Getting Healthcare Right

The reason we have the highest cost of anything in a free competitive market said no one ever.

 

Then what?

 

I believe it is more complicated and interconnected than simply inflated profits. There are too many cooks in the kitchen.

Obama care is failing epically. There are people out there on Obamacare with dire health problems who are about to have the rug pulled out from under them - not because the Republicans failed to gain consensus; but because Obamacare was structured to end federal support in 8 years. That's right about...now.

 

Seems to me there was a thread of common decency that existed up through mid-twentieth century. A boss would not have sucked all the profits for himself while underpaying the staff beneath him. And the staff enjoyed an economic climate where they could simply go to work for a better employer. We have lost that balance. Top echelon is shamelessly greedy, while workers are stuck with no place to go.

That's where I think an external referee would help. Lock in models where everyone in a corporation receives a fixed percentage of the success of the operation, and you have provided motives for success. It isn't socialism, because no one gets paid for doing nothing. It isn't communism, because there is incentive and rewards attached to upward mobility, and it isn't raw, unfettered capitalism, which results in the huge ones overpowering and taking advantage of the small ones (remember slavery?)

 

We could zero out the military budget and still not be able to pay for healthcare. The OP is correct in every respect. Throwing more money at the solution doesnt fix any problems with the equation. The problem with every plan the dems have come up with is that none of them do anything to fix any of the problems. All they do is give away money for nothing. When that doesnt work, they claim its because of rich people and that they just need more money to give away.

 

Did you ever hear of retailers ordering more supplies? Yes. Do distributors watch changes in their retailers' prices as the indicator of when they need to provide them with more supplies? No.

Again, who is it that doesn't understand supply and demand?

 

You didnt understand the remarks you quoted. Unless of course, you want to remove profits from the law profession also.

 

Agreed. Good observation. That was a time when capitalism was robust due to good incomes and good demand/consumption. Everyone was winning in some meaningful measure.

That is a fair idea.

But that isn't a description of socialism. Remember "from each according to his ability; to each according to his work"? That's socialism and it's not so different from what you're accustomed to.

Well, communism has never happened and won't in our grandchildrens' lifetime or that of their grandchildren.

 

Are you saying people should be practicing active euthanasia on grandma? Who is conscious but doesnt have the capacity to make that decision herself?

You could well end up in prison in the US for that. Giving a drug like morphine, while not being licensed to do so, is a felony.

 

You, obviously.

 

How much do you pay per month in health insurance?

 

Like the ACA that the repubs have found they cannot beat after 7 years of working on it?

 

exactly. Im glad it failed. It did nothing to address the costs of healthcare. It just changed who paid the higher costs. The more govt gets involved in paying, the more costly it will get too.

Just look at student loans. The more the govt gets involved in paying for college, the more expensive it gets.

 

Your points are well taken; although to me, socialism connotes more government control than I am advocating for. But rather than get into semantics, I think many of us can agree that what we would call success is a return of that mid-century model that produced a robust middle class. EVERYONE was more secure then, even with the looming A-bomb. Business owners relied upon a strong consumer base to keep the business afloat, employees took it as a matter of fact that each year they would be making more than the previous year and could budget to buy their first home in x-years. Expectations of a better tomorrow were valid.

And here, you will probably experience revulsion, but that's what the MAGA movement is all about. No one is perfect and there is certainly an abundance of material to fuel criticism, but I do feel Trump is sincere in his goal to rebuild a robust middle class. I would be grateful to my fellow Americans if they would try to cooperate and give it a chance. I find myself becoming openly intolerant and scornful of the Resisters.

 

Well, it's not semantics but that aside for now, why would anyone oppose people having greater control over their lives and futures?

Completely true, but why was the economy better and more rewarding to everyone then? And why has it changed to what we have now with middle class incomes flat for 40 years? It's all in the economics and evolution of our economic system. And what is that evolution that has led to this? Can you tell me? It's the natural progression of, ....sorry if it offends you .... capitalism. It's a crisis involving the advancing end of growth. And that shows up in a decrease in demand and consumption.

But he can't do it. The problem is not one of making the economy robust again. It one of late-stage capitalism failing more and more. In spite of flat incomes since the 1970s, the economy was shored up only by artificially increasing demand and consumption through a huge increase in the use of the credit card. People were told via TV ads and billboards that the way to finance their dream lifestyle was by using the credit card, and they did it. But now people who were bitten by credit in the 2008 downturn are reluctant to turn to credit again. So now consumption is not what the economy demands in order to be robust and positive for all. And now corporations are dealing with this by merging and turning to automation in a desperate attempt to increase profits by cutting costs. So what can Trump do to make capitalism great again?

 

While it is true that healthier people requires less care- the care needed for those who are sick is altered by the number of people who are sick. While total medical costs for a healthy nation would be lower, the cost to treat an illness is not affected by that. The cost of insurance or distributed risk would be. That does not address the wasted money between real costs of the service and the prices we have in America- and that is the number one problem.

If we abolish freedom and tell people what they must eat, how they must exercise and sleep, what habits they must adhere to- we could impact their physical health. We would however, impose on their mental health- and that has brutal consequences. At the time my cancer was diagnosed, I had been is a crisis for about three years (business collapse, divorce) creating high stress. I asked my doctor how much that would be a factor- and he said that he had just read a study on that, finding that people living under high stress were three times more likely to develop serious diseases. I asked other cancer victims a question- in the 2-3 years before your diagnosis, were you living in a period of unusually high stress? The majority of them said things like- How did you know?"

Your mind controls your body mostly with chemicals, and stress screws up the chemical balance of them- and that screws up your health. Anytime you try to run others lives, ever because you think it is for their own good- your are more likely to harm them and do more damage than what you prevent. I'm not in favor of being physically healthy and mentally miserable. That's where suicide comes from- where seeing no value to life comes from, making it worthless.

But neither our habits nor profits are the driving force of our medical prices. Even with the incomes of doctors and professionals considered, we are way overboard on costs- but not overboard in terms of actual earnings for these medical people. Those costs are coming from things other than the cost of providing medical care- they are coming from the sources I pointed out in the original post.

You may have noted the mention of the ER visit in the post, less than an hour- $5000.00. The actual costs: morphine shot with syringe, possibly $5. one hours total staff time, either doctor or nurse- lets be generous and say $500 per hour. No room or other services. Throw in $100 for paper work in reception. That leaves $4390 for profit? But the stats on hospitals show they net about 7%- which would be $350. So we have a gap between the very generous allowance of expenses and the net profit of $4,040.00, which is 80% of the total bill. Where did that money go?

Then we have the fact that these same services would have been provided in other countries for about 25% of what they are here. The services in those countries have to pay there bills too. When you try to follow the money, you do not find the trail going to related expenses, but to manipulation, abuse and damn poor regulations. That is fixable- but nobody wants to address it. Politically dangerous to go there.

 

Yo9u may note I wasn't endorsing the proposed new health bill- it doesn't sound like anything I would vote for either. Congress is sort of a committee of people who's only real expertise is political gaming. They should be giving the entire job of designing health care regulation to a board of pros in the field- in effect, architects that know the problems and what a real solution must provide. Instead, this committee of self appointed experts who say they are designing a race horse wind up delivering a three-legged camel with a huge appetite but no performance. Congress is the problem, not the solution. They won't listen to those who could really get the job done.

 

First question has an obvious answer. Because it is in the DNA of some people to want to have control over other people. Some people just think they are smarter, or have the right answers, or don't want to have their personal agendas thwarted. Hence, we live in a world where institutions are dictating all kinds of personal decisions to us - in ways too numerous to mention.
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Is it the evolution of capitalism or the worship of progress?
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I know you are right about the credit trap. I remember a friend of my dad's arguing to buy everything on credit, and by the time inflation catches up with your purchase, you will have gotten a great deal. That doesn't answer the question on where all the white collar jobs went, or why the guy who was a corporate controller yesterday is just a clerk today - doing the same job. The corporate controller was a larger consumer than the clerk is, obviously. If Trump wants to bring back prosperity, he has to convince the cream at the top to share the fat down into the milk. He's got to get it more homogenized. I wouldn't say he CAN'T -- and I wouldn't bet my eyes that he can. I just know he is the only one who identified the issue, so let's give him a chance to work at it.

 

True. And so the changes needed to our healthcare system are fundamental and extensive.

I see no chance of needing to tell people how to do anything. It's not about dictating habits. It's about education so people can make more informed choices. I learned about hydrogenated oil 30 years ago because I worked as a chemist and actually hydrogenated oils in the lab. (The process is an eye-opener.) And so I scrupulously avoided hydrogenated soybean oil in foods all those years because of education. Same with high fructose corn syrup. Same with GMO foods. And government never told me what to buy and what to eat.

That's right.

Regulation and litigation are not the problem. And as long as we have private medical services and private insurance we will need regulations. There is no way around that fact. But the problem is multiple. It is overhead, as you also said, and that sums it all up in one word. And part of that is the fact that the CEO pay in the health insurance industry is the highest of any industry in the nation. Profits are part of the overhead also, as are regulation compliance, the cost of legal departments and related cost, investment funds, advertising, and much more.

Greed, mostly.

No argument there. Those other countries utilize some degree of private insurance integrated with their national healthcare, and their private insurance industries are heavily regulated, so regulation itself is neither dispensable nor unaffordable. The problems we face are entirely wrapped up in our private medical system for private profits.

 

Do you have data that says costs rose because the gov't gave poor people money to attend? And wouldn't rise anyway? Now granted, as gov't gave money to poor, more students attended, ie more demand.
But in the healthcare world, would more people use doctors?

 

Seems then the R's are in a pickle. If they do nothing, people will start losing insurance under their watch. Simply by not being able to afford insurance.

 

True, and so we need to exclude such people from positions where they could feed that DNA. But my question was really intended to be "why would anyone oppose people having greater control over their own lives and futures? -more individual input and control of one's own destiny?"

As I mentioned in my previous post to you, after the credit card/debt crash and with incomes still not big enough to support the level of consumption needed for a robust capitalism, corporations, -still requiring increases in profits, -resorted to cutting costs as the solution. This cost-cutting was accomplished by moving to countries where labor is very, very cheap, and by merging, and by automation. This led to huge unemployment and therefore employers could pick and choose. IT professionals who insisted on holding out for IT jobs often lost out. Same with other white collar jobs. And many with bachelor degrees were hired for low-level positions. Many of the baristas at Starbucks had bachelor degrees because they were available and in need of a job.

So to address your "question" about where white collar jobs went, they went overseas.

But it would mean higher taxes at the top tax brackets to increase the employer's "incentive" to pay more to workers, and Trump is cutting their taxes. And since much of the problem is corporate survival and need for profits, that survival takes precedence for corporations. And Trump just can't address these the way he's going.

Bottom line is that capitalism did great for everyone while capitalism had room for continued expansion and growth and gain. That's the nature and need for capitalism. But now it has gone just about as far as it can with the expansion overseas and increases in automation. Oh sure, there is still some room left for growth in profitability. But already the political environment is gearing up for increased "need" for a police state and exertion of maximum control over us because they see the need ahead. So if we go along with the plan to wait and hope for solutions to this crisis, we forego our opportunity to prepare for fundamental change. And being this close to the end of the line for this system, the final end is not far off, and if we don't start now to prepare, we will have to deal with it then when it will be much more difficult.

Most people don't see all this. They don't see the writing on the wall that spells out the end for this system. Part of preparing is in helping spread the bad news.

 

Yes, this saga is far from over.

Having a health care bill fail in the House is NOT an excuse for our president or congress to ignore our health care system.

 

not at this point, since they've already taken so much control of it.

 

The ACA's shortcomings are ALL related to COST, but IMO, it was a noble ATTEMPT to make better coverage affordable to ALL. The failed AHCA was just an attempt to reduce government spending by offering BARE MINIMUM COVERAGE to placate citizens.

Before making ANY radical healthcare changes, we should tackle the problem at its source: UNJUSTIFIABLE INFLATED PROFITS. This is most obviously illustrated by our overpriced pharmaceutical products.

Most doctors I know take their responsibility seriously. The problem is with the medical hierarchy.

As I have said many times before, the AMA is a doctors' union, not a patients' advocate; yet it has convinced OUR GOVERNMENT to delegate to it exclusively the authority to regulate the medical sector, justified by saying government is not qualified to make decisions regarding medical matters. In fact, our Surgeon General is a voting member on the legislative board of the AMA. . . . This is a fox-in-the-henhouse situation. . . . We need the medical sector, but our dependence leaves the door wide open to exploitation.