Miscellaneous And Off Topic Subjects

[iam416]

Under a single payer I think there are risks in who makes those decisions where at least today there are options (though fewer than in the past).

Of course. Socialized medicine is a reduction to the lowest common denominator.

And I'm with you -- when I was in private employment I would have gladly gone high deductible/catastrophic if that was an option. I had 3 options and none of them that. I think I paid $10K/yr at the time -- which was 7-8 years ago. Can't imagine how much it is now.

My bias is preventative care, and choice. I know that bias is not universally shared.

The problem with is that those things are inherently in tension. You almost have to mandate preventative care (like seatbelts) and that goes contra the broader concept of choice (though I know you're using it in the insurance context).

Further, we, as a country, have decided that healthcare is, effectively, a right. So, no matter your choices, decisions and actions, we will pay for it. And that's not going away.

And we will continue to remove consequences from numerous other areas of life and act surprised when folks behave rationally in response.

[iam416]

Any forecast comes with assumptions. We know that. Sometimes those assumptions are used to cast doubt on the whole thing and are enlisted as a reason to do nothing. Sometimes they aren't. It's the choice of exactly when to be suspicious of forecasting and when not to that is the real problem.

Assuming all forecasts to be equally valid, then (a) your conclusion is correct; (b) your conclusion isn't a justification to disregard uncertainty; and (c) of course, its applicable across the board.

All forecasts aren't equally valid, so there are justifiable reasons to doubt some things more than others. I'm quite certain we have no common ground as to the specifics, but the general principle is obvious enough.

[crashcourse]

"But, as it currently stands, we consume healthcare without regard for cost. That can't stand. It won't."

bingo talent

read somewhere that 50% of health expenditures occur in the last 6 months of life.
ive said it before --have a good friend dying of lung cancer just placed on hospice--went through 6 or 8 chemos including some experiemental drug --bottom line cost to medoicare and his supplemental was w3ell over 200K and likely shortened his life knocking out his immune system and leaving him stagnant . he's 79

common sense will tell you 79 yo lung cancer pateints will not survive they never do unless you can cut it out. chemo and radiation do squat yet every year we spend billions on hopeless cases.

the whitneys of the world and froots MIL are examples where medicare and Medicaid is properly used. but the fleecing of America takes place in oncology offices all over the world--in nursing homes all over the world. to take someone who is demented and cant feed themselves and rush them to an emergency room for some kind of treatment boggles my mind. to extend anything but comfort care to smokers and alcoholics who show up year after year into emergency room into ICU's then get discharged to go out and continue to smoke with scarred up lungs or drink with cirrhosis or shoot up with HIv just boogles my mind that we are continuing to pay for that

you place a reasonable cap much less then it is now on patients that the government will pay for

[iam416]

The continued failure of the ACA's marketplaces:

https://www.washingtonpost.com/news/wonk/wp/2017/05/04/one-of-marylands-biggest-obamacare-insurers-wants-to-hike-rates-50-percent-next-year/?utm_term=.67accb4cd1bd&wpisrc=nl_daily202&wpmm=1

[iam416]

read somewhere that 50% of health expenditures occur in the last 6 months of life.

Entropy posted a link that showed US healthcare expenditures are basically on par with most other countries until end of life, when they balloon.

You are, of course, making the case for a cold-hearted, rational "death-panel" approach. Or rather, the "waiting list" approach -- put them on a waiting list with no front of the line preference and, you know, wait.

I'm not sure if that's politically feasible, but it's where the costs are. Actually, I'm quite sure that it's politically infeasible.

[iam416]

I do like that headline, the ACA saves no lives. Buried in that word salad it says the ACA provides access to expensove procedures to prevent life threatening situations and that it should still be the case post ACA. It kind of contradicts the headline.

I liked the part comparing mortality in Medicaid expansion states and non-Medicaid expansion states.

[Wild Hoss]

Legalize euthenasia.

Sent from my SM-G900P using Tapatalk

[froot loops]

The thing about those end of life stats is they are skewed to the measurement if someone actually dies. You spent a lot of money and they died anyway. If the expensive treatment gets you back on your feet and you live another 5 years, I would think it is worth it.

In the case of my mother-in-law there were at least three times where we thought she was a hospice candidate and somehow she pulled through. The hospital stay was expensive, but it doesn't qualify as spending on end of life stuff. She had a brother and a sister, the same kind of issues. Her brother was a farmer and strong as an ox, had the same thing, expensive medical stays where hospice was considered but he recovered a d live another decade farming. He never complained about medicare and he was sympathetic to tea party politics.

There is always going to be fraud, but it shouldn't be an argument for nothing at all. It shows how powerful the anecdote is, entropy knew someone gaming the system 15 years ago and it influences his judgment to this day.

[hack]

Or we have the Terri Schiavo thing and the culture warriors rush in and as a result we spend tons of money keeping alive people who are actually ready to go.

[froot loops]

I liked the part comparing mortality in Medicaid expansion states and non-Medicaid expansion states.

So maybe coverage isn't needed for the poor?

[hack]

hack..

Assuming I'm correct and we go to a single payer system and lets say it's an expansion of medicare... Do you really believe Health systems will provide the same services as today? Do you really think when budgets are tight, decisions won't be made to cut services? Do you really think lobbyist have your best interest?

I'm not saying the current system is not without flaws. It is.. those without jobs are a glaring issue for our health economy. But my experience is govt's are slow.. slow to adopt.. slow to change.. slow to respond.. I've seen health systems struggle to payments from certain states. I've seen the writeoffs due to not paying for care. I don't see people in large numbers electing to go to gov't owned health systems over non for profits or for profits. So I'm not "excited" about a gov't owned monopoly of decisions. At least today there are competing entities to keep each other in a loose form of checks and balances.

I think insulating the process from lobbyists would be great. I think that goes for everything, though. I don't think faulty economic assumptions, like that health care will be better because employers will always compete to attract talent, is a substitution for fixing the process by which health care would normally be delivered and does so with a reasonable degree of success everywhere else in the developed world.

That goes back to why my preferred candidate for president was Lessig and not Sanders. The analysis of US politics and its outcomes starts with the amount of money in politics. It's corrupted the process. You don't have good policy outcomes in a corrupt environment, even if the policy is brilliant. So we can debate health care this week and Dodd-Frank next week and whatever else in the weeks to come, and overshadowing all of that will be the utterly insane notion that free speech rights extend to corporations buying legislative and regulatory outcomes in DC. That's insane.

[iam416]

So maybe coverage isn't needed for the poor?

Well, you have two ready-made test groups, Froot. You're very staunchly in favor of Medicaid expansion. It will be interesting to compare Expansion States to Non-Expansion States. Initially, at least in terms of mortality, the N-E States are doing better. I have no idea how those numbers will change over the course of several more years. But, I am certain that if the N-E States continue to produce data comparable (or ahead of) Expansion States that your response will be some sort of snarky rhetorical question.

[THE_WIZARD_]

I'm all for a death panel...determining Talent's fate...

[THE_WIZARD_]

Re: Single Payer Nirvana...hell while were at it let's just socialize all industries in the US...

Nirvana!

[entropy]

hack.. thanks for the response