Miscellaneous And Off Topic Subjects

[Jeff Buchanan]

......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.

I get the same kind of feedback from patients.

You are describing the Medicare Wellness Visit. This is a preventative service offered under Medicare at no cost to the patient.

You are right. For some, especially those that are healthy because (a) they have grown up in a socioeconomic environment that allows access to health care and (b) they have the intellectual tools to understand health risks, avoid them and stay fit, it is somewhat unnecessary but for the disadvantaged, and this pool is a lot larger that one might think, it is useful.

As well, these are excellent screening tools for o/w healthy patient's in their late 70s and older, when infirmity becomes a fact of life. It's pretty interesting when daughter brings in her 85 year old Mom who is still driving, was just in a minor fender-bender but still thinks she should be is confronted by her HC provider who tells her she needs to give up her keys, what kind of preventive impact that has.

[froot loops]

Jeff - for my part, I don't know that single payer is inevitable, but the politics of this week make much moreso. Like I said before the ACA was an attempt at bipartisanship, the framework of the plan was borne out of a conservative think tank. It was implemented by Romney in Massachusetts. The moderates who had done a lot to hold the more left leaning legislators back are looked on with scorn because of this week. Lieberman, Baucus, Emanuel to name a few now look totally foolish for that attempt at bipartisanship.

Say what you will, when Obama was elected, he campaigned on health care, he won in a wave election. He had a mandate. Trump campaigned on repealing the ACA and replacing it with insurance for everybody at a cheaper price without touching Medicare and Medicaid.


If the Democrats ever get back in power, the urge for single payer will be huge, the Thursday Beer Bash in the Rose Garden will sear in people's memories.

[froot loops]

When people talk about preventive care as part of their solutions, you are going to have a lot of things that Da Geezer finds useless like that visit. The point is trying to catch things early.

I have read an article or two against preventive care. The studies were saying it isn't the holy grail people think it is. I believe the argument they say is it ties up too many resources. But my knowledge of that extends no farther than having read those articles.

[SeattleLionsFan]

The LASIK example provided by Geezer above is a great one. But I think he draws the wrong conclusions. He says its be lack of government involvement that lowered the price, but the government is just as involved with the provision of those health services as any other (excepting abortion). There are the same standards of care, licensure requirements, etc.

IMO there are two big differences between LASIK and Chemo that explain the difference. 1) If you don't get LASIK, you have to wear glasses. If you don't get chemo, you get super sick. Market forces will ensure that people will pay more for chemo. This to me indicates that trule healthcare is difficult to conceptualize as a commodity because there is no rational way to justify skipping it or bargain shopping. 2) insurance will pay for chemo, and not LASIK. So the cost is invisible and inconsequential to the consumer. So who cares how much the Chemo costs. This is part of the reason I believe the "insurance" model is inherently flawed.

[Da Geezer]

Jeff, why is it necessary to know exactly what guns I own? I understand the argument that I should store them away from children, but once I tell them I'm an old fart living alone, what then is the rationale?

[froot loops]

Yesterday an Idaho congressman said nobody dies because they don't have access to health care.

http://www.idahostatesman.com/news/local/article149013339.html

In fact there is a highly publicized case in Idaho of a person who did die because they didn't have access to health care because the job didn't provide it and they couldn't afford it. Death by poverty.

http://www.idahostatesman.com/news/business/article41425458.html

[hack]

Good post, SLF.

[Da Geezer]

1) If you don't get LASIK, you have to wear glasses. If you don't get chemo, you get super sick. Market forces will ensure that people will pay more for chemo. This to me indicates that trule healthcare is difficult to conceptualize as a commodity because there is no rational way to justify skipping it or bargain shopping. 2) insurance will pay for chemo, and not LASIK. So the cost is invisible and inconsequential to the consumer. So who cares how much the Chemo costs. This is part of the reason I believe the "insurance" model is inherently flawed.

Fair points. Maybe that is why it is so hard to discuss the issue of "health insurance", because it has so many facets. No one lays in an ER and bargains on the price of a hip replacement.

I think it is true(ish) that the more we as consumers are cognizant about price, and actually do shop, the better. That is where health savings accounts would be beneficial.

[CGVT]

If you can't afford food, you aren't putting any money into a heath savings account.

HSAs are a red herring when it comes to providing health care.

[Da Geezer]

froot, you continue to conflate health care with health insurance, and by this time, I believe you do it on purpose. Neither article says anything about anyone being denied health care. The second article, the one which you describe as "death by poverty" has a second paragraph that says:

That weekend, they found time to escape for a quick Island Park camping trip, one of their favorite activities. Several weekends prior the couple drove from their home in Idaho Falls to Grand Targhee Ski Resort, where they listened to music and rode the chairlift to the top of the mountain.

“We just enjoyed each other’s company,” Jason, 43, said recently. “I’m grateful for those three weeks, because they were three really good weeks.”

Is it racist, sexist, homophobic or whatever to suggest that Jason spend his money on health insurance rather than on vacations?

[hack]

https://www.bloomberg.com/news/articles/2013-04-10/the-reason-health-care-is-so-expensive-insurance-companies

Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence.

[froot loops]

Shopping around is much easier for tires than it is healthcare. Most of the time you get the bill well after and you have no idea what the price is. If I know I need 4 new tires, I can call as many tire places as I want and get free estimate. If I want a burger, I can go into BK, McDonalds or Wendy's and know the price. In the example SLF gives, it is hard to call around to find out how much your chemo is going to cost. I have yet to walk into a doctor's office and see the menu of prices.

With Lasik you can call around, that has something to do with being out of pocket, but also very specific to that procedure. Certainly there can be more examples like that but I'm not sure it scales to the whole medical system. And if you want to get to the point where you are truly getting market forces to cut costs it needs to be as close to a McDonald's menu scene ario as possible.

[froot loops]

Asthma medicine costs a hell of a lot more than a chairlift. it sounds like in your world they made the poor decision and deserved it.

Again with racist, sexist, homophobic victimology. You play the victim all the time. Give me a break.

[Da Geezer]

If you can't afford food, you aren't putting any money into a heath savings account.

What has been proposed is that your employer or the government puts the money into the HSA, and you eventually keep any excess. The idea is to encourage people to shop price when possible by letting them benefit from any savings they achieve.

What is your solution CGVT? You sit there on the dole and criticise any thought other than getting you more money from the government.

[Da Geezer]

Asthma medicine costs a hell of a lot more than a chairlift. it sounds like in your world they made the poor decision and deserved it.

You mean the ACA didn't cover this guy for his asthma medicine???

Oh, yes, he made too much money. And, yes, in my world there are consequences for decisions, even bad ones. Remember Hillary's question about virtually any decision made by an individual: "What if they make the wrong choice?" The other option is Hillary and her ilk making the choice for you. That may appeal to most here, but it doesn't appeal to working folks. One reason we work is to be independent and make our own choices, even if they are wrong.