U.S. Politics: The Bipartisan Dismemberment of the VA

[lokisnow]

The major thing the affordable care act avoids addressing is provider compensation. A big part of why American healthcare is so expensive is that we pay our hospital staff very well across the board. When doctors and nurses and support staff are willing to take a couple decades of wage freezes or a few years of wage cuts we might be able to reduce insurance premiums, but if we're not willing to control wages then we're not willing to reduce insurance premiums.

those prices thinker is talking about are so high because hospital staff gotta get paid. If you institute draconian price controls, they ain't getting paid.

they ain't getting paid they ain't going to workl big problem. So a few $60 qtips and everyone's happy except the uninsured person stuck paying for $60 qtips.

[aceluby]

9 hours ago, lokisnow said:

The major thing the affordable care act avoids addressing is provider compensation. A big part of why American healthcare is so expensive is that we pay our hospital staff very well across the board. When doctors and nurses and support staff are willing to take a couple decades of wage freezes or a few years of wage cuts we might be able to reduce insurance premiums, but if we're not willing to control wages then we're not willing to reduce insurance premiums.

those prices thinker is talking about are so high because hospital staff gotta get paid. If you institute draconian price controls, they ain't getting paid.

they ain't getting paid they ain't going to workl big problem. So a few $60 qtips and everyone's happy except the uninsured person stuck paying for $60 qtips.

I know some nurses, and for the hours they put in they don't get paid nearly as well as you are suggesting.  A quick google search shows average pay of a nurse to be $70k.  Suggesting that they should take a couple decades of freezes or wage cuts is frankly ridiculous.

There isn't a single source of why healthcare is so expensive.  It's a combination lots of things.  Yes, 75% of every dollar collected goes to supplies, staff costs, and keeping the lights on; however there are many, many dollars that are not collected.  Insurances deny claims every day.  People don't pay every day.  Hospitals sell debt for pennies on the dollar.  Hospitals will settle for as little as 10% of the billed cost to insurance companies.

So yeah, there's a $10 qtip that Joe Shmoe will be on the hook for because he doesn't have insurance, but the big insurance company that has worked for that hospital will get the qtip adjusted to $1, or $.50, or $.10.

To put blame on the people going to years of college, providing the care, and working crazy hours is just providing a scapegoat to an entire system that is being gamed for billions in profit.

[White Walker Texas Ranger]

15 minutes ago, aceluby said:

I know some nurses, and for the hours they put in they don't get paid nearly as well as you are suggesting.  A quick google search shows average pay of a nurse to be $70k.  Suggesting that they should take a couple decades of freezes or wage cuts is frankly ridiculous.

There isn't a single source of why healthcare is so expensive.  It's a combination lots of things.  Yes, 75% of every dollar collected goes to supplies, staff costs, and keeping the lights on; however there are many, many dollars that are not collected.  Insurances deny claims every day.  People don't pay every day.  Hospitals sell debt for pennies on the dollar.  Hospitals will settle for as little as 10% of the billed cost to insurance companies.

So yeah, there's a $10 qtip that Joe Shmoe will be on the hook for because he doesn't have insurance, but the big insurance company that has worked for that hospital will get the qtip adjusted to $1, or $.50, or $.10.

To put blame on the people going to years of college, providing the care, and working crazy hours is just providing a scapegoat to an entire system that is being gamed for billions in profit.

I'm not blaming anyone. It's just the way it is.

[Swordfish]

13 hours ago, ThinkerX said:

 

We have had entire threads dedicated to this in years past.  Have you somehow forgotten?

For starters, pretty much the entire pharmaceutical industry.   Remember that greedy idiot who inflated the price of the one pill set by something like 700% last year?  Extreme example, but common throughout the industry.  And the boardroom types behind these pills have little or no regard for others.  I don't have television any more, but I do visit the folks place now and again where the channel is always set to Fox.     There, I pay as much attention to the commercials as I do the actual shows. 

 

So, every half hour there is a set of prescription drug adds - the ones that start off ' feel this? well you may suffer from such-and-such.  But don't worry, we have this wonderful new pill...and then zip to the end where there is a lightning quick spiel about possible side effects, often far worse than the supposed disease.   Next cycle, well there is a notification about pending class action lawsuits against the wonder pills from a couple years ago.  And it just continues. 

 

And no, I don't buy the 'research' excuse.  The 'research' is solely directed at profit, making each new wonder pill just a hair different from its predecessors.

 

That's pills.  The other thing is billing practices.  Don't you remember the big cost comparison studies?  Hospital 'A' charges $20,000 for a given procedure, while Hospital 'B' across town charges $2000, and Hospital 'C' three towns over charges $60,000.  Nor is this isolated.  It is across the board, all procedures.  And our insurance/Medicaid system is set up to encourage this sort of criminal behavior.  My view, knock those prices down to the low mark with draconian price controls.  If some complication warrants an increase, then they better be able to justify that as well.

 

Even hit me a few years ago.  Went to the emergency room for road rash after piling up but good on the bicycle.  They slapped a soft bandage on me, gave me some over the counter pills, and some cleanser.  When, the bill came, they tried to tell me that stuff - available for maybe $20 at the store - was worth well over $200.  That on top of the $2000 bill, though I saw a grand total of two doctors for all of ten minutes.  I took advantage of the poor persons discount and got that tab dropped 75%.  Other people here have very similar stories. 

 

 

 

 

 

Anecdotes are not evidence.  None of this is proof of ' fraud and unethical profiteering', nor does it address scale at all in  way that validates your claim that reducing 'fraud and unethical profiteering', even assuming they exist which I'm not convinced they do to a substantial degree, would reduce healthcare costs by 'a fair amount'.

it's not like countries with socialized medicine are not also facing cost concerns.

 

[DireWolfSpirit]

So skipping the tit for tat debate over singleing out vested parties, could we look at the overall systemic ideas for making healthcare more economical in the U.S.? It doesnt seem to be one culprit that has brought the overall HC industry to such an expensive place but rather a collection of factors. If we focus on just drug prices or Nurse wages we are still ignoring other factors and third party layers that have contributed to bringing us the Worlds most expensive HC on one hand, yet an industry that doesnt measure as the Worlds best on the other. Were paying Cadilac prices for a Yugo delivery. Is it possible for the U.S. to adopt more of "the Best Practices" from other countries, to improve the equation of "what we pay for what we get"?

I dont like paying for a fu@&ing Caddy and getting a Yugo, how much longer can this stand?

[Swordfish]

42 minutes ago, DireWolfSpirit said:

So skipping the tit for tat debate over singleing out vested parties, could we look at the overall systemic ideas for making healthcare more economical in the U.S.? It doesnt seem to be one culprit that has brought the overall HC industry to such an expensive place but rather a collection of factors. If we focus on just drug prices or Nurse wages we are still ignoring other factors and third party layers that have contributed to bringing us the Worlds most expensive HC on one hand, yet an industry that doesnt measure as the Worlds best on the other. Were paying Cadilac prices for a Yugo delivery. Is it possible for the U.S. to adopt more of "the Best Practices" from other countries, to improve the equation of "what we pay for what we get"?

I dont like paying for a fu@&ing Caddy and getting a Yugo, how much longer can this stand?

I disagree with your assessment of the situation.  healthcare quality in the US is actually quite high.  Where you see it falter against other countries is when you factor in access.  but the care itself is pretty exceptional for those who can get it and afford it.  generally, people in the US who have access to healthcare are pretty happy with the care they receive.

Our healthcare system is hardly at the level of yugo, and i don't know how you even begin to have a conversations about it if you're going to poison the well like that from the outset.

 

 

[aceluby]

3 hours ago, White Walker Texas Ranger said:

I'm not blaming anyone. It's just the way it is.

Didn't say you did, I quoted lokisnow who said the reason for high costs ($60 qtips as the example) is because of high cost of labor and that nurses should spend 20 years at a wage freeze, as if that would do anything but reduce care and people willing to go into the field.  It's just not that simple and the healthcare industry likes that it isn't that simple so the charade between care and insurance can continue for massive profits with patients (and the insured who don't utilize their insurance) caught in the middle.

[ThinkerX]

8 hours ago, Swordfish said:

Anecdotes are not evidence.  None of this is proof of ' fraud and unethical profiteering', nor does it address scale at all in  way that validates your claim that reducing 'fraud and unethical profiteering', even assuming they exist which I'm not convinced they do to a substantial degree, would reduce healthcare costs by 'a fair amount'.

it's not like countries with socialized medicine are not also facing cost concerns.

 

From my standpoint, you appear to be going to considerable lengths to remain deliberately ignorant.  But, here you go:

http://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/#643ad91a5cc4

 

One of the several articles posted and debated here in the past.

 

For the very first time, the federal government is publicly releasing the “rate card” (the full charge before insurance company discounts) prices hospitals throughout the nation charge for the one hundred most common procedures and services. The huge amount of data made available covers claims filed with the Center for Medicare & Medicaid Services (CMS) in 2011 and includes 163,065 separate charges from 3,337 hospitals in 306 metropolitan areas.

Take a look at this fascinating graphic provided by

The Huffington Post showing the comparative pricing for treating chronic obstructive pulmonary disease (COPD) in the New York area. Note that the average amount charged by the Bayonne Hospital Center, located in New Jersey, for the treatment of COPD is $99,690 per patient while the Lincoln Medical and Mental Health Center in the Bronx, New York—approximately 20 miles away—charges just $7,044 per patient for the identical

  (apologies, quote issue)

 

director of the Center for Medicare ,“What drives some hospitals to have significantly higher charges than their geographic peers? I don’t think anyone here has come up with a good economic argument.”

So, is this information proof positive of the benefits of consumer driven healthcare? Now that we see these ridiculous disparities, will consumers of healthcare be motivated to avoid hospitals that are charging grossly inflated prices in favor of lower-cost facilities, forcing the more expensive providers to lower their prices in order to compete?

Maybe. But today’s news is hardly going to come as a surprise to the private health insurance companies who have been complicit in this charade for so many years. Do we not have to ask why these companies would have allowed this insanity to happen? Certainly, the private insurers have more than adequate leverage in their negotiations as no hospital could hope to survive without negotiated agreements with the largest health insurance

 

And this:

http://articles.latimes.com/2011/aug/16/business/la-fi-lazarus-20110816

The 'Reader's Digest' list:

http://www.rd.com/health/wellness/wildly-overinflated-hospital-costs/

This article gets into what I was talking about with pills:

 

https://www.drugwatch.com/2014/10/15/americans-pay-higher-prices-prescription-drugs/

 

[all swedes are racist]

In related news... These people should be trebucheted into an ocean. (Lol and "fuck you" to Martin Shkreli for being totally right if hilariously and disgustingly un-self-aware)

[lokisnow]

8 hours ago, aceluby said:

Didn't say you did, I quoted lokisnow who said the reason for high costs ($60 qtips as the example) is because of high cost of labor and that nurses should spend 20 years at a wage freeze, as if that would do anything but reduce care and people willing to go into the field.  It's just not that simple and the healthcare industry likes that it isn't that simple so the charade between care and insurance can continue for massive profits with patients (and the insured who don't utilize their insurance) caught in the middle.

I wasn't trying to advocate that, I was trying to describe that if thinker believes costs are inflated then those costs would be being inflated because of staff salaries, for example. 

In other words it is is all well and good to shriek about unfair pricing, but that pricing has a cause behind it, and he really ought to be shrieking about that cause, not the effect. 

And this should also point out that if thinker wants draconian price controls, he is actually talking about draconian wage freezes or cuts for staff, because that would be the consequence of price controls.

[ThinkerX]

1 hour ago, lokisnow said:

I wasn't trying to advocate that, I was trying to describe that if thinker believes costs are inflated then those costs would be being inflated because of staff salaries, for example. 

In other words it is is all well and good to shriek about unfair pricing, but that pricing has a cause behind it, and he really ought to be shrieking about that cause, not the effect. 

And this should also point out that if thinker wants draconian price controls, he is actually talking about draconian wage freezes or cuts for staff, because that would be the consequence of price controls.

'wage cuts or freezes for staff'...already happening at the lower levels. Gal that draws my blood at the clinic makes $14 an hour.  Clerical staff up front is in the same range.  Don't any of you here actually bother to talk with people?  Or is that useless anecdotal evidence?   Meanwhile, the hospital here and doctors associated with it (or in private practice) are gobbling up prime properties.  My take is the bulk of the rip-off proceeds in the current system go to a relatively small number of hands, compared to the total in the health care industry. 

 

Then there's the flip side.  What is sinking the ACA are all the UNHEALTHY people that signed up, folks who'd suffered for years unable to afford treatment until the ACA came along.  A major group that blindsided the insurance companies.  Treating them ain't cheap.  And the providers/insurers kept the same old corrupt song and dance going.  So costs go up, and more and more relatively healthy folks who are looking at high premiums and ridiculous deductibles are saying 'screw this' and dropping out all together. 

 

So what happens when medical costs increase to the point where nobody can afford the bills involved?   Whoops!  We are already there.

 

 

 

 

 

 

[lokisnow]

1 hour ago, ThinkerX said:

'wage cuts or freezes for staff'...already happening at the lower levels. Gal that draws my blood at the clinic makes $14 an hour.  Clerical staff up front is in the same range.  Don't any of you here actually bother to talk with people?  Or is that useless anecdotal evidence?   Meanwhile, the hospital here and doctors associated with it (or in private practice) are gobbling up prime properties.  My take is the bulk of the rip-off proceeds in the current system go to a relatively small number of hands, compared to the total in the health care industry. 

 

Then there's the flip side.  What is sinking the ACA are all the UNHEALTHY people that signed up, folks who'd suffered for years unable to afford treatment until the ACA came along.  A major group that blindsided the insurance companies.  Treating them ain't cheap.  And the providers/insurers kept the same old corrupt song and dance going.  So costs go up, and more and more relatively healthy folks who are looking at high premiums and ridiculous deductibles are saying 'screw this' and dropping out all together. 

 

So what happens when medical costs increase to the point where nobody can afford the bills involved?   Whoops!  We are already there.

 

 

 

 

 

 

Not really, the successful aca insurers offer Medicaid like products on the exchanges and their customers are largely equally happy with these same products as customers with fancier products, aca plans are likely to migrate to follow this model of success. The failed aca insurers are trying to implement employer plan types of models and are largely not working except in the largest population centers. Much of the grumbling seems to be coming from people who expect employer caliber coverage rather than Medicaid caliber coverage, and they don't like the difference.

 

Mostly, people on the exchanges think that access to coverage via the exchange is superior to being priced out of the market altogether.

 

[Swordfish]

18 hours ago, ThinkerX said:

From my standpoint, you appear to be going to considerable lengths to remain deliberately ignorant.  But, here you go:

http://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/#643ad91a5cc4

 

One of the several articles posted and debated here in the past.

 

 

 

 

  (apologies, quote issue)

 

 

 

 

I'm going to almost no lengths to do anything but ask you to back up your argument,.

No one is denying that there is some fraud and that there are issues of disparate pricing, There would be fraud and waste in single payer as well. The argument you made was that 'fraud and profiteering' area large driver of cost, and eliminating these things would make a meaningful impact on healthcare spending.

You've posted virtually nothing to support that argument.

 

 

[ThinkerX]

8 hours ago, Swordfish said:

 

I'm going to almost no lengths to do anything but ask you to back up your argument,.

No one is denying that there is some fraud and that there are issues of disparate pricing, There would be fraud and waste in single payer as well. The argument you made was that 'fraud and profiteering' area large driver of cost, and eliminating these things would make a meaningful impact on healthcare spending.

You've posted virtually nothing to support that argument.

 

 

Then we disagree.  To me, those articles and similar ones indicate that price gouging is a major cost driver. 

[Swordfish]

On 8/24/2016 at 5:14 PM, ThinkerX said:

Then we disagree.  To me, those articles and similar ones indicate that price gouging is a major cost driver. 

 

 

They don't.

I think you lack a good understanding of scope and scale here, but ok.

[DireWolfSpirit]

On August 24, 2016 at 1:48 PM, Swordfish said:

I disagree with your assessment of the situation.  healthcare quality in the US is actually quite high.  Where you see it falter against other countries is when you factor in access.  but the care itself is pretty exceptional for those who can get it and afford it.  generally, people in the US who have access to healthcare are pretty happy with the care they receive.

Our healthcare system is hardly at the level of yugo, and i don't know how you even begin to have a conversations about it if you're going to poison the well like that from the outset.

 

 

At a cost of over 17% of the GDP its not enough to pat ourselves on the back over having quality care. Americans want quality yes, but they want it at a value and they want it delivered for a fair price as a measurement of that value. If Switzerland or France or other advanced nations can achieve quality care for 8-11% of GDP, in the internet age, consumers will not be satisfied with continuing such a discrepancy indefinately.

Historical

 

The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care. The data are presented by type of service, sources of funding, and type of sponsor.

U.S. health care spending grew 5.3 percent in 2014, reaching $3.0 trillion or $9,523 per person.  As a share of the nation's Gross Domestic Product, health spending accounted for 17.5 percent. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html 

This Harvard Business Review article discusses some of the problems with American Health Care costs and some possible solutions, its very good imo. https://hbr.org/2011/09/how-to-solve-the-cost-crisis-in-health-care

[DireWolfSpirit]

^^^^ I give up trying to get the quote or edit function to work properly. For what its worth the last sentence regarding the Harvard Business Review article, belongs below the damn quote box.

[Paladin of Ice]

Maine governor and Tea Party darling Paul LePage has had a bad couple of days.

 

Quote

WEDNESDAY

Mr LePage was asked about a statement he made in January, in which he blamed the state's heroin problem on "guys by the name D-Money, Smoothie, Shifty" who "come from Connecticut and New York". 

"They come up here, they sell their heroin, then they go back home. Incidentally, half the time they impregnate a young, white girl before they leave," he said.

Speaking on Wednesday, he denied it was racist, but said that since January he had been putting together a binder cataloguing drug arrests in the state, and that "90-plus per cent of those pictures in my book, and it's a three-ringed binder, are black and Hispanic people".

Asked by reporters to provide the binder, Mr LePage replied: "Let me tell you something: Black people come up the highway and they kill Mainers. You ought to look into that."

He then stormed off, telling the reporters: "You make me so sick."

Maine daily newspaper the Portland Press Herald has reportedly filed a Freedom of Information request for the governor's binder.

THURSDAY

A reporter appeared to suggest to Mr LePage that Democratic state representative Drew Gattine had called him a racist.

Mr LePage called Mr Gattine and, when he was unable to reach him, left him an abusive, expletive-laden voice message.

The recording was released by the Portland Press Herald.

He later invited reporters from the Press Herald and WMTW TV channel to an interview to explain the voice message, and told them he wished he could shoot Mr Gattine in a duel.

 

"I'd like him to come up here because, tell you right now, I wish it were 1825," Mr LePage said. 

"And we would have a duel, that's how angry I am, and I would not put my gun in the air, I guarantee you... I would point it right between his eyes, because he is a snot-nosed little runt and he has not done a damn thing since he's been in this legislature to help move the state forward."

Rights group the American Civil Liberties Union (ACLU) said it had filed a freedom of information request for records related to the arrests of black and Hispanic people in the state.

Its executive director, Alison Beyea, said Maine police were nine times more likely to arrest people of colour for selling drugs than white people, even though white people were just as likely to commit drug offenses.

FRIDAY

The Portland Press Herald published FBI statistics which show that 1,211 people were arrested on charges of drug sales or manufacturing in Maine in 2014. Of those, 170 - 14.1% - were black, and almost all the rest were white.

At a State House press conference, Mr LePage said he was "enormously angry" at being called a racist, and restated his earlier remarks which cast Maine's drug problem in racial terms.

He said: "When you go to war, if you know the enemy and the enemy dresses in red and you dress in blue, then you shoot at red."

He added: "You shoot at the enemy. You try to identify the enemy and the enemy right now, the overwhelming majority of people coming in, are people of colour or people of Hispanic origin."

[DanteGabriel]

2 hours ago, Paladin of Ice said:

Maine governor and Tea Party darling Paul LePage has had a bad couple of days.

 

Also on Friday: the Portland Press Herald published an editorial saying, on behalf of Maine, they apologize for giving us LePage.

http://www.pressherald.com/2016/08/26/our-view-message-to-america-sorry-we-gave-you-lepage/

[DireWolfSpirit]

Thank You Portland Press Herald, apology appreciated.

I dont even live in Maine but I feel like someone owes me an apology over LePage having been spawned onto the same planet, I have a son on this planet FFS. Maybe he (LePage) could be recruited and enticed to join a Russian Roulette club since he wants to play with dueling guns, he could point one in the right direction.