Miscellaneous And Off Topic Subjects

[entropy]

I think everyone who really wants a single payer should really research the U.K. System. That is my guess for what we will end up with...

Just know.. nothing is perfect. There are always winners and losers in decisions.


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[Da Geezer]

I actually don't understand the need for insurance. Let health systems pool people together or employers. Insurance performed tasks computers and technology now allow others to do as or almost as efficiently.

I'm beginning to favor a repeal of the ACA and let it go at that. Let the market take over as Ent implies. Doc H. makes a good point too in that doctors are not now what they were. Doctors now seem to be moving to an exalted "employee" status, where they once were fiduciaries in the truest sense. That is why the broken promise of "you can keep your doctor...." meant so much to the middle class. I think the ACA redefined health insurance as a basic right, and it broke forever the doctor-patient nexus. I'd like to consider going back to what we had before all these "improvements"

But don't kid yourself in what you are getting. You will be waiting for a year for elective surgery, and preventative medicine won't be as available. In a single-payor system, rationing of some form is inevitable.

[Mainevent]

This apparently is not a new thing but the first I've read about it was in the articles posted over the weekend and I found it amusing. The Trump organization plagiarized the crest they are using, having stolen it from the U.K. family who founded Mar-a-Lago. The only change they made, fittingly enough, was replacing the Latin word for integrity with the name Trump.

[hack]

My gosh, you can't make this stuff up. Just read the Times story. Another thing here is that he's using a double-headed eagle on his UK crest instead, and so does the crest of the Russian Federation.

In some circles that kind of maybe-conincidental symbolism is enough to accuse somebody of a pedophile ring from his pizza joint...

[Dr. Strangelove]

Has Hannity announced his resignation yet so that he can travel the country in a van to uncover the "truth" of the Seth Rich murder?

Meanwhile in resignations, White House comms director resigns. This guy was brought in only 3 months ago to try and keep everyone 'on message'. Didn't realize it was a complete snakepit and clusterfuck.

http://www.bbc.com/news/world-us-canada-40090865

And as the article notes, rumors are flying that Lewandowski is being brought back along with other NYC style goons that Trump is more comfortable around than the pro politico set.

[entropy]

http://www.columbiatribune.com/news/20170515/university-of-missouri-enrollment-to-decline-more-than-7-percent-400-jobs-to-be-eliminated

Univ of missouri's enrollment will decline for a second year in a row


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[Jeff Buchanan]

Jeff... Medicaid is not this great answer. Several states are going broke due to Medicaid... they can't fund the obligations they have.

I don't think this is an accurate statement. Refer back to my link in the post above and read the section on the effect of the ACA on state budgets......those that adapted the expansion provisions v. those that didn't.

Look, my original post, as I stated above, is not about using Medicaid as a third option unifier. It is about adapting a single payor HC delivery system that incorporates the regulatory aspects designed by CMS and implemented by law as was done at the federal level for Medicaid. I'd add, this sort of approach is not at all like the Canadian or UK models of HC delivery. It is a hybrid of a free market system like we have now in the US and a completely price controlled government regulated supply and demand side system.

Here's an exmple: medical service providers know what Medicaid will pay for a given service because pricing is set by evaluating specific markets. So, the price of a colonoscopy, for example, is different in NYC than it is in small town Kansas. The prices are not arbitrary figures. They are determined based on regional front end costs (salaries, supplies, capital costs) versus realistic regional payments for a colonoscopy v. funding for Medicaid medical services provided by Congress. There are built in margins in the calculations. That's pretty much like a for profit entity would set pricing for any product that they are selling.

In the past, plenty of providers would not see Medicaid patients because reimbursements were too low. That is changing, especially with the consolidation of independent practices and hospitals into affiliated entities. What is driving consolidation is cost efficiency and economies of scale.

IOW, these larger entities, if they want to play in the expanding pool of Medicaid beneficiaries profitably, they will develop processes for lowering the cost of delivering a specific service. One way that is accomplished is through columinating service provision from entry to exit. I've explained this in previous posts and given links to further understanding.

Finally, CMS introduced the concept of value reimbursement or payment to a service provider is based on outcomes. It was a controversial concept and strongly resisted from several quarters, one of them being big hospital conglomerates. For example, you are admitted for decompensated heart failure. You're tuned up in standard fashion and discharged to followup with your PCP. Two days later, you become fluid overloaded again, are short of breath, go to the ER and are re admitted. Depending on circumstances the hospital may not get reimbursed for this second admission.

When that happens, hospitals will develop protocols that physicians have to follow to insure discharge doesn't happen prematurely. This way the hospital is more likely to get reimbursed. It's a way of forcing efficacy. They are typical market forces at work. You can see why this kind of thing is resisted by MD controlled big hospital entities and why that sort of management of those entities is disappearing.

In the big scheme of things, Medicaid is a small piece of the billion dollar HC pie. But it is, in a micro way, an example of what would work in a US inclusive, single payor system. Makes sense, right? What's stopping movement in this direction? The combination of Big Pharma, profit, not value driven Big Hospitals and the Insurance industry lobby. All of these entities are making big money out of the status quo and work Congress incessantly to preserve it. That's what needs to change and I'm not confident it will.

[entropy]

Miscellaneous And Off Topic Subjects

jeff... you realize you're linking a marketing piece, right?

"Numerous studies show that Medicaid'
"Medicaid provides more comprehensive benefits than private insurance "

that is a very geezer like link. =)

I'm well aware of what CMS has introduced. We live it everyday. In fact in the near future, reimbursement for will reward some systems, punish others based upon where you land on the bell curve for quality/costs/efficiency. But what you failed to note is how private insurance has done the same. In fact, it was private insurance that started the trend of not reimbursing readmissions. Federal and state programs adopted it. Private insurance has adopted several of the quality metrics for medicare as well.... even aligning targets. In fact, both have leveraged "payer best practices" from each other. It is not a one leads and the other follows.

I don't think there is anymore waste or efficiency between private or gov't. Both have waste in terms of margin or gov't overhead. So I don't buy stats without data sources, especially from marketing blogs. There is waste in having both (from a billings perspective), but private is pushing to be more efficient and reduce costs/payments. Gov't is doing that too, but they're also full of bearcats and union like behaviors. Again... both have waste.

As for states going broke.. I work in several states where our clients are not receiving Medicaid because the states have run out of money. This is back to my statements weeks ago.. it's not an unlimited supply of $$. restrictions have to happen.

All that said, I'm still not following how this is a third option from ACA vs Single Payer. ACA is a hybrid today.. That was my question. I'm not following you on how this is a third option... Medicaid is not a new option or something unique. You're either going to stay with what we have today (with variations depending upon modifications to the ACA) or you're going to go to a single payer (medicare/Medicaid like system) with people of means having private insurance. Again, for people like froot, I think we end up with a single payer.

[Whitley]

a fascinating interview on Health Care here at the link. Interview is an hour long. Interview is with the former CEO of Kaiser Permante. Talks about how to do national health care and how other countries do it.

[ame="https://www.youtube.com/watch?v=b4d3DKtLSIg"]https://www.youtube.com/watch?v=b4d3DKtLSIg[/ame]

[Jeff Buchanan]

On the Geezer like link: uh, click home, about, donor list. This is a research organization with a liberal leaning donor list and a socially liberal outlook even though it calls itself non-partisan. It's been reliably referenced in numerous articles on health care I am familiar with.

Anyway, I think you're last remark, the ACA is a hybrid, is something we'd agree on. My view is that in that regard it is so compromised that it fails to serve that purpose.

I'm sure you're familiar with Tom Daschle's views on HC. He was BO's HHS nominee but withdrew his name. He was arguably the first high level public official to advocate for Universal Health care. In his book, Critical, he proposed a Federal Health Board with similar composition and role that the article you linked to suggests. A lot of the originally proposed ACA was based on Daschle's ideas but in that form it was DOA. Hence the Obama's administration's willingness to negotiate with the R's.

The end result of those negotiations, in my opinion designed to insure it's failure, is the failing ACA that is now law. Frankly, if you wanted to see incremental improvements in the ACA, you wanted Hillary to win despite her warts. I was in that group fearing Trump's warts more than Hillary's but that reflects my personal, if not admittedly narrow view, that HC is the nation's most important issue to be dealt with.

[entropy]

It would not surprise me if Paul and Tom know each other. from Paul's site: During the period preceding the passage of the Affordable Care Act, he facilitated sessions between White House Office of Health Reform sessions and major health industry trade groups as private sector input was sought in the legislation.

He was part of the think tank for the ACA.

[crashcourse]

we as a society are too much gimme gimme gimme

trumps budget and proposed tax cuts our what we need but too many special intersts out there will never allow it to succeed

literally could save millions in the VA and in retirement by going to a modified version of retirement which cuts a few costs and the entired government employees union is going nuts with all there political weapons

we have a high 3 year retirement plan now going to a average high 5 which would save futre costs
increased employee obligation 1% point a year in order to get matching FERS contribution
cut cola allowances by 0.5 %

all moves to help pay for vetchoice option and its like trump shot the pope the hysteria going on from govt empoyees

same goes for the 100 million americans receiving entitlements right now--touch anybodys peiec of the pie and the media and politicans act like your stealing from a blind disabled truly homeless invalid instead of somebody that has a better car then I do, a better phone then I do a better gaming system then I do and a better tv then I do with more channels

makes me puke the feeling of entitlement so many people have

[hack]

We also have way too much tolerance for general statements unsupported by facts

We believe those for years and years after facts have become available

I wanna puke too

[THE_WIZARD_]

I blame liney

[Wild Hoss]

Absolutely.

Now STFU.

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