Medicare for all — net costs

[summit]

The current situation of ever rising cost trends is absolutely unsustainable in the midterm, and when we suffer a big recession, that will likely pop the bubble. I don't like MFA but there needs to be universal preventative care and some sort of multipayer very basic universal care that includes public and private and self care incentives.

Current system favors large companies and insurance companies.

[reckless toboggan]

[evdog]

He's unintentionally showcasing why the US system as it is is doomed to failure. Everyone cares about out of pocket which is only tangentially related to the actual cost of healthcare and so there is no market incentive for individuals to make decisions that reduce their heathcare consumption. Individuals get really angry in the US if they actually have to have free market healthcare in my experience. They also often make more rational decisions.

Everyone cares about out of pocket....because it's exactly that... money coming out of your pocket.

But I think fucked up pricing models for healthcare and how the system incentivizes providers to prescribe expensive treatments (ie excessive tests and expensive drugs) contributes a lot more to high cost than patients who don't reduce their healthcare consumption because most of the cost is covered by insurance. Copays and deductibles are designed to discourage seeking unnecessary treatment by putting some cost on the patient, without making treatment unaffordable. If everyone had to pay the full cost of all of their treatments few people could afford healthcare at all. That's why insurance exists.

By your logic shouldn't the Canadian system be even worse off since people there don't even see bills for treatments and have minimal copays or other expenses for treatment? Yet the per capital healthcare spending is about half that of the US. Why is that?

[dunfree]

Everyone cares about out of pocket....because it's exactly that... money coming out of your pocket.

Insurance premiums paid by your employer are money coming out of your pocket. You choose a mix of benefits + cash in the market. supermoon is paying $20k/year for health insurance because he's his own employer.

the canadian market has that evil "rationing" boogeyman, which the US market has, just people don't see it.

with this

But I think fucked up pricing models for healthcare and how the system incentivizes providers to prescribe expensive treatments (ie excessive tests and expensive drugs) contributes a lot more to high cost than patients who don't reduce their healthcare consumption because most of the cost is covered by insurance

you described the same effect, just two different ways. the system is incentivized to charge a shit ton of money for stuff because they get reimbursed by insurance and the ultimate recipients of service have minimal incentive to ration treatment for themselves.

[DougW]

One thing I've heard about, but don't know how true it currently is or how much it really affects things, is a relative scarcity of high-tech machinery in Canada. About 7-8 or so years ago I was talking to a Doctor about this same general topic, and he claimed that there were more MRI machines in Greater Boston than there were in Canada.

He said it was because there's financial motivation for US hospitals to get the equipment and that that they don't have that motivation in Canada, in fact kind of the opposite. He wasn't claiming that Canadian doctors are bad and was emphatic on that, or that the standard of care was bad, just that resources are scarcer in that system and that affects the way things are diagnosed and treated..

There is some truth here. MRIs are rationed in Canada. So for a MCL tear you might wait 3-6 months. On the long end if its not really critical. Now there are lots of places you can get an MRI and pay for it yourself and have it done the next day or so. Now if the Doc suspects a brain tumor or something like that you will get one immediately there is no wait time for that.

I've done it both ways. knee was bugging me one winter , not bad but a bit of a pain. Go in get on a wait list wait a full 6 months. Knee was fine at that point so I could have cancelled but didn't. Turned out having that piece of paper years later got me in for a meniscus trim in about 6 weeks when knee really was starting to hurt.

Last winter went the private route as GP had no clue what was causing pain in other knee. Got appointment to see specialist, not surgeon but sports doc. Last time I went directly in to see surgeon as I had an MRI. So I paid for an MRI in Calgary. Had to see GP to get a prescription for one and off I went to Calgary. Was only $600 or so and I had a problem that 10 visits to GP or sports doc would not have found with out an MRI. The public system radiologists are the ones who read the MRI so they are still in the public system. The $ pays for the machine and the techs and the nice waiting room with the big TV and the snacks.

[4matic]

ACA doesn’t use an asset screener. It’s all based on current income. You can have millions of dollars in cash but if you have no income you can qualify for Medicaid funded insurance. And, it’s better insurance than the crap businesses provide. Politicians know that but I doubt most of the public does. Republicans don’t make light of it because it might cost them their poor white base.

Democrats could also lose their liberal middle class over it too. The middle class is the hardest hit. That part is true

[Supermoon]

That’s sort of true. If you actually withdraw the money to spend it on living expenses or hookers and blow, or whatever, that counts towards your earnings.

[4matic]

That’s sort of true. If you actually withdraw the money to spend it on living expenses or hookers and blow, or whatever, that counts towards your earnings.

Does not. Only if the money is from pension or retirement account. Cash savings that have already been taxed are not counted in the equation. There is no asset test in California. Each state makes their own rules regarding eligibility so ymmv

[Supermoon]

Oh. Sorry. Didn’t see you said cash. I just saw assets.

[4matic]

Having a rental property as your only income would suck or being just over the minimum. That would put you into the exchange and then you don’t have enough income to offset the tax credit.

[Sirshredalot]

ACA doesn’t use an asset screener. It’s all based on current income. You can have millions of dollars in cash but if you have no income you can qualify for Medicaid funded insurance. And, it’s better insurance than the crap businesses provide. Politicians know that but I doubt most of the public does. Republicans don’t make light of it because it might cost them their poor white base.

Democrats could also lose their liberal middle class over it too. The middle class is the hardest hit. That part is true

It's also true that the set of people with a bunch of assets tucked aside who are too young for Medicare and who realize so little income that they qualify for Medicaid or ACA exchange subsidies is vanishingly small.

[iceman]

Yeah but that guy sucks.

[Cono Este]

The current situation of ever rising cost trends is absolutely unsustainable in the midterm, and when we suffer a big recession, that will likely pop the bubble. I don't like MFA but there needs to be universal preventative care and some sort of multipayer very basic universal care that includes public and private and self care incentives.

Current system favors large companies and insurance companies.

I got my bill for my ER visit in June.

2000 but got a Cigna discount to $800. I thought that was it, then I got a separate bill for the physician who treated me in the ER, for 500!!! Guy put an IV in me and ordered an X-ray. And then another 350 for the 15 minute follow up with a specialist. My Obamacare pays zero at $400 a month in premiums.

Please add doctors to your list of problems. I actually know the specialist personally, son plays B.B. with his son, guy literally laughs to me about the coin he makes giving paid speeches for pain management, and drives a Turbo Cab. Only because of that did he probably give me 15 min and not 5.

Btw. Celebrex is a wonder drug.

[MagnificentUnicorn]

Uh, I suppose 'cuz they wanna do right by the people they're taking care of?

Believe me, "better jobs and more money" does NOT necessarily correlate with better clinical skills, whether it be by working harder or leaning more "stuff".

I'm glad you posted this, ime working 30 years with surgeons, it's the greedy and ambitious that make the most money. Often the most skilled and caring surgeons don't care that much about how much money they're making. They can basically work office hours and make more money than most Americans.

[MagnificentUnicorn]

There is some truth here. MRIs are rationed in Canada. So for a MCL tear you might wait 3-6 months. On the long end if its not really critical. Now there are lots of places you can get an MRI and pay for it yourself and have it done the next day or so. Now if the Doc suspects a brain tumor or something like that you will get one immediately there is no wait time for that.

I've done it both ways. knee was bugging me one winter , not bad but a bit of a pain. Go in get on a wait list wait a full 6 months. Knee was fine at that point so I could have cancelled but didn't. Turned out having that piece of paper years later got me in for a meniscus trim in about 6 weeks when knee really was starting to hurt.

Last winter went the private route as GP had no clue what was causing pain in other knee. Got appointment to see specialist, not surgeon but sports doc. Last time I went directly in to see surgeon as I had an MRI. So I paid for an MRI in Calgary. Had to see GP to get a prescription for one and off I went to Calgary. Was only $600 or so and I had a problem that 10 visits to GP or sports doc would not have found with out an MRI. The public system radiologists are the ones who read the MRI so they are still in the public system. The $ pays for the machine and the techs and the nice waiting room with the big TV and the snacks.

An MRI isn't necessary for MCL tear diagnosis. It can be diagnosed with a physical exam. Often the MRI is ordered because the insurance company won't authorize the treatment without one. Of course this is in the States.

Another example of this is appendicitis. It's a best practice to get a CT for all patients with suspected appendicitis. We still have many patients come into surgery with sub acute appendicitis or a normal appendix because the radiologist reads the CT and says he suspects appendicitis. This happens even if all other clinical signs indicate no appendicitis. It's a liability thing and the push is to remove any critical thinking. Our system is broken in this regard. Some surgeons are brave enough to buck this trend but they are dwindling in number.

[XXX-er]

Insurance premiums paid by your employer are money coming out of your pocket. You choose a mix of benefits + cash in the market. supermoon is paying $20k/year for health insurance because he's his own employer.

the canadian market has that evil "rationing" boogeyman, which the US market has, just people don't see it.
]

yeah its paid out of the taxes everyone pays

[iceman]

Hence the beer and gas prices. Ain't no free.

[XXX-er]

HC isn't supposed to be free up here just universally available to anyone who needs it

would you rather pay less for a case of beer and be bankrupted by a major illness?

How much is gasoline subsidized in the USA, do you really pay a world price ?

[iceman]

I wasn't being negative, it's just that it has to get paid for somehow. Raising taxes on vice products both raises money and (at least in theory) cuts consumption and thus health care costs.

Ain't no free.



As far as gas, it's a global commodity, there is a price for it. You guys choose to tax the shit out of it for your own reasons, and we don't for ours. Different story completely.

[XXX-er]

well if I goggle fuel subsidies in the USA i get all kinds of hits ... fake news eh ?

[iceman]

I'm really not enough of an expert to debate it - there's plenty of indirect subsidies like money for roads etc. but I'm not aware of direct subsidies to keep gas prices low and I don't think they exist. But I could be wrong.

[BCMtnHound]

I don’t think the refinery end of the biz receives much. And we buy the fuel in USD so there’s the exchange on top of the taxes for us. But subsidy in exploration and extraction of the raw certainly exists. But that’s a whole different market.

[MagnificentUnicorn]

https://www.nrdc.org/experts/daniell...fuel-subsidies

It seems the only G7 country that ranks worse than the US for fossil fuel production is CA according to the link.

[summit]

An MRI isn't necessary for MCL tear diagnosis. It can be diagnosed with a physical exam. Often the MRI is ordered because the insurance company won't authorize the treatment without one. Of course this is in the States.

Another example of this is appendicitis. It's a best practice to get a CT for all patients with suspected appendicitis. We still have many patients come into surgery with sub acute appendicitis or a normal appendix because the radiologist reads the CT and says he suspects appendicitis. This happens even if all other clinical signs indicate no appendicitis. It's a liability thing and the push is to remove any critical thinking. Our system is broken in this regard. Some surgeons are brave enough to buck this trend but they are dwindling in number.

Defensive medicine is a function of the lack of tort reform in the US.

[ncskier]

30% of California on Medi-Cal, a form of Medicaid. I can tell you first hand that it is excellent insurance. Much better than the corporate scam. Frees up a lot of money that gets spent on the economy.

As someone who works in the field of medicare and medicaid reimbursement for hospitals, I can assure you that if 100% of providers and doctors were paid medical rates. there would be no providers or doctors to go to.