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Thread: Your insite on health care in the usa

  1. #11
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    Quote Originally Posted by Meshuggah View Post
    Doctors and Thieves both Wear Masks.
    And people in NYC.

  2. #12
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    Quote Originally Posted by mitchless View Post
    The best descriptors for health care in the USA is "rent seeking" and "bureaucracy."

    Physicians are highly educated and credentialed individuals, and that education and credentialing costs a lot of money. As a result they want a lot of money for their services. Consumers, on the other hand, want to pay as little as possible for the services of those physicians. Rather than negotiate this tension and meet in the middle somewhere like every other good or service, a variety of third-party payers have emerged. These third-party payers then become gatekeepers between physicians and their patients, and decide how much physicians get paid and how much patients will pay. Left unsaid is that the third-party payer also decides how much of that transaction they keep for themselves -- that's the rent-seeking.

    It doesn't matter if the third-party payer is a not-for-profit charity, for-profit insurance company, co-op, government agency, or some other arrangement. This is how it works, and that's the bureaucracy. Almost all of the "solutions" proposed are variations of third-party payers. Some of them are fourth-party services designed to help you navigate the third-party services. Very few "solutions" get at the root of the problem. One that I'm aware of is called "direct primary care." This is the apparently novel idea that a patient should directly pay their primary care provider for the services provided, usually as a monthly subscription.

    NOTE FOR EVERYONE: I am well aware that the service offerings around medical care are far more complex than I have expressed above. The word "physicians" above could be replaced with "service providers" to more accurately reflect the state of the market. This is a model and the complications that arise from hospital systems, pharmaceutical companies, imaging companies, etc. None of that changes where all the "action" in this space is going on -- it just changes the size and number of players in the different roles.
    Well said.
    Also an unfortunate fact is that those who need the most medical treatment are frequently those who can least afford it.
    While some professions can pick and choose their pro bono cases, health care systems don't usually turn away sick people but charge more than necessary to those who can pay to offset the total lack of payment from some of the sickest patients who are unable to pay.

  3. #13
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    Quote Originally Posted by Lost and Found View Post
    Also an unfortunate fact is that those who need the most medical treatment are frequently those who can least afford it.
    It is, indeed, unfortunate. For those in this situation some form of charity is necessary, which will take form as some kind of third-party payer. That third-party payer may be a physician offering services on a pro bono basis, or perhaps subsidized by outside parties. In other sectors of the economy, charitable provision of goods and services coexists with normal provision without utterly disrupting the normal provision. Food banks, for example, provide a service necessary to many people without disrupting the trade at grocery stores. Meditating on the difference between these two sectors (food and medicine) is enlightening.

    The first thing key difference that occurs to me is the stigma of charity. Receiving food at a food bank requires humbling oneself to admit that one is unable to provide his or his family's own needs. In order for someone able to purchase their own food at a grocery store to do this, he must first accept that humility. Second, he must also accept the shame of taking resources away from someone less able than he.

    Quote Originally Posted by Lost and Found View Post
    While some professions can pick and choose their pro bono cases, health care systems don't usually turn away sick people but charge more than necessary to those who can pay to offset the total lack of payment from some of the sickest patients who are unable to pay.
    This is another unfortunate state of affairs, on many levels. First, it is important to note that those health care systems are legally mandated to treat patients that have no ability to pay. Second, by driving up the costs to those able to pay these health care systems make the services unaffordable to a larger segment of their patients. This creates a vicious cycle wherein fewer and fewer patients pay higher and higher prices. Third, this lays the ground for the situation I described in my original post.

    I'm sure there is more that I have left unstated -- Rip's Starting Strength Radio #167 (Starting Strength Radio: Free Market Healthcare Starting Strength Radio #167 on Apple Podcasts) takes a look at this problem from a physician trying to solve the problem.

  4. #14
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    Good knows the UK's NHS isn't perfect, and I don't think the services have to be provided by the government, but I appreciate the fact that when people injure themselves in EG a strongman competition they don't have to create a gofundme to get their bicep reattached.

  5. #15
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    Quote Originally Posted by gadders View Post
    Good knows the UK's NHS isn't perfect, and I don't think the services have to be provided by the government, but I appreciate the fact that when people injure themselves in EG a strongman competition they don't have to create a gofundme to get their bicep reattached.
    Gadders, do you really believe that people in the US are denied access to surgery, medicine, etc. because the government doesn't own the heathcare system? Is that what the BBC tells you, and you believe it? Seriously, what else does the BBC tell you that turns out to be true?

  6. #16
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    Quote Originally Posted by gadders View Post
    Good knows the UK's NHS isn't perfect, and I don't think the services have to be provided by the government, but I appreciate the fact that when people injure themselves in EG a strongman competition they don't have to create a gofundme to get their bicep reattached.
    You appreciate that the government forcibly collects money to pay for a surgery resulting from someone taking personal risks? Do also you appreciate being taxed to pay for Type II diabetics who are so indifferent to their lack of health that they continue to eat too much and not exercise to the point where their feet die and have to be removed?
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  7. #17
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    Quote Originally Posted by AndrewLewis View Post
    You appreciate that the government forcibly collects money to pay for a surgery resulting from someone taking personal risks? Do also you appreciate being taxed to pay for Type II diabetics who are so indifferent to their lack of health that they continue to eat too much and not exercise to the point where their feet die and have to be removed?
    And after the so-called Affordable Care Act was passed, that is now true for US insurance as well. In NY, for as long as I'm aware of, insurers have charged the same amount for a healthy 21-year-old as they did for a 64-year-old on multiple transplant lists.

  8. #18
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    Quote Originally Posted by Logan1 View Post
    And after the so-called Affordable Care Act was passed, that is now true for US insurance as well. In NY, for as long as I'm aware of, insurers have charged the same amount for a healthy 21-year-old as they did for a 64-year-old on multiple transplant lists.
    It has been 8 years so I am fuzzy on the exact numbers, but prior to 2014 a young, single male in Ohio could get coverage for something around a quarter of what he could after Obamacare took effect. Critics derided (and continue to deride) such inexpensive coverage as insufficient or not-real-insurance but it covered the services needed by a young, single male. And the existence of such coverage did not preclude him from purchasing more "comprehensive" and concomitantly expensive insurance. My own premium for a family of 5 nearly doubled from just under $400/month to nearly $800/month, while the network of available physicians shrank. I did not receive double the value.

  9. #19
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    NY is a shithole, Logan. My BCBS policy under Obama raised my premium 60% and reduced the number of doctors on the network to ONE (1), IN A 125,000 market.

  10. #20
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    Every single western country with a "free" healthcare system is seeing healthcare providers generate an annual deficit of several percent of GDP yearly. It is one of the principal reasons for why everyone went bankrupt and we are having to deal with bullshit pandemics and similar. Not that this means much to forging students in rural NC.

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