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mugtang

If the United States adopts some form of national health plan

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2 minutes ago, Broncomare said:

I think we should follow the VA model.  The government is already running ruining it.  How many vets have committed suicide in VA parking lots???  

No lets do the North Korean Model. Everybody has so called healthcare and everybody is equally miserable. 

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14 minutes ago, bornontheblue said:

No lets do the North Korean Model. Everybody has so called healthcare and everybody is equally miserable. 

Of course North Korea denies that they have any corona virus cases but with their poor medical care, it is probably ravaging their country.

 

 

 

 

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Australia's is a system that I'm surprised doesn't get more discussion here.

 

Its effectively a public option that still forces you to get private insurance after a certain age ( I think 30) or to pay a fine.

 

From there you can choose between the free government hospitals or the better and  more expensive private ones that your insurance may or may not cover

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9 minutes ago, SJSUMFA2013 said:

I like what they have in Germany. Everyone is covered but there’s nothing stopping people who can afford it to buy private insurance. Similar to how public schools function. 

I’d be ok with the German or Israeli models here. 

thelawlorfaithful, on 31 Dec 2012 - 04:01 AM, said:One of the rules I live by: never underestimate a man in a dandy looking sweater

 

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36 minutes ago, SJSUMFA2013 said:

I like what they have in Germany. Everyone is covered but there’s nothing stopping people who can afford it to buy private insurance. Similar to how public schools function. 

Same thing in Finland and Sweden.

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22 hours ago, IanforHeisman said:

You never hear of countries with a national health care plan say it’s terrible and they wish they had America’s health care system.

Not so fast. Everyone of my patients that have to seek care in Canada and England come back telling me how much they appreciate American health care. 

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16 hours ago, Jackrabbit said:

Requiring service providers to post their fees would solve a helluva lot of problems.

How would that solve problems? If you need a cardiac stent, and it costs $25k, are you not going to get one. You go to the Er and you get one. If hemorrhaging from uterine bleeding, are you going to pay the $300 office visit to a doc you’ve seen for 10 years or go to a new doc that you know nothing about for $250. I send people to a non hospital imaging center for people who have a high deductible or cash pay but then you can’t compare your previous mammograms at your previous place and if you have to have a biopsy, the surgeon will probably repeat it because he/she can’t get the original to review. Don’t tell me single payer because just spend a day at an IHS/VA facility and tell me how efficient they are.

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16 hours ago, Wyobraska said:

This.  Why can't doctors list their fees for services.  All this negotiation between doctors and insurance is BS.  

I’d be happy to. Insurance companies have all the leverage and base their reimbursement as a percentage of their proprietary Medicare relative value scale. If you have commercial insurance, depending on whether the availability of doctors, they reimburse you as close to Medicare as possible, sometimes less. My price for a moderate complexity visit is $169 based on suggested guidelines for my area. Medicare reimburses about $96. Try to get a plumber or lawyer for that.

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12 hours ago, mugtang said:

I’d be ok with the German or Israeli models here. 

I'd be okay with the CIA operating more like Mossad.  :ph34r:

 

 

 

 

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11 minutes ago, NMpackalum said:

How would that solve problems? If you need a cardiac stent, and it costs $25k, are you not going to get one. You go to the Er and you get one. If hemorrhaging from uterine bleeding, are you going to pay the $300 office visit to a doc you’ve seen for 10 years or go to a new doc that you know nothing about for $250. I send people to a non hospital imaging center for people who have a high deductible or cash pay but then you can’t compare your previous mammograms at your previous place and if you have to have a biopsy, the surgeon will probably repeat it because he/she can’t get the original to review. Don’t tell me single payer because just spend a day at an IHS/VA facility and tell me how efficient they are.

No....no one will go shopping in an emergency.  In wyoming, there is little competition.  A knee done in salt lake or denver can be 50% of one done here..  employers are beginning to reimberse travelling costs to keep their group costs down.

To help making these decisions, these costs have to be pried out of providers in private conference...not on the phone.   Insurance agents at least have this info and will share it.

I have more than one "self insured " friend who shops for services with cash.  They have been banking the cost of a policy for years and guard it carefully. Thwy usually pay about 50% of the insured cost to the hospital, but rarely get any deals from the specialists.

It also sucks that we cant buy a catastrophic plan.

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9 minutes ago, Jackrabbit said:

No....no one will go shopping in an emergency.  In wyoming, there is little competition.  A knee done in salt lake or denver can be 50% of one done here..  employers are beginning to reimberse travelling costs to keep their group costs down.

To help making these decisions, these costs have to be pried out of providers in private conference...not on the phone.   Insurance agents at least have this info and will share it.

I have more than one "self insured " friend who shops for services with cash.  They have been banking the cost of a policy for years and guard it carefully. Thwy usually pay about 50% of the insured cost to the hospital, but rarely get any deals from the specialists.

It also sucks that we cant buy a catastrophic plan.

True it's about supply and demand. Unfortunately for docs and fortunately for Medicaid recipients, Medicaid expansion has really leveled (lowered) the playing field for reimbursement. An unintended consequence is more doctors becoming hopital employees and the consolidation allows big conglomerates to charge what they want when the competition is gone. Meanwhile, rural states and areas like Wyoming and NM won't be unable to attract new doctors when they can go to Denver and work less for the same money. When my kids are done in school, I'm thinking about moving back to Reno. I take trades for fees and give discounts to cash payers to close the gap between sticker price and medicaid. Won't happen with a hospital. Obamacare effectively killed private practice for better or worse.

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12 hours ago, mugtang said:

I’d be ok with the German or Israeli models here. 

I like the German model as well but those systems have a strict Tort process. Are Americans willing to give up the right to sue for every damn thing? Maybe the ED doc won't have to order a CT scan when you come in when you haven't had a bowel movement for 3 days because your diet consists of Doritos, diet coke and weed. (not you specifically)

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23 hours ago, WYO1016 said:

I came up with a theory very early on in my insurance career. Let's treat health insurance like we do auto insurance. You are required to have a minimum coverage level (call it an emergency room policy). If you go to a hospital and you don't have one it is considered a criminal offense. This will trigger an SR-22 type situation where the insurance company reports directly to the state your real-time coverage status for a set period of time. Because everyone is carrying a policy it makes the base policy costs very low. There are also options to increase your coverage in return for higher premiums.

I recognize that this is an imperfect solution, but it's a hell of a step up from what we currently have. It would also make an effective bridge towards universal healthcare if that is indeed the direction we end up going.

I think, like auto, if you have a policy you can’t be canceled or excluded for something for which you were previously insured.  Sadly the Republicans try to game the system by allowing companies to cancel sick people a Dems re-gamed it for people by allowing them to buy when ever with no pre-existing conditions.  

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I think any model has to recognize the market inefficiencies and then go from there.  With a vet, MD and DPT in the house this topic gets some conversation..

market inefficiencies...  

Price transparency- healthcare is very hard to price up front.  Even vet care which is the closest thing to market based health care can’t tell you the price for a procedure until it happens.  Too many unknowns such has resistance to sedation etc.

Vertical demand curve-  much of medicine has a vertical demand curve as no one will say ( as vet clients do) that price is too much put the kid/parent to sleep.   So people pay any price regardless.  It also keeps people from saying often this price is too steep for a person in their 90’s.   The essence of a demand curve is rational choices and people don’t make rational choices in life altering procedures.

Delayed gratification-  again much of preventative health care has minimal instant gratification or fills an instant need.  Therefore despite being a critical component of health care most consumers prioritize other items and preventative care gets the ignored.   
 

I think any model has to consider these factors.  For example, what the government spends on low cost benefit procedures for the elderly could likely pay for preventative care for the rest of the population. 

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3 minutes ago, sactowndog said:

I think any model has to recognize the market inefficiencies and then go from there.  With a vet, MD and DPT in the house this topic gets some conversation..

market inefficiencies...  

Price transparency- healthcare is very hard to price up front.  Even vet care which is the closest thing to market based health care can’t tell you the price for a procedure until it happens.  Too many unknowns such has resistance to sedation etc.

Vertical demand curve-  much of medicine has a vertical demand curve as no one will say ( as vet clients do) that price is too much put the kid/parent to sleep.   So people pay any price regardless.  It also keeps people from saying often this price is too steep for a person in their 90’s.   The essence of a demand curve is rational choices and people don’t make rational choices in life altering procedures.

Delayed gratification-  again much of preventative health care has minimal instant gratification or fills an instant need.  Therefore despite being a critical component of health care most consumers prioritize other items and preventative care gets the ignored.   
 

I think any model has to consider these factors.  For example, what the government spends on low cost benefit procedures for the elderly could likely pay for preventative care for the rest of the population. 

Would the fact that we are the fattest and least healthy population of a developed country in the world (especially in AAC cities) be a market inefficiency? 

There are only two things I can't stand in this world: people who are intolerant of other people's cultures and the Dutch. 

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