Steely_D wrote:

+1

 kurtster wrote:

<Polyanna>Of course, that advocate is their primary physician.</Polyanna>

I developed a smile as I said, to more than one person who came in with their Good Housekeeping list of tests they wanted, "Would you like fries with that?"

After they recoiled and understood what I meant, I gently said, "What you really want is high quality medical care, and that's what I'm here for. Tell me what's up and we'll work on it together." And - usually but not always - they got it. The ones that didn't were ingrained with the "they're all liars and cheats and you have to fight for what you want!" mentality.

IMHO, I wanted no part of that sort of relationship. Good Housekeeping medical advice was replaced with the internet and Oprah and Dr Oz and now AI. Glad to be out.

Back to the topic of politics: Every day without universal health care coverage, not predicated on being employed, is a failure of our nation's leaders. Shameful at best, tortuous and murderous in reality.

BTW, screw the AMA, which allows ads for drugs on TV, Dr Oz in a position of leadership, and fails at advocacy for our nation's healthcare. They're worse than worthless, because they wear a cloak of importance, while failing at their job.

 kurtster wrote:
I'll try to keep this short... but we're aligned on this.

Trusting someone is critical, but so is the ability to responsively act. Referrals, networks, and other connections beyond the advocate need to be made with immediacy and without all of the useless noise that insurance creates.

That human (the advocate), and others "downstream" in treatments, need to be able to direct care through the system quickly and completely. If they say "do it", there shouldn't be someone remotely deciding it's not necessary. All treatment should cost something, as services are rendered. I think co-pays are a good thing. Financial ability for copays should be driven from your tax return, not which of the 15 plan levels you decide. The complexity drives costs, and profits, with zero benefit to the patients or healthcare providers.

Part of the reason that many avoid the doctor is because of the complexity and the deductible/co-pay system.  US healthcare now has the reputation of being expensive, and understanding what you pay is incredibly difficult.  The current system rewards not seeing a doctor.  If you want to encourage participation, create a surcharge for those who don't see someone each year.  The longer the avoidance, the higher the surcharge.   

So what I first responded to, and what I took as Islander's point, is that there are technological ways to streamline all of this and remove the vast majority of the complexity... IF... you're willing to accept that the for-profit insurance industry no longer delivers value in the US.  There is no balancing of efficient, affordable healthcare and shareholder returns.  They can not, and do not, support one another.  They are polar opposites.

We've also reached a point in our capitalist evolution that the connection to healthcare via employment is an impediment to both employment and healthcare.  It's time for a divorce.

I'm pretty sure we're all mostly aligned on this stuff... and to the realization that no politician yet has found the energy to take on the system.  At some point it will be a necessity, not something that can be argued for decades.  Technology makes the changes easier than ever...if someone will take on the healthcare industry.

Last thought... the stress that healthcare administration puts on everyone needs to be alleviated. It's insane to think that someone like Luigi Mangioni can garner any support for murder, but the frustration is real, and nothing ever seems to get easier or less expensive.  

A system as a whole can only be as good as it's worst member.

To my knowledge drawn mainly from personal experience, a health-care system with free access for all doesn't automatically work in the best way. Instead, it may have many issues. Here's one.

Two subsequent generations of fully insured patients (women) have been subject to histerectomies by more than 80%, just because some nutface in power said these surgeries were fully covered by public insurance, because of "studies". Same goes for knee and hip joint-replacements, etc. - Such waves of cashing-in always are being followed by further costs to the system as a whole.

Any "market" is easily exploited, as long as any actor's heart isn't guided by the will to serve all members of the system.
Health-Care should be covered for all, as all pay taxes. 

The path to an incorrupt system of health-care seems eons away from materialising, just as most any & all public endeavours. No Endsieg in sight, neither in reasonable economics, nor in political ideas applied in practise, not in health-care either.

UTOPIA - yet another goal to thrive for, for all of us.

Then perhaps the end result will be:
WE are all of us. Who are you?

 steeler wrote: 
I'm going to foolishly jump in on the advocate thing.

A critical part of any major treatment is having an advocate.  Even a knowledgeable patient needs someone trustworthy a step back watching and taking notes.  

I say this as someone who has been in a doctors office roughly once a week for the past 15 years.  Every other Wednesday at minimum.  And not in a lower tier outdated facility.

I am willing to say that I cannot see any medical system that deals in treatments of pathological situations and surgeries that can be designed to be foolproof and not require any human oversight on the patient's behalf.  Kinda like someone who acts as their own attorney ...

And then access does not guarantee care or outcome, at any level.

The best illustration I have for this is the unfortunate death of local Congresswoman Stephanie Tubbs Jones that happened right at the beginning of my medical odyssey and the whole health care debate in 2008.  She had access to the best health care in the US.  You got to use it properly or it doesn't matter how good it is. Point is that with regular visits a condition like hers would most likely have been detected and treated at some level. 

*You got to show up in order to get the proper care that you may not know that you need

Then there is the rest of the mess.  Address these issues first and then redesign a system around those results.  What ever is needed will have to be integrated into the existing system.  Can't start from scratch on this.

Of course this is in the perspective of  "a perfect world", which there ain't no such thing.

.
*  This is an afterthought on the showing up part.  Way back when discussing this in the days of the ACA discussion, the Japanese model was brought up where the individual or patient had to see a doctor on a regular basis whether they needed one or not in order to keep their health insurance coverage in effect.

Going around in circles does wonders for the status quo.

 black321 wrote:

Those are great, but have their own issues at the scale needed.  We could also do what EVERY OTHER MAJOR INDUSTRIALIZED COUNTRY has done, and implement a flavor of universal health care. And since we sat on our ass for so long while everyone else went forward, there are dozens of great examples that we can look at and cherry pick the best parts. We already know what works and what doesn't.

 islander wrote:

There could be ways to work within our current systems/markets. 
Some of this is tied back to stock ownership - maximize profit ideology.
That may be fine if you are selling tshirts or even cars.
But other industries like healthcare, no. 
Get rid of the stockholders and bring in the stakeholders. Return to mutual insurance cos, where policyholders own the insurer. 
I believe more of these, coops, esops...could help correct some of the big getting bigger issues, without the other side of the evil coin - more gov intervention. 

continuing on the healthcare topic...The Conference Board holds free conferences discussing lots of different issues. Here's one on healthcare. 

The US health care system is undergoing important changes as rising costs, workforce shortages, and shifting Federal budgets and priorities are redefining how Americans access and pay for care. Policymakers and business leaders face the challenge of sustaining affordability and quality while ensuring that vulnerable and aging populations can access care. CED has long advanced solutions that promote market-based innovation, fiscal responsibility, and broad access to high-quality care.

This webcast will explore practical approaches to achieving those goals in today’s evolving health care environment. Join us for a timely discussion on how current reforms, fiscal pressures, and market trends are reshaping public and private health care—and what they mean for employers, providers, and consumers.

https://www.conference-board.o...

 black321 wrote:

Lots of things all convoluted and crosslinked, let me add one more - The CEO I mentioned - he was CEO of a non profit. His pay package was structured much more like yours and mine (only ridiculously larger). He paid a LOT of taxes. But since the organization was a Non-profit, they paid no taxes, and all the money paid to the CEO (including the $s passed on as taxes) were and expense to the company. 

Our entire system is a complex game that has been rigged for the benefit of a few at the expense of most. 

 steeler wrote:

Yes. More evidence of the Us v. Them, haves and have nots, big getting bigger, rich getting richer...
It's everywhere in our society.
I recently heard a comment that more US people took overseas vacations last year...while at the same time, the number of people facing food/shelter insecurity is the highest in decades. 
GOP is clearly catering to the Us part...while doing a great job marketing to the Thems they will make their lives better too. 
Democrats are stuck in last year's model, leading to the rise of socialists/progressives, whose messaging is getting better. 

 rgio wrote:

I think a stumbling block is that the current system presents as one of winners and losers, and those who, rightly or wrongly, see themselves as winners (“I want to pick my own doctors” and have access to the best doctors and facilities) do not want to risk their perceived status in a change to universal healthcare.  To me, an indictment of the system is the mantra “you have to have an advocate or be your own advocate” to navigate the system and get good care. 

 islander wrote:
Absolutely correct!

It is the single greatest problem facing employment, innovation, and growth now... healthcare makes hiring people inefficient. Healthcare is now approaching 20% of GDP.  It's insane.

The concerns about "quality" and "access" are pointless... My BIL needs to see an internist specialist after being in the hospital this week... he was given an appointment in February.

 islander wrote:

Taking insurance profits out would help...a little. 
Last year the top 5 insurance cos  generated net profits of $27B...but thats for all their business lines and only represented ~0.5% of healthcare spending. Even if you look at operating profits- about $55B - that's only about 1% and maybe the rest add 0.5% - 1%. The counter argument is these companies are more efficient than gov management. 

The bigger issue is these cos are all now vertically integrated - involved in not just insurance but also pharmaceuticals, managing Rx claims and providing care themselves. So not only have they grown to control the insurance market but the overall healthcare market.
And the biggest issue is how opaque the whole supply chain is around pricing. The whole thing is overly complex and more bandaids will only make it more complex.
We need to redo the management of our entire healthcare industry...but of course neither side will actually do that. 
ps, I also am a big proponent of universal care. It's the best way for controlling costs...not to mention the morality issue. 

 black321 wrote:
This is partially correct. But the top 5 US healthcare insurance companies have seen a  230% increase in PROFITS since the ACA. That is a significant contributing factor to the premium increase and it's not like they weren't making money initially (one of our clients was a CEO for a non-profit health insurance company, we worked on his yacht). 

Again, we are the only major industrialized country that doesn't have some kind of universal health care.  It's time. It's doable - we have the advantage of 100+ working models to cherry pick from. It is just the entrenched interests making money from the current system that are holding everyone back. 

I did say - Put the ball in the GOP's court...who of course are not interested in negotiating a new plan.
this is more of a negotiating strategy, than an actual effort to reinvent our healthcare, which given the GOP stance then (during Obama) and now will never happen.

The history is, Obama forced through a flawed plan to placate the insurance companies, a clear beneficiary of ACA, without any GOP support and very mixed/marginal public support. 
The GOP then proceeded to gut a key ingredient - the individual mandate - which incentivized only the sickest to participate in the marketplaces, while the healthy chose to forego insurance. This was important because the individual mandate was needed to ensure everyone was in the risk/insured pool to create diversification, smooth out claims and reduce overall costs. Again, only the sickest are choosing to become insured and thereby helped lead to the runaway premiums we currently have.

Back to the point, the democrats are essentially arguing to increase payments to insurance companies, and not to help lower healthcare costs and increase healthcare coverage. If they want to get public back on their side, agree to a short-term fix while arguing to go back to drawing board to fix our healthcare system. But, again GOP doesnt even want to start and most democrats dont really want to fix healthcare, because that means pissing off a lot of big cos - United, CVS, Cigna. 

 black321 wrote:

"A simple solution for the democrats - argue for another s-t extension, 6-12 months, as the negotiate a new health plan."

I invite you to read a history of US healthcare and healthcare reform—or at least a recounting of the struggle to get the ACA enacted. Obama's biography would be one place to go. 

The ACA was a titanic struggle. Obama was ready to give up on the plan and go for piecemeal progress. Nancy Pelosi pushed it over the goal line. 

It cost the Dems dearly in the mid-terms because there was a struggle to roll it out and because people wanted Obama to work on job creation first. 

So no one is just going to hash out "a new health plan" anytime soon. The best you can  hope for, I think, is that the next Dem president will push for gradual expansion of Medicaid and Medicare as well as strengthening of the ACA. 

I think we can all stop listening to the GOP when it comes to healthcare. As Islander pointed out, they pushed the notion of "repeal and replace" but only had plans for the first step of that slogan. 

 black321 wrote:

What evidence leads you to think the republicans have any interest in this? Trump started the 'repeal and replace' bs in 2015. It's been a decade and there has never been anything. We are one of 43 countries that don't have a form of universal health care, including such notables as Afghanistan, Iran, Nigeria and Yemen.  We are the ONLY major industrialized country without it. The ball has been in their court forever and they have done nothing with it. 

The democrats are pushing for subsidies, to essentially increase payments to insurance companies.
Both parties have contributed to the ACA’s shortcomings, as unintended consequences have driven premiums to unsustainable levels.
A simple solution for the democrats - argue for another s-t extension, 6-12 months, as the negotiate a new health plan.
Put the ball in the GOP's court...who of course are not interested in negotiating a new plan.