How would you fix the U.S health care system?

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You amend your application, of course!

You do that now for other forms of assistance, if you suddenly need help in the middle of the year.
My dad got a very aggresive cancer and had to go directly to begin radiation the same week for him to have a prayer in hell that he would survive.

Do you see any problems with your plan in this situation? Assume the situation of the person making much less money than last year (just enough to make frugal living expenses) at the time of their diagnosis.
 
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Do you see any problems with your plan in this situation? Assume the situation of the person making much less money than last year (just enough to make frugal living expenses) at the time of their diagnosis.
Do you see that the plan provides for help? Where do you see an obstacle to updating requests for help?
 
Do you see that the plan provides for help? Where do you see an obstacle to updating requests for help?
Is there going to be a 24/7 storefront on every block for people to refile and get an answer within 20 minutes? A phone line with no wait time that will give an answer in 20 minutes? What if the answer is still “no”?

Again…. Sounds like you don’t have first hand experience of being in that type of situation where time is of the essence and the individual has no resources.
 
Again…. Sounds like you don’t have first hand experience of being in that type of situation where time is of the essence and the individual has no resources.
My mother died of beast cancer in 1967 and my father of heart and kidney failure in 1969 – both before Medicare. As a result, everything they has was gobbled up by medical expenses.

When you assume what another person’s experiences and thoughts are, you aren’t talking to that person any more, you’re talking to an imaginary person who lives only in you own mind.
 
Then how DO you propose to pay? Are you not responsible for yourself and family? Shouldn’t you pay for your own needs, if you can?
Make Medicare universal. Increase the medicare tax and apply it to all forms of income. Establish what is essential medical care. Have Medicare cover that. Prohibit Medicare from paying for abortions or birth control or sterilizations (not included in the abortion/contraception ban would be hormone pills that treat a medical condition like endometriosis or a sterilization like a hysterectomy that is done for a medical reason, or even a pregnancy termination done for a grave medical reason like an ectopic pregnancy). Every citizen will have medicare from birth to death. Every citizen will have their Medicare delivered through a non-profit program run by an insurance company that is regulated by the government. People will also have the option to purchase supplemental coverage (even for profit) from their insurance company, but emergencies, chronic illnesses, regular checkups, and catastrophic medical problems like organ failure, cancer treatment, or getting hit by a bus will be covered at no out of pocket cost or a very small out of pocket cost.

See how health care is run in Switzerland, Germany and Japan. No government run insurance. All non profit private insurance, at least partially funded through tax. All 3 countries have excellent care.

Done
 
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Make Medicare universal. Increase the medicare tax and apply it to all forms of income.
How is that different from “those who can pay should pay” except that a large and expensive bureaucracy is injected into the system?
 
My mother died of beast cancer in 1967 and my father of heart and kidney failure in 1969 – both before Medicare. As a result, everything they has was gobbled up by medical expenses.
Nope. Medicare was introduced in 1965. Harry and Bess Truman were the first two people enrolled.
 
My mother died of beast cancer in 1967 and my father of heart and kidney failure in 1969 – both before Medicare. As a result, everything they has was gobbled up by medical expenses.

When you assume what another person’s experiences and thoughts are, you aren’t talking to that person any more, you’re talking to an imaginary person who lives only in you own mind.
The 60’s were a much different time. My mother delivered my brother at a large hospital in 1968 and was hospitalized for four days. There were some complications. The bill was $835. Even when adjusted for inflation and today’s dollar, you wouldn’t even get a half day hospital stay for that , let alone a birth.

Anyone who has suffered financial medical hardship in today’s world knows your plan is unconscionable.
 
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How is that different from “those who can pay should pay” except that a large and expensive bureaucracy is injected into the system?
It is a bureaucracy that already exists, and it would eliminate every other government insurance program and it would standardize every health insurance company’s basic benefits plan, which will make a huge cut in administrative costs. The Federal government already pays around 50% of the US bill for medical care. Add states and local governments, you have about 60%. In Canada, the government pays for everyone, and only pays 70%-75% of the bill (the rest is private supplemental coverage).

The overall system will be far less complex than what we currently have and everyone will pay in via a flat medicare tax on all income plus a national VAT (similar to sales tax, but more efficient—widely used in countries around the world). The actual administration of your plan would be by a private company that has to comply with federal regulations. There will be no tax money for abortion or birth control EVER.

All pharma prices will be under strict regulations to prevent the kind of out of control pricing we have now. Every insurance plan will pay the same amount for every medicine or service, and the prices will be controlled strictly.

It is no different than taxes for anything else. But everyone will benefit from this and the massive hidden tax of our insanely expensive healthcare system will be gone and we will actually spend less money on medical care, which eats up 1/5 of every dollar in the US and still leaves millions without coverage or undercovered. We pay by far the most per capita in the world.

Your “pay out of pocket” plan will make life for most people who have health problems miserable.

And I said “hogwash” because you think that R & D is actually what big pharma spends money on. It is around 13% of the average pharma budget. around 24% is spent on advertising and marketing. That is not done in the rest of the world and is obscene and perverse. Prescription meds are not consumer products like candy or soda or kids toys or even movies. They should not be advertised directly to the public nor should pharma reps be bribing doctors to proscribe their overpriced medicines.

Done. and out.
 
My parents didn’t get a penny and had to sell the ranch.
They could have if they were over 65. The whole point of medicare was so that elderly people weren’t bankrupted by medical costs, which was a major problem in the pre-medicare era.
 
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Does anyone know how much drug research is by Pharma vs government money vs university research? I’m thinking that Pharma gets quite a bit of research money or at least the benefits of medical research from NHI grants and such. I know that NIH funds have been drastically reduced recently putting more of the burden on Pharma. The problem is that Pharma won’t develop non profitable drugs, especially for those rare diseases.

Is Pharma the best place for R&D to take place? Or would NIH grants to university researchers be better?
 
Lawyers also advertise. And automobile makers. Does that make them evil?
No, not evil. Wasteful and inefficient. But you do understand what advertising is, don’t you? Think about what is advertised most : cars, beer, makeup, drugs… How many ads have you seen for Honda Accords or Toyota Camrys lately? None, right? And how many for Lincoln, Cadillac, Ford pickups, etc.? Every other commercial. Ever wonder why? Advertising 101: You advertise goods that are nearly identical in order to create a fiction in the customers’ minds that the goods are somehow classy, effective, or popular. It’s all about perception. Nothing to do with the actual worth of the products. And that’s why drug companies advertise directly to the consumer–to create an impression: “Ask you doctor if hardened beeswax is right for you!” Please. Don’t fall for it.
Do you see that the plan provides for help? Where do you see an obstacle to updating requests for help?
I think that one answers itself. Are you kidding me? These are the same companies who are sending me bills almost two years after a procedure, and somehow they are going to be lightning fast to update my file? Please.
How is that different from “those who can pay should pay” except that a large and expensive bureaucracy is injected into the system?
  1. Everyone pays. You’re not splitting the population into “haves” and “have nots.” That’s how it’s different.
  2. Large and expensive bureaucracy? By law (see NAIC model laws, adopted with variations by all states–but this provision is universal) health insurance companies have to pay out 70% of premiums in claims. They get to keep the other 30%. Please name an insurance company that says “Oh, we thought it would be great if we paid out 85% of premiums in claims! Our stockholders just loved that idea!” Ludicrous. They all take the maximum of 30% (Under the ACA, those companies participating could only take out 15%–horror–in “expenses.” And what are acceptable expenses? A private island. A fleet of private jets. Corporate retreats in Tahiti. $10 million for the CEO + bonus. And so on. Meanwhile…what are Medicare administrative expenses? 3%. Ten times less. Please, if you want to talk about “large and expensive bureaucracy” at least pin the label where it belongs.
The problem is that Pharma won’t develop non profitable drugs, especially for those rare diseases.
Yup. And worse. Haven’t you read about all those common drugs that are no longer common simply because the drug companies refuse to make them? They’re not very profitable. And their criterion for manufacturing is like any other corporation: what product brings in the most contribution (to use MBA language) or profit (to use a common term)? Can you see the boardroom where some VP raises his hand and says “You know, drug xyz isn’t very profitable, but it will help 20 million people.” You know what that guy is called, right? Two things: Not a team player and unemployed.
 
You fix it by getting the government out of the way. Just look at the VA hospitals and tell me it’s a good idea to involve the government.
 
Does anyone know how much drug research is by Pharma vs government money vs university research?
There are a lot of articles, but https://www.researchamerica.org/sites/default/files/2016US_Invest_R&D_report.pdf gives you the breakdown for 2015: industry, 64.7%; federal gov., 22.62%; universities 5.45%; then misc. organizations.

As I pointed out above “costs” are flexible, depending on what you want them to be. Obviously (I hope everyone sees that) drug companies have a financial interest in inflating research “costs” as high as possible to get tax breaks. And, as I pointed out before, NO ONE knows what these “costs” consist of outside the financial depts. of the companies involved.

I will give some examples from the vaccine company I used to work for. We had one anti-toxin used to treat food poisoning. We bought it after WW II as surplus. The brilliant accountants at the time said, “I have a bright idea! First, we’re going to expense the lost interest income we COULD have gotten if we had invested that money instead of buying that stupid anti-toxin!” And another brilliant accountant said, “And look! We have to store it! And since it’s live cells, we have to keep it at a certain temperature in special containers and so on! We’ll add those costs on every year, and compound them!” And the head of finance said, “Great ideas, guys!” Fast forward 40 years. The “cost” of the anti-toxin was now MORE THAN the retail price every other producer was selling it for. So did we sell any? Ever? Of course not. Did the company revise it’s accounting system and write off the compounded “costs” accrued since 1945? Silly question. Of course not. It’s still sitting there accumulating costs.

We also produced a typhoid vaccine. One problem: it was a live vaccine. That meant it could actually CAUSE typhoid in some people. We could have developed another type of vaccine that would NOT be able to cause typhoid in those who got it. Think we did it? Nah, it cost too much.

We also produced factor 8, which is a blood product that helps hemophiliacs with blood clotting. Where did we get the blood to produce it? Prisons in Louisiana. Hmmm…AIDS, anyone? Well, yeah, but that heat treating process that would have prevented it from spreading AIDS is expensive…we can’t afford THAT. And so, we shipped factor 8 that mostly likely gave a bunch of people AIDS.

Then of course there was the failure of type 2 Sabin polio vaccine. Our vaccine was trivalent: it protected against three different strains of polio. We found out (through a customer…) that the type 2 wasn’t effective. We tested it (on employees, including me). Yup, sure enough. No type 2 antibodies. So we had a massive recall of the product…just kidding. No recall. What are you, Socialists? We wanted that nice green paper called money. Nope. Kept it secret. Did people die? Only God knows. Did we fix the problem for future batches? Yes, at least we did that.

So when you start talking about “costs” and “research” you need to look at the real world. And what makes the world go round? Money. Cold cash. Not that do-gooder stuff about helping people.
 
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Just look at the VA hospitals and tell me it’s a good idea to involve the government.
You’re talking apples and oranges. The VA owns its own hospitals, and the doctors are employees of the VA. The VA is chronically under-funded, we all know that.

But a single-payer health system? The government simply pays the bills. It doesn’t own hospitals, it doesn’t employ doctors, nurses, or any health care workers at all. In other words, it does exactly what private insurance companies do now, but 10 times more efficiently in terms of cost, and without an incentive to deny care.

Would there be fraud? Sure. Can you show me an industry without fraud? No. Then ask yourself: That last statement you got from your insurance company that said it paid Abbott Labs (just an example…) $565 for drug ABC. If you are paying 20% of the cost, does the insurance company have an interest in making that cost as high as possible? Of course. For two reasons: first, it might cost so much you don’t use it. In that case, the insurance company keeps your premiums. Second, what if it REALLY cost $400…and you paid 20% of $565 ($113) instead of the REAL copay of $80. So you paid $31 more than you should have. Multiply that by 12 months a year and millions of people. Now we’re talking real money, right?

So take that example. Now under the current system, the insurance company tells you it paid Abbot Labs $565. How do you know that? Can you demand to see the invoices? Can you march into their finance office and go through their records? Are you kidding? Now look at single payer system under the federal gov. Can the federal gov. ask to see the invoice? Why yes, it can. Can it march into their finance office (with a warrant!) and demand to see their records? Why yes, it can. So tell me: which system leads to more fraud?
 
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Because there is no standard accepted way to account for the cost. How do you charge R&D for a drug that didn’t pan out?
Correct on #1. Each company can set its own accounting policies. There is no standard, except that you can’t do it one way one year and another way the next year. You have to be consistent. And you have to follow FASB rules, which are pretty loose.

How would you expense a drug that didn’t work out? Well, one obvious way would be to write it off as an expense without a corresponding income attached. I imagine most companies throw ALL R&D into a big pot, successful or not. Does that make sense? Maybe for the company, but not in the common sense real world. Does it matter? I think so. Stockholders wouldn’t like expenses without attached income, even if the expenses were tax deductible. You would have a big incentive not to fail. Of course one cure for all this would be either a) government-owned drug companies that would take big risks to develop novel drugs or b) gov. subsidies to fund risky projects. But of course that’s not how it works now–the gov. would only fund projects it thinks will pay off. Thus the companies have no incentive to take risks, even if 10% of the time the risks would pay off with a cure for cancer or something.
The method used is to see how it affects the bottom line.
Absolutely. The bottom line is sacred!
Nevertheless, R&D in Europe has dropped dramatically, and THAT is the point.
Let’s check that one out…let’s look at statistics from the European Federation of Pharmaceutical Industries and Associations ( Pharmaceutical R&D expenditure in Europe, USA and Japan )

First, look at R&D expenditure from 2000-2010:
US–up 90%
Europe–up only 54.4% (so less than the US, but up, not down)
Japan–up 71%

Then take the next 5 years, 2010-2015 (that pesky financial crisis caused by all those Socialist on Wall Street that had no idea what they were doing):
US–up 18.2%
Europe–up 19.7% (huh. Europe’s up 1.5% more than the US.)
Japan–up 14.2% (less than the Europeans…)

No “decline” in sight. Everyone is spending more, often at a higher rate of increase than the US.

But there is a caveat to all this: What do you count as “US” and what do you count as “European”? What if the company has its HQ in New York, but it’s research labs in Zurich? What if another company has its HQ in Paris, but its research labs in California? It’s complicated to sort out.
 
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Why not start with the government paying for the emergency response and care? That would be the ambulances, helicopters, and emergency room units. They are expensive to operate and hospitals and insurance companies would be relieved of a large financial burden.

It might also make sense to Americans. Other emergency services such as fire and police are paid for by the government. Americans are acustomed to the idea. My understanding of the current system is that the cost is paid for by hospital patients. Often, those who receive emergency medical care cannot or will not pay their bill. The cost is passed on to other patients and covered sometimes with federal aid.

I have seen a figure of 40 billion for unpaid emergency room care in a recent year. This was about 6 percent of the operating cost of the nation’s hospitals. However, the cost of emergency care is probably many times higher than 40 billion through insurance companies. The total operating cost of emergency care must be enormous yet a 1985 federal law requires hospitals to treat and stabilize anyone entering their doors regardless of their ability to pay.

I think that if the people’s government pays for emergency care and response units, a huge burden will be lifted from private insurance and hospitals. Direct costs to patients will go down, taxes will go up, but insurance options will increase. Factoring out emergency care costs from insurance premiums would allow insurance companies greater flexibility and creativity in inventing insurance policies that cover other non emergency related packages. Meanwhile, all people would benefit from emergency care. Emergency care could also include things such as terminal illness, starvation, and exposure to inhospitable climate.

Second, the government could assist or even outright cover preventative care. Prevention is the sister initiative to providing emergency care. This gives the government two related initiatives to focus its financial efforts; to pay for emergency care and to pay for the prevention of emergency care. One wing insures that all Americans can be treated for emergencies without incurring massive bills while the second wing works to lower the overall cost of emergency care through prevention.

Since private insurance usually includes preventative care in the premium, this is a second cost that can be factored out. This cost is the sort that is nearly guaranteed since people are inclined to use what they have almost certainly paid for. I say “almost” because some people might not take advantage of those preventative services.

Removing emergency care and preventative services from the burden of private insurance companies would further reduce premiums for basic non emergency coverage while allowing these companies to invent a greater range of coverage packages that sit on top of emergency and preventative services.

Continued below…
 
Continued from above…

This strategy would increase the options provided by insurance companies while lowering the price of premiums for basic coverage beyond emergency and preventative care. It would provide a universal safety net to all Americans. Current initiatives such as requiring the acceptance of those with preexisting conditions by insurance companies can remain in effect and the cost accepted as a layer of the cost of the premium like it is now.
 
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Ah, I can hear the response now: “Sure, but the US spends so much more on R&D than the Europeans…” Yes, they do. And my neighbor paid $5,000 more for the same car I just bought for $5,000 less than he paid. I’m not sure that makes him a genius. Maybe you do.

Here’s a nice study from Stanford, a bit old at 2009, but still interesting since it covers 1982-2009: Researcher: Europe surpasses United States in new drug discoveries | Stanford News Release

Let me quote a few passages:

“the research productivity of U.S. pharmaceutical companies has fallen behind European competition…”

“European researchers actually have been more innovative since 1982…”

“European companies discovered more drugs than U.S. companies from 1982 to 2003, overall and in proportion to funding…”

“in the last 40 years, only about 11 to 15 percent of new drugs provided significant clinical improvement over existing ones, while the remaining 85 to 89 percent include what are called “me-too” drugs, clones of existing drugs, marketed as the latest breakthrough…”

So what, right? Read more: “European buying groups assess new drugs and if the drugs aren’t much better, they are not willing to pay much more. That’s an incentive to find drugs that are substantially better because they’ll get a higher price. American insurers and Medicare pay high prices regardless of added value.”

“European pharmaceutical companies are not only producing more, but doing it for less. European patented drug prices run about half the cost in the United States…”

“High prices for these new drugs enable [US] companies to spend 2.5 times more on marketing than on R&D to persuade physicians to prescribe them and patients to want them. Thus, current incentives reward better marketing over better value…”

So. The US is spending more to get less. That’s the story of US healthcare in a nutshell.
 
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