Miscellaneous And Off Topic Subjects

[The Oracle]

Lol, how could public officials get away with something THAT crazy??

[froot loops]

It's paywalled, it isn't available, I don't know what else I can tell you.

Maoists, so much for not labelling. Maybe you should read what I said about NRO. Or how about another birther joke to lighten the mood. FFS.

[Da Geezer]

I wasn't referring to you, froot.

[froot loops]

Maybe not, but nobody in here is a Maoist. Nobody in here is a Stalinist, nobody in here is a Nazi.

[CGVT]

Nobody here is a Leftist, but that is a favorite word of the right, too.

[froot loops]

I know right, I guess if you repeat it enough times I guess it sticks. When you start calling people Maoists, it either reveals an ignorance of the Cultural Revolution or intellectual dishonesty.

[Dr. Strangelove]

Huge dump of emails stolen from the Macron campaign gets dumped by Wikileaks just 2 days before the French election.

Can't imagine what country wants Le Pen to win badly...

[froot loops]

Yep, Trump's favorite Wikileaks has been promising that. Wikileaks os an arm of the Russian government.

[iam416]

Hmmm. If you keep repeating that Russian Puppet stuff enough....

[hack]

That is a point I've not thought of. Good point. ACA made insurance portable.

I purchased health insurance for myself throughout my career, and I had a pre-existing condition. For me, Medicare is better than the insurance I bought for myself. I thought one of the better parts of the ACA was its accommodation of preventive procedures. I believe the cost/benefit of, say, a colonoscopy is a net positive, not even considering the benefit of not getting colon cancer. But that takes a longer time horizon to play out, and politics seems to have about an 18-month horizon max.

Another fact no one has mentioned is that IMO, inertia is a factor in any discussion of changing health insurances. The whole subject is hard to understand, and I believe most folks would rather opt for the known rather than the unknown. When the polls say that few people favor the ACHA, I think some of that is from folks who just don't want to go through a change again.

I know a single payer is coming. There is really no other way to accommodate the half of the country that is on welfare. The great victory of the ACA was that it turned health insurance into a "right" rather than a commodity to be purchased.

Credit where it's due -- one of the few posts today that transcend the political spectrum; my own included.

(The only others were by Wiz, who does not know what the political spectrum is, or where to find it)

[froot loops]

Hmmm. If you keep repeating that Russian Puppet stuff enough....

1. Trump's CIA director denounced Wikileaks as a intelligence service abetted by hostile actors like Russia.

2. Trump said he loved Wikileaks during the Campaign because of what it did to Hillary Clinton and The DNC.

3. The Clinton campaign and the DNC were the victims of numerous federal crimes. It should be repeated numerous times because this point is lost on people. If you don't like Clinton it's OK because the ends justifies the means. That's never a good rationale, it might happen to the other side next time. It will happen next time. which brings me to point #4.

4. The French hacking news shows it will happen again.


Oh yeah, there are rumors that there are 3 current grand juries going on for Trump Russia. One is a FARA relared, one RICO and another one that is unclear. In Comey's various testimonies he has kind of alluded to it.

[froot loops]

One other point, every administration prior to this one would have denounced these actions forcefully.

[Jeff Buchanan]

I don't think a single payor, government run HC system is inevitable as some of you are speculating. Even Medicare and Medicaid, while technically both single payor systems, have components of a market based enterprise. They are, fundamentally, hybrid systems.

The interplay between various parts of Medicaid do serve as cost control mechanisms in a competitive market place. For example, in the development of Medicaid 's drug formulary, Medicaid drug prices are set by law at the lower end of a discounted price or the lowest price anyone is able to negotiate. This is NOT Government price controls. It is the free market letting manufacturers bid low to obtain contracts with Medicaid to provide drugs.

The VA negotiates prices in a similar manner, receives mandatory rebates, and maintains a National Drug Formulary. It's a race among drug manufacturers to provide drugs at the lowest price if those manufacturers want to play in this expanding pool of Medicaid and VA eligible beneficiaries.

Nothing like this exists for Medicare nor does it exist for commercial delivery of HC covered by the nation's insurance plans. The reasons for this are complicated and beyond the scope of the point I am making. There are similar examples for procedures, hospital daily charges - all of it. The point is, as some have pointed out, we have large hospital entities that are profit motive driven, pure and simple and this is not consistent with providing the whole range of HC services affordably for consumers of HC.

To that end, the ACA implemented legislation that attempted to blunt the profit motive behind the provision of HC by adopting outcome measures designed by CMS (Medicare's administrative body). For example, Medicare (CMS) stopped reimbursing for hospital care when it was delivered following an initial admission for care, a discharge to home, a deterioration in the condition and subsequent readmission for the same condition. Hospitals started improving care to prevent readmission for the same condition. As hack notes, this is unsurprising human behavior brought about by well thought out government action. Importantly it is an example of legislative action that favorably affects HC costs.

A hybrid system that includes a combination of free market concepts with legislative action designed to nurture profit driven entitie's behavior is eminently achievable. To do so requires a new direction and a huge shift in the current HC delivery paradigm. I'm not confident that Congress has the ability to do this even though it appears to be possible.

[Da Geezer]

I just read an article about Lasik eye surgery. When it started about 15 years ago the cost was roughly $ 3,000 per eye, and the operation was done one eye at a time. Now, there are ads in metropolitan areas for the same procedure at $ 250.00 per eye. Lasik has been a cash-on-the-barrelhead item since its inception, and it has not followed the general increase in medical costs. That is what can, not will, but can happen in a market environment without government interference.

I talk about this ACA stuff with some MDs I golf with, and they say that their biggest cost is liability insurance. All of these countries with socialised medicine also have loser-pays when it comes to tort claims. We have never discussed tort reform at any length, but if you want immediate cost savings, that is where to find it. Just say a tortuous death is worth $ 5 million, and work backwards from there. I guess you would have to find a way to ensure that the doctors pass the savings on to the patient. But legal fees are a "pure" cost that results in a negligible benefit to the patient in comparison to the cost.

I went in for my Medicare "session" that is required under the ACA in early March. I could have answered all the questions online, (particularly the one about whether I have a gun and where I keep it) with the exception of two matters. The PA administering the test gave me three nouns to remember and asked me later to recall them. The other was to make me stand on one leg for 10 seconds and to basically do 10 deep knee bends. The bill was $ 274.00. Took about half an hour. Of course, this was all "free", no co-pay or anything. I say this kind of crap doesn't need to tie up a PA's time.

[Jeff Buchanan]

...... but if you want immediate cost savings (to the HC system), that (medical Liability cost) is where to find it.

Nope.

The medical liability system costs the nation more than $55 billion annually. This is less than some imaginative estimates put forward in the health reform debate, and it represents a small fraction of total health care spending........

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/