we pretend healthcare is a right but it actually available only for the privileged.

 

If we as a nation believe healthcare is a right then we our focus would be on a system that ensures healthcare for all. We would need to agree it is a value we hold as a society and want to fund. Yes we can do things on the margin like include incentives for healthy lifestyles and we would need to address hard issues like allocation of resources in situations such as end of life care, but that can be worked out. The central question is do we want a society that ensures such care for all. As a former healthcare worker I believe it is a matter of human dignity and essential. I dont think you have a moral society without providing such care. I am also willing to sacrifice my own resources to make it happen.

 

However, there is also a school of thought that the goal should be health care available to all who can afford it. This is what I consider to be the school of believing healthcare is a privilege. Here the discussion focuses on means to maximize efficiency and market systems to provide health care to many, but the premise that healthcare is a right of all is never accepted. Here is the fundamental moral issue that is never discussed. Are we as a nation willing to let people suffer and die because they cannot afford healthcare. You can dress it up however you want but that is the question. Many try to dodge the question by saying we simply cannot afford it. We are the largest economy the world has ever known. The question is our own priorities. Does a moral economically advanced country allow its citizenry to not receive healthcare?

 

How to finance and deliver that care most efficiently is in my opinion a much easier issue. But we are hung up on the first one and never dare to discuss it openly. Is healthcare a right or are we okay with a system that works for a majority but leaves a minority to suffer and have an early death? Do we value some lives more than others and is the right way to differentiate between those lives simply their ability to generate income?

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I don't believe that there is any question that not everyone has the same access to healthcare or to the same quality of care. I doubt that I'll live long enough to see that happen. Like most people, when ours has been good we felt the system was great but when we had problems getting care or paying for it, we thought the system bad. No matter what we each believe should be done we have to find a way to pay for whatever we wish to provide and printing more money is not a solution. I suspect that all of us are biased by our political beliefs, but we still need to find some common ground if we are ever to move forward.

 

How do we balance the issue of providing healthcare to those in need against what it will cost each of us to provide it? How much of the income of those of us who have good healthcare should we be willing to pay in order to provide that level of care to those who do not have it? The article posted by Deveh is well worth the time to read. There is at least one part of it which does agree with what is said by the other side.

 

 

Covering people who can’t afford to pay for their own medical care means making other people pay for it.

That is the crux of the problem. Do we agree that access to equal quality/quantity healthcare is a right of citizenship, or perhaps of existence? Historically it has not been true in most of the world, if it is anywhere. Is there some minimum level or quality of care which everyone is entitled to, but those who have deep pockets get the better? These are legitimate questions that any change needs to address.

 

We may never agree on many things, but we must accept that all of us need to find some means of compromise for the common good. Arguing will never solve anything but honest debate is necessary if change is to take place.

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I did not know the history: "You may not be aware that the coupling of health insurance to employment began when post-WWII wage controls exempted health care premiums paid by employers" or that Medicare is forbidden from negotiating the price of prescription drugs: "Congress forbidding Medicare from negotiating the price of prescription drugs when the Part D program was authorized." Thank you for the info.

 

Health care is a huge subject, I believe trying to cure all the ills (sorry for the pun) at once will be too overwhelming and we need to take it a portion at a time. Each person will have different concerns and it would be helpful to work on the concerns that affect the most people. ie pre-existing conditions, covering children up to age 26 as many do not seem to be leaving at age 18 or those that do return for economic reasons and lastly medical care for the elderly.

 

I have a couple of years to go before medicare and currently pay my own way. We chose to start traveling early and knew that healthcare would be a big portion as we didn't want to wait till "company' retirement time and be too old to enjoy our travels. We expected to see increases in our premiums every year as all expenses go up. No regrets just find it hard to justify the exponential increases the last few years. We do hope medicare will continue as that was part of our overall life plan.

 

More people are seeking health care then in the past as the marketeers are doing a good job encouraging annual check ups as well as other tests that may be unnecessary when a family history is taken and big pharma advertising their products to a largely uniformed public. Dr's for the most part want to help their patients and to that end we had an over prescribing of antibiotics and many a patient insisted they be prescribed resulting in the current dilemma of sever drug resistant strains ie MRSA. IMHO Drug commercials should go the way of cigarette commercials.

 

Though this is a year old the Top 10 issues impacting healthcare industry in 2016 it provide insight into the tangible changes occurring in the medical field. http://www.healthcarebusinesstech.com/issues-impacting-hospitals-2016/

 

This article Future Health Care Challenges was written in 2003 and it appears the same challenges still exist.

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Access to care being restricted by insurance companies pulling out of the ACA. We are required to participate or ace a penalty. Maybe insurance companies need some incentive to participate.

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Over the last few years, I've noticed on many forums (And gee, not all RV'ing related:)!), that another method of separation between the overall good, neutral, evil opinions of ACA lies on the financial front. I say 'another' as it's obvious that political differences is usually seen as the primary separation of opinions...

 

-Those all on Medicare, have a less impacted opinion on ACA

 

-Those Pre 65 Retired, without covered or heavily subsidized Health Insurance, have another view

 

-Those still in the work force, with covered or heavily subsidized Health Insurance, have another view

 

-Those with lower income, and prior were not covered by Employee Health Insurance and now obtaining ACA subsidy, have another

 

 

And that is understandable, as on many things those that are receiving a specific benefit and or not having to pay too much for something - are usually fine with the way things are:)! While those that are not able to receive, and or feel they are paying thru the nose for something - are usually wanting this injustice to be corrected:)!

 

Me? Yeah, I've whine many times that our retirement planning never budgeted for this large of a monthly outlay for less health insurance then we'd ever had before. So much so, that this year we elected not to pay for Health Insurance. In contrast, my little sister is a many decade meth addict, EBT carrying, scurrying from the bright lights great sponge on society - with heavily subsidized Gold ACA coverage.... Gee, I'm not a fan of ACA as it is now. And surprise, she thinks it rocks!

 

Yep I want changes. Yep I want to help those that 'can't' (Vs 'won't') help themselves (BIL is very low functioning Down Sydrome, and l feel myself, and society, have an obligation to help him, and likewise...). Yep I want no pre existing blocks. Yep I want a right to choose yes or no to living. Yep I want less overhead and non value added portions of our overall medical landscape removed. Yep I want medical professionals to make a good living, and return on their efforts to become educated. Yep I want less profits, and actually would prefer a Nationalized Health Coverage for all. Yep, I sure don't want Congress to have a different Health Coverage then all of us...

 

I could (As some of you know!) go on. But I'll stop, with only two more 'Yep's'. Yep, I'd like to know what happen to Jimmy Hoffa. And, Yep, I'd also like see an amendment for term caps in congress....

 

ACA a success? Sure, for those it helped. ACA a success? Many feel it is a failure! --- It all comes down to the ones that are given too, vs those that are taken from...

 

Once I get smart enough to figure out how to stay out of these kinds of threads - I'm sure I'll come up with first a USA comprehensive reform plan. Then roll it out thru the rest of the world....

 

Don't wait up for me! And best to all,

Smitty

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