Trump to unveil healthcare plan
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@Larry said in Trump to unveil healthcare plan:
Are you aware that the world existed before 1985?
So what's the formula then? What changed in the 70's that could bring cost control mechanisms back to the healthcare market?
Can we at least agree that much of the cost of care is going up because we have way more advanced, numerous and expensive therapies than in the past?
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@Larry said in Trump to unveil healthcare plan:
Good God....
What are you even saying? At least I'm telling you where I'm coming from.
That the cost of therapies is going up, pushing up the cost of insurance. Doctors or hospitals don't try to contain cost when thinking about savings patients lives.
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@Larry said in Trump to unveil healthcare plan:
You insist on making everything fit through the system you know. It's like beating my head against a wall trying to get you to stop doing that.
I really don't know what you're talking about.
I'm no healthcare expert. I don't know much about healthcare.
I was surprised when I moved here that - if I had sufficient insurance (my employer's plan), I could see pretty much any doctor I wanted. (good doc, shitty doc - if you go by 3rd party review sites or credential prestige, or reputation)
We had 3 hospital systems to choose from for my wife's pregnancy (only real experience we have with the system here). No difference in cost to us.
Doctors don't typically charge you more or less if they think a procedure is warranted.
Doctors don't think about cost-first when trying to treat patients.
And again - my cost point. (therapies are getting more and more expensive - which makes insurance more expensive)
That's it.
I expected a lot more of a market-based system in the U.S. when I moved here - and it's not a market based system.
That's it. That's my point.
I don't know what you're getting riled up about.
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@xenon said in Trump to unveil healthcare plan:
@Copper said in Trump to unveil healthcare plan:
@xenon said in Trump to unveil healthcare plan:
Do you pay more out of pocket for the best surgeon or ortho? Should you?
Why wouldn't you pay more for higher quality?
You do that for everything else, food, clothing, shelter, transportation, toys and games.
Have you ever explicitly paid more or less for specific physicians?
Yes.
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@xenon said in Trump to unveil healthcare plan:
@Jolly And what context was that in?
Were you insured? Why did you have to go beyond insurance?
Insured. Out of network. One of the top vascular guys in the South.
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@Jolly said in Trump to unveil healthcare plan:
@xenon said in Trump to unveil healthcare plan:
@Jolly And what context was that in?
Were you insured? Why did you have to go beyond insurance?
Insured. Out of network. One of the top vascular guys in the South.
Right - which is the same thing that Copper said (kinda).
Outside of physicians being in/out of network, there's not really any reason to pay for a physician.
And I'm guessing that top guy is in certain other networks. (and that doesn't tell you if his network or your network are better/worse)
But the treatments he uses (drugs, therapies, procedures), I'm guessing are largely in line with other docs - and what he bill insurance is going to be similar to other docs.
You see what I'm getting at? You're not paying for a standard of care.
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@xenon said in Trump to unveil healthcare plan:
@Jolly said in Trump to unveil healthcare plan:
@xenon said in Trump to unveil healthcare plan:
@Jolly And what context was that in?
Were you insured? Why did you have to go beyond insurance?
Insured. Out of network. One of the top vascular guys in the South.
Right - which is the same thing that Copper said (kinda).
Outside of physicians being in/out of network, there's not really any reason to pay for a physician.
And I'm guessing that top guy is in certain other networks. (and that doesn't tell you if his network or your network are better/worse)
But the treatments he uses (drugs, therapies, procedures), I'm guessing are largely in line with other docs - and what he bill insurance is going to be similar to other docs.
You see what I'm getting at? You're not paying for a standard of care.
Do you understand that some docs are better than others?
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@Jolly Ugh...
I know that, Jolly.
Let's simplify. Are there networks that only have top-tier doctors in them? (I don't think that's a thing, but let's assume it is)
Those insurance plans are going to be increasing just as much in cost, if not more, than other plans.
Why? Because of the underlying cost of therapies+aging population.
I don't think differences in doctor quality are a large cost increase driver. Do you agree / disagree?
There's lots of choices to be made in an insurance plan (deductible, network, caps, etc.) - but you're typically not buying a standard of care though. Am I wrong?
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I think I've figured this out. I haven't given the younger guys enough history.
In 1973 or so there were lots more insurance companies. Any insurance company could sell policies in any state. There were no Jo's to speak of, The democrats were in the process of creating them. Most all companies offered a product called Major Medical. Then were quite easy to follow - the policy was 80/20 until your out of pocket costs reached 1,000. No paying for office visits, no paying for prescriptions, until you had spent 1,000. Turn in your Dr visit and prescription receipts, they were added up and applied toward your 1,000 out of pocket. Once you'd paid out 1,000 dollars, the policy paid 100% of your medical bills. No networks, not HMO, just give the hospital your card and they sent the bill to the insurance company. You could go to any doctor you wanted to, any hospital you wanted to, no one told the doctor or the hospital what they could charge, competition kept everyone honest.
Then Edward Kennedy got the bright idea to set it up where the government could dictate things. The HMO Act of 1973 introduced HMOs, and all sorts of regulations. It got more and more intrusive over time, choices became limited, doctors and hospitals began getting told what they would be paid. Now here we are, maybe 2 choices if you're lucky, home that are incentivised to get their revenue by paying hospitals and doctors peanuts, a populace who goes along with it like trained seals.
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@xenon said in Trump to unveil healthcare plan:
@Copper said in Trump to unveil healthcare plan:
@xenon said in Trump to unveil healthcare plan:
@Copper said in Trump to unveil healthcare plan:
@xenon said in Trump to unveil healthcare plan:
My point is that there’s a mistaken assumption that market forces are somehow controlling cost in this country.
They are not. That’s a market failure.
The market is just fine.
Obamacare is a very small part of the picture. And obamacare users participate in the market.
So does whoever gives you your insurance - go ask them. They will tell you they spend a lot of time watching the market.
You should go talk to Larry, he says there's no market and thinks you're a moron. He's already explained it.
Go on.
Go ask your friends in HR if there is a market.
Even better tell them you don't want their handouts anymore. You want to participate in the market.
I guess you missed it above when I took the time to answer your question about expensive plans with high quality. Here is one I used: https://www.mdvip.com/
Sorry I didn't respond. But if I understood you correctly, you switched networks to follow a doctor who moved to another network.
You're not going to pay more or less within that network for doctors (presumably they're not all of the exact same quality in that network).
And I'm not saying there's not higher quality networks, or that there aren't plans with "better" coverage.
I'm saying - there's very little adjustment of the standard of care across doctors.
Would you agree that there is more treatment we can throw at patients now than 20 years ago? Wouldn't that increase cost? How is that controlled?
Who decides when enough treatment and enough dollars have been spent on a patient? Who is looking at the outcomes / $ spent on specific treatments?
No, not a different network, a higher quality of care with a higher cost.
I don't know what you mean by adjustment of standard, but there is a wide range of quality of care. It is closely monitored and published. I know I used to publish this data.
A lot of people decide when enough has been spent. A lot of people just pay their bills and decide when they have spent enough. If you depend on health insurance you decide how much insurance to buy.
When I was collecting and selling quality of care data for about 93% of the hospitals in this country CDC was responsible for looking at outcomes and the amounts spent. This data was published and it was public. I have been away from this for a while but I assume they still do it. There were a lot of people who used this data beside the hospitals involved, including insurance companies and medical peer groups.
This is all public information. You should consider using google to find this stuff. It is probably a little easier for you to come here demanding answers, but keep in mind that just because you aren't familiar with it doesn't mean it doesn't exist.
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Now we know @Larry draws his healthcare comparisons with whatever he thinks he remembers from the early 1970s, before the HMO Act was signed into law in 1973 by Richard Nixon (a Republican, just in case @Larry forgot).
Whatever he thinks he remembers, @Larry simply do not know the facts.
Infant mortality rates:
1973: 17.814 deaths per 1000 live births
2020: 5.681 deaths per 1000 live birthsLife expectancies:
1973: 71.42 years
2020: 78.93 yearsHealthcare expenditures growth rates:
1970s: 12.1% per annum
2010s: 3.6% per annumQuite simply, if you draw the comparisons for healthcare between 1970's and the present day, the outcomes and cost controls have improved across the board. Infant mortality rates dropped significantly, life expectancies improved markedly, and cost control also improved significantly. Healthcare expenditures were growing about 12% per year in the 1970s, versus about 3.6% per year in the 2010s (and this includes the effects of ObamaCare).
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Science has nothing to do with it.
Next thing, you're going to tell me something shocking...Healthcare was better in 1955 than in 1865.
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@xenon said in Trump to unveil healthcare plan:
@Jolly Ugh...
I know that, Jolly.
Let's simplify. Are there networks that only have top-tier doctors in them? (I don't think that's a thing, but let's assume it is)
Yes, it is a thing.
It is usually not referred to as a network.
It is a service and it wouldn't be covered by most insurance.
It is a group of doctors who charge extra for the service. You buy this service in expectation of higher quality and higher service.
If you don't like the quality or service you can go elsewhere like any other market based service.
Differences in quality without question result in differences in cost.
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@Axtremus said in Trump to unveil healthcare plan:
Now we know @Larry draws his healthcare comparisons with whatever he thinks he remembers from the early 1970s, before the HMO Act was signed into law in 1973 by Richard Nixon (a Republican, just in case @Larry forgot).
Whatever he thinks he remembers, @Larry simply do not know the facts.
We're you there, ass wipe? No. I was. I'm fully aware that Nixon signed it into law. I'm also fully aware that it was Edward Kennedy and the democrats who wrote the bill and stuck it into a bigger package, and I'm aware that Nixon didn't have line item veto. So fuck you.
