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Kirk W

Where will healthcare go in the near future?

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JM,

 

The best thing one can do is too choose their grandparents well. Everything else we do is all to maximize the good genes and minimize the bad genes. My husband never smoked, has done everything he should, but his ancestors from Ireland died from atherosclerosis and he, and his brothers, are all dealing with various complications from this fact. None of them smoke, none of them did anything to exacerbate the problems, in fact all have lived longer than their father or grandfather or great grandfather, but all have experienced serious problems because of it. Thankfully because of access to good educations and working in jobs were good health insurance was/is available, they are all still alive. not everyone is as lucky

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There are MANY ways to improve what we have today, and at a reasonable cost. You will never get everyone to agree to it, though.

 

I'm no fan of the ACA - my observation is that overall it is a failure, and it is pretty easy to enumerate the reasons why. What is not so easy is to get anything concrete done to fix it. Personally, I would advocate some major overhaul, but leave it in place. Because it is so unlikely to get another comprehensive bill passed that I doubt the Republicans can do it in a reasonable fashion. Hopefully, I'm proven wrong and things will improve for everyone.

 

Personal responsibility should be the underpinning of any change. Meaning responsibility to manage your health care in a preventative fashion. Any barriers to that should be removed....and there are MANY, for MANY people.

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Personal responsibility should be the underpinning of any change. Meaning responsibility to manage your health care in a preventative fashion.

 

Jack:

 

I agree that personal responsibility should be an objective. But despite the fact that it's a good sound bite, I contend that creating a plan to do that is far harder than one might think. As usual, the devil is in the details.

 

The "dog whistle" about personal responsibility in healthcare often brings to mind visions of poor people wasting their limited food dollars on soda pop, cracklins, bacon, and who knows what else. But, in fact, many (if not most) Americans have poor diets resulting from overconsumption of prepared and restaurant foods along with far too many calories, in general. So the problem isn't limited to the poor--plenty of relatively affluent families have diets that don't meet nutritional standards and a relatively small percentage exercise anywhere near recommended levels.

 

So, are you proposing that health insurance premiums be scaled with BMI (body mass index)? Should they also factor in how often we scan our health insurance cards at the gym? Maybe we should submit our weekly meal plans along with photographic evidence that we actually served the proposed food?

 

The bottom line is, are you prepared to deny life-saving medical treatment to someone who has high cholesterol, high blood pressure and Type II diabetes because they "clearly" have failed to take adequate personal responsibility for their healthcare? Although I'm sure that some would say "yes" to that question, I suspect that most have a more compassionate view of the issue.

 

I don't mean to trivialize your issue, but my contention is that it's a lot easier to make the statement than to implement it. Personally, I side with those who believe that health-care in a developed country such as ours should be a right of citizenship, not a privilege. Sure, some will abuse the right, but that's true with every other right we hold dear. For example, I may dislike what someone says but I will defend his right to say it. In this case I may deplore someone's lifestyle choices, but I will be there to provide care should he need it. IMO compassionate care includes care for those who don't care for themselves.

 

Joel

Edited by docj

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I'd be more interested in a story I can read without being a subscriber to the Wall Street Journal - which will never happen. :)

I didn't realize that the link was going to do that as I read the entire thing and am not a subscriber. I just found another source for the article which seems to take a pretty hard look at the near future.

 

Republicans must sell their replacement to ObamaCare—the way the president didn’t.

Edited by Kirk

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The best thing one can do is too choose their grandparents well.

How very true, along with living right as a child.

 

A large part of our problem is that healthcare is a for profit business.

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Thought this may be of interest to read one doctors point of view: Why We Stopped Accepting Insurance

 

Here is their alternative to insurance: http://ciampifamilypractice.com/terms-conditions/

 

Their helpful links are an interesting read: http://ciampifamilypractice.com/helpful-links/

 

There are some things he said that just dont make sense.

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JM,

 

Why is it that ophthalmologists, radiologists, orthopedic surgeons, nephrologists, neurologists, cardiologists, dermatologists, internists, gastroenterologists, retinologists, etc. in Mesa all seem to be able not only to stay in business, but do quite well, all the while excepting Medicare. Yes, because of the large retiree population in Mesa, it does mean that there is a volume of patients so physicians/hospitals make money. But also, most of those disciplines have expanded because Medicare provided a guarantee of a payment for procedures, which meant hospitals could plan, and if payment was there, then physicians and researchers began looking for ways to keep their patients going for longer periods of time. Cataract surgery was rare in 1960 (my grandfather was just about completely blind by the time he died) - forward 60 yrs and cataract surgery (which is by and large an 'old people' problem) is done on an almost assembly line system at outpatient surgery centers all over the country. No laying still without movement for days, you are up and out in 30-40 minutes following surgery, looking at new colors with drops to keep swelling down and a cover to wear at night so sheets don't touch eyes. Just one example of how things progress - there are thousands of others in every field.

 

When my grandfathers died, before Medicare, it was from pneumonia, because there was no health insurance to cover them, no effort was expended - they were 80/83 and that was what everyone excepted for someone their age. My 94 yr old mother had pneumonia last spring - immediate aggressively treated at the hospital in Everett, WA and she will celebrate her 95th birthday this summer. Medicare covered the treatment. Should she have just been made 'comfortable' and allowed to die? Mind you, she still walks 1/2 mile each day, is active in the Seniors Writing Group in the town she lives in, enjoys a glass of wine 1-2 times a week, etc.

If we see health care as a right, then the country works towards making sure everyone receives the proper care, which encourages research and innovation. The only people who would be hurt by universal coverage (aka, Medicare for everyone) would be for-profit insurance companies. Physicians, nurses, researchers, etc., would all know that their work was needed, innovation in treatment, in prevention, in finding different avenues, and as a result of helping to keep people healthier, the economy improves, etc.

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I can't wait to see the "solutions." I am with you Joel. I miss compassion, honor, tolerance, inclusiveness, facts, and journalism, not jingoism.

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Joel, I agree with what you said. When I say personal responsibility, I mean the ability to manage your healthcare yourself, to the extent possible. To do that, you must have good insurance and the ability to access health care. And you must have the will/education to handle issues before they become critical. THAT is easier said than done, but with some education things would progress. The education aspect is pretty important in my opinion. It would not change fast, but eventually things would improve, but not be perfect, and costs would at least stabilize, if not come down. I'm definitely a "small federal government" supporter, but when it comes to health care, like defense, a government backed health care system seems to make sense. But certainly not structured the way the current system is.

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When my grandfathers died, before Medicare, it was from pneumonia, because there was no health insurance to cover them, no effort was expended - they were 80/83 and that was what everyone excepted for someone their age. My 94 yr old mother had pneumonia last spring - immediate aggressively treated at the hospital in Everett, WA and she will celebrate her 95th birthday this summer. Medicare covered the treatment. Should she have just been made 'comfortable' and allowed to die? Mind you, she still walks 1/2 mile each day, is active in the Seniors Writing Group in the town she lives in, enjoys a glass of wine 1-2 times a week, etc.

If we see health care as a right, then the country works towards making sure everyone receives the proper care, which encourages research and innovation. The only people who would be hurt by universal coverage (aka, Medicare for everyone) would be for-profit insurance companies.

While there are parts of this I agree with, I can't say that I totally agree. With a single payer plan, would we then buyout the existing health insurance industry, or just nationalize them and leave the owners with empty pockets, or some other plan? Remember that most insurance companies are publicly held stock companies and even your investment portfolio may well include some of them and so would suffer. It really isn't all that easy to do, and even those of us who are on Medicare do not all have the same exact coverage since some have no supplement at all, while others of us have the ability to buy a supplement that allows us to pay nothing out of pocket at all other than the premiums. A few are even fortunate enough to have those premiums paid by a former employer! Medicare is not a program that is equal for everyone. Don't forget that someone has to pay for these programs.

 

At least some of the citizenry is also concerned about the control side of things for questions such as what age we stop spending vast amounts to keep people alive. With our current system, those who have good coverage can do much more than those who have only Medicare because of economic ability but would a single payer plan be one that pays an unlimited amount for as long as the patient or patient's family asks it to do so? It simply comes down to the fact that truly free people are not equal because they don't all have the same abilities.

 

Universal care for all is a very desirable goal, but reality is that in order to achieve it we must also pay for it and stop just increasing the federal debt until our society collapse's under the burden. Party politics really shouldn't be a part of the debate, but unfortunately it seems to have become the main point.

Edited by Kirk

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While there are parts of this I agree with, I can't say that I totally agree. With a single payer plan, would we then buyout the existing health insurance industry, or just nationalize them and leave the owners with empty pockets, or some other plan? Remember that most insurance companies are publicly held stock companies and even your investment portfolio may well include some of them and so would suffer. It really isn't all thateasy to do, and even those of us who are on Medicare do not all have the same exact coverage since some have no supplement at all, while others of us have the ability to buy a supplement that allows us to pay nothing out of pocket at all other than the premiums. A few are even fortunate enough to have those premiums paid by a former employer! Medicare is not a program that is equal for everyone. Don't forget that someone has to pay for these programs.

 

 

 

 

 

Kirk:

 

Many people are unaware of the fact that the Social Security Administration employees thousands of contractors to manage portions of the process. My former employer, Lockheed Martin, has been providing support to SSA for decades. I would expect that any "federalization" of the health care industry would require thousands of contractor employees to perform tasks, such as claims adjudication and payment. Even if a "Medicare for All" approach was adopted, the existing staffing would be overwhelmed by the addition of new recipients.

 

It has been my assumption that if a single payer plan was adopted many of the needed contractor employees would, in fact, come from the existing health insurance industry. Rather than being stand-alone insurance companies they, in essence, would re-formulate themselves as operational support for the single payer program. I realize this is a simplistic explanation and there probably would be upheaval in the insurance industry. But, in the long run, it does seem logical that the best qualified people to support a single payer program are already employed in the healthcare insurance industry.

 

Joel

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Can you be more specific?

 

From one of the links:

 

"The second is ethical. Part of the PP/ACA legislation establishes Accountable Care Organizations. These a revival of the HMOs we all hated so much in the 80’s and 90’s, but worse. In this model, a health care organization (usually a hospital and its employed physicians) is given a lump sum of money to take care of a set number of patients. If the organization spends less than the government gives them, they make money. If they spend more because the patients are sicker than expected, the hospital and the doctors have to write checks to the government for the balance. Our margins are already so thin, doing this would break us. The obvious ethical dilemma is that providers will be incentivized to not provide services for our oldest, sickest, and most vulnerable patients if they are to survive financially."

 

The part in this paragraph where it says that if the organization spends more that what the government gives them, then they owe that amount to the government. Looks to me like if the organization spends more than what the government gives them, then it is a business loss. If the author saying that the government is telling them how many patients they have to see, and how much the government will pay, and that the organization has no say in the matter?

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One of the biggest problems in finding a way to make healthcare more available to all at a lower cost is the fact that so few American citizens trust the government today. When you turn your healthcare system over to the government to control and manage, you are literally putting your life in the hands of the politicians. Does the management of other resources by our government make you feel confident in doing this? If we do turn our healthcare system over to government management, do you really think that we would be able to then take control back if we don't like the result?

 

Questions like these play a major role in the reluctance of those who have good healthcare now to let the government take over. What we have may not be ideal, but at least we have it. It is much less difficult to convince those who have little or no healthcare to support changes but when you have reasonably good care now, what guarantee do we have that any new federal system will make it better or less costly? As much as I agree that it would be a good thing to get at least some sort of coverage for everyone, I am very reluctant to surrender what I have now to get a promised improvement from a federal government with the management history ours has.

 

When someone can show me a plan that will not take away any of the benefits we have, and that will help others without running up more and more debt, I will support it. Any plan must also be paid for by someone.

Edited by Kirk

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We have 60 yrs of history with Medicare. Millions of boomers are counting the day until they can qualify for coverage. Seems to me that is a pretty good model. Have anyone meet people who want to get rid of their Medicare?

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While Medicare seems to be good for some the payer doesn't seem to be able to pay for it. Politicians need to do something before it goes broke. There is more fraud than I think there should be and trying to fix a medicare payment problem is a real trial. If a way could be found to pay for and provide a single payer system run by professionals it might be a way to remove some of the political pressures. Medical advances are thundering ahead just like all technology and depending on political management to keep up is not comforting to me. Especially when we talk about care restrictions to save money.

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I subscribe to the NYT so if this is behind a pay wall, I apologize. Mr Trump made a statement today urging the immediate repeal of the ACA and saying he wants the plan replaced "shortly" thereafter. It is pretty clear they can not pass a replacement shortly thereafter so this puts a lot of pressure on them. Mr Trump's statement contradicts what Rand Paul states the Mr Trump told him just a few days ago. Paul is one of the senators that has indicated he will not vote for repeal until a replacement plan is ready. Will be interesting to see if these senators stand up to the President-elect. We are going to get changes but hopefully not fast sloppy changes. https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-donald-trump.html?emc=edit_na_20170110&nlid=58667151&ref=cta&_r=0

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With a single payer plan, would we then buyout the existing health insurance industry, or just nationalize them and leave the owners with empty pockets, or some other plan? Remember that most insurance companies are publicly held stock companies and even your investment portfolio may well include some of them and so would suffer.

 

How about having a "government" health plan as an option in addition to insurance companies? If people still like what the insurance companies are selling, the insurance companies will do fine. If people prefer the government health plan, the insurance companies won't do fine, but that will be the market talking, and companies tank all the time, taking the shareholders along with them. I don't think shareholders in insurance companies deserve protection that shareholders in other companies don't have.

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How about having a "government" health plan as an option in addition to insurance companies? If people still like what the insurance companies are selling, the insurance companies will do fine. If people prefer the government health plan, the insurance companies won't do fine, but that will be the market talking, and companies tank all the time, taking the shareholders along with them. I don't think shareholders in insurance companies deserve protection that shareholders in other companies don't have.

 

No private industry of any type could possibly compete with the non-profit, taxpayer subsidized government.

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No private industry of any type could possibly compete with the non-profit, taxpayer subsidized government.

Unless healthcare proves to be quite different, there are many situations where this has been disproven. The profit motive tends to increase efficiency while the government employee gains rewards by managing more people and larger budgets. Of course this is also dependent upon the citizen realizing that the taxes he pays are a part of his healthcare costs. I suppose we could continue as we have for many years by just spending away in government while adding to the national debt......................

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... I suppose we could continue as we have for many years by just spending away in government while adding to the national debt......................

 

Whether healthcare is run by the government or by private industry means nothing until there are controls on the price of healthcare. Supply and demand does not work in the healthcare business.

Edited by Paul Stough

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Paul Strough said "supply and demand does not work in the healthcare business."

 

Many find this a controversial statement but when you combine the extremely high capital requirements of setting up an equipped hospital in a certain geographical area, the relative lack of choice and price transparency of products and combine that with the get it or die necessity of the product, it just makes sense the normal supply and demand rules don't apply.

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Paul Strough said "supply and demand does not work in the healthcare business."

 

Many find this a controversial statement but when you combine the extremely high capital requirements of setting up an equipped hospital in a certain geographical area, the relative lack of choice and price transparency of products and combine that with the get it or die necessity of the product, it just makes sense the normal supply and demand rules don't apply.

 

 

Since supply and demand does not work in the healthcare industry, that is why there needs to be some other form of control on prices of goods and services related to healthcare, otherwise, we are going to continue to see such outrageous prices such as the Epi-Pen.

 

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