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  • USA - Medical Insurance ~ Treatment ~ Health Care, etc.

    As title might suggest, a somewhat catch-all thread title/topic, but one bandied about in various forms over the years.

    I'll try not to post too much of full text, but the material is such as been tossed about in various forms over the years and in need of consideration ...

    A Short History of American Medical Insurance
    September 2018 • Volume 47, Number 9John Steele Gordon
    John Steele Gordon
    Author, An Empire of Wealth: The Epic History of American Economic Power
    ...
    Perhaps the most astonishing thing about modern medicine is just how very modern it is. More than 90 percent of the medicine being practiced today did not exist in 1950. Two centuries ago medicine was still an art, not a science at all. As recently as the 1920s, long after the birth of modern medicine, there was usually little the medical profession could do, once disease set in, other than alleviate some of the symptoms and let nature take its course. It was the patient’s immune system that cured him—or that didn’t.

    It was only around 1930 that the power of the doctor to cure and ameliorate disease began to increase substantially, and that power has continued to grow nearly exponentially ever since. This new power to extend life, interacting with the deepest instinctual impulse of all living things—to stay alive—has had consequences that our society is only beginning to comprehend and address. Since ancient times, for example, doctors have fought death with all the power at their disposal and for as long as life remained. Today, the power to heal has become so mighty that we increasingly have the technical means to extend indefinitely the shadow, while often not the substance, of life. When doctors should cease their efforts and allow death to have its inevitable victory is an issue that will not soon be settled, but it cannot be much longer evaded.

    Then there is the question of how to pay for modern medicine, the costs of which are rising faster than any other major national expenditure. In 1930, Americans spent $2.8 billion on health care—$23 per person and 3.5 percent of the Gross Domestic Product. In 2015 we spent about $3 trillion—$9,536 per person and 15 percent of GDP. Adjusted for inflation, this means that per capita medical costs in the United States have risen by a factor of 30 in 90 years.

    Consider the 1980s, when medical expenses in the U.S. increased 117 percent. Forty-three percent of the rise was due to general inflation. Ten percent can be attributed to the American population growing both larger and older (as it still is). Twenty-three percent went to pay for technology, treatments, and pharmaceuticals that had not been available when the decade began—a measure of how fast medicine has been advancing. But that still leaves 24 percent of the increase unaccounted for, and that 24 percent is due solely to an inflation peculiar to the American medical system itself.

    Whenever one segment of an economy exhibits, year after year, inflation above the general rate, and when there is no constraint on supply, then either a cartel is in operation or there is a lack of price transparency—or both, as is the case with American medical care.

    So it is clear that there is something terribly wrong with how health care is financed in our country. And a consensus on how to fix the problem—how to provide Americans the best medicine money can buy for the least amount of money that will buy it—has proved elusive. But the history of American medical care, considered in the light of some simple but ineluctable economic laws, can help point the way. For it turns out that the engines of medical inflation were deeply, and innocently, inserted into the health care system just as the medical revolution began.
    ....
    In 1850 the U.S. had 40,755 people calling themselves physicians, more per capita than the country would have in 1970. Few of this legion had formal medical education, and many were unabashed charlatans. This is not to say that medical progress was standing still. The stethoscope was invented in 1816. The world’s first dental school opened in Baltimore in 1839. The discovery of anesthesia in the 1840s was immensely important—although while it made extended operations possible, overwhelming postoperative infections killed many patients, so most surgery remained a last-ditch effort. Another major advance was the spread of clean water supplies in urban areas, greatly reducing epidemics of waterborne diseases, such as typhoid and cholera, which had ravaged cities for centuries.

    Then finally, beginning in the 1850s and 1860s, it was discovered that many diseases were caused by specific microorganisms, as was the infection of wounds, surgical and other. The germ theory of disease, the most powerful idea in the history of medicine, was born, and medicine as a science was born with it. Still, while there was a solid scientific theory underpinning medicine, most of its advances in the late nineteenth and early twentieth centuries were preventive rather than curative. Louis Pasteur and others, using their new knowledge of microorganisms, could begin developing vaccines. Rabies fell in 1885, and several diseases that were once the scourge of childhood, such as whooping cough and diphtheria, followed around the turn of the century. Vitamin deficiency diseases, such as pellagra, began to decline a decade later. When the pasteurization of milk began to be widely mandated around that time, the death rate among young children plunged. In 1891, the death rate for American children in the first year of life was 125.1 per 1,000. By 1925 it had been reduced to 15.8 per 1,000, and the life expectancy of Americans as a whole began a dramatic rise.

    Hospital “Insurance”

    One of the most fundamental changes caused by the germ theory of disease, one not foreseen at all, was the spread of hospitals for treating the sick. Hospitals have an ancient history, but for most of that history they were intended for the very poor, especially those who were mentally ill or blind or who suffered from contagious diseases such as leprosy. Anyone who could afford better was treated at home or in nursing facilities operated by a private physician. Worse, until rigorous antiseptic and later aseptic procedures were adopted, hospitals were a prime factor in spreading, not curing, disease. Thus, until the late nineteenth century, hospitals were little more than a place for the poor and the desperate to die. In 1873, there were only 149 hospitals in the entire U.S. A century later there were over 7,000, and they had become the cutting edge of both clinical medicine and medical research.

    But hospitals had a financial problem from the very beginning of scientific medicine. By their nature they are extremely labor intensive and expensive to operate. Moreover, their costs are relatively fixed and not dependent on the number of patients being served. To help solve this problem, someone in the late 1920s had a bright idea: hospital insurance. The first hospital plan was introduced in Dallas, Texas, in 1929. The subscribers, some 1,500 schoolteachers, paid six dollars a year in premiums, and Baylor University Hospital agreed to provide up to 21 days of hospital care to any subscriber who needed it.
    ...
    The original hospital insurance also contained the seeds of two other major economic dislocations, unnoticed in the beginning, that have come to loom large. The first dislocation is that while people purchased hospital plans to be protected against unpredictable medical expenses, the plans only paid off if the medical expenses were incurred in a hospital. As a result, cases that could be treated on an outpatient basis instead became much more likely to be treated in the hospital—the most expensive form of medical care.

    The second dislocation was that hospital insurance did not provide indemnity coverage, which is when the insurance company pays for a loss and the customer decides how best to deal with it. Rather than indemnification, the insurance company provided service benefits. In other words, it paid the bill for services covered by the policy, whatever the bill was. As a result, there was little incentive for the consumer of medical services to shop around. With someone else paying, patients quickly became relatively indifferent to the cost of medical care.

    These dislocations perfectly suited the hospitals, which wanted to maximize the amount of services they provided and thereby maximize their cash flow. If patients are indifferent to the costs of medical services they buy, they are much more likely to buy more of them and the cost of each service is likely to go up. There is no price competition to keep prices in check.

    Predictably, the medical profession began to lobby in favor of retaining this system. In the mid-1930s, as Blue Cross plans spread rapidly around the country, state insurance departments moved to regulate them and force them to adhere to the same standards as regular insurance plans. Had hospital insurance come to be regulated like other insurance, those offering it would have begun acting more like insurance companies, and the economic history of modern American medicine might have taken a very different turn. But that didn’t happen, largely because doctors and hospitals, by and for whom the plans had been devised in the first place, moved to prevent it from happening. The American Hospital Association and the American Medical Association worked hard to exempt Blue Cross from most insurance regulation, offering in exchange to enroll anyone who applied and to operate on a nonprofit basis.

    The Internal Revenue Service, meanwhile, ruled that these companies were charitable organizations and thus exempt from federal taxes. Freed from taxes and from the regulatory requirement to maintain large reserve funds, Blue Cross and Blue Shield (a plan that paid physicians’ fees on the same basis as Blue Cross paid hospital costs) came to dominate the market in health care insurance, holding about half of the policies outstanding by 1940. In order to compete, private insurance companies were forced to model their policies along Blue Cross and Blue Shield lines. Thus hospitals came to be paid almost always on a cost-plus basis, receiving the cost of the services provided plus a percentage to cover the costs of invested capital. Any incentive for hospitals to be efficient and reduce costs vanished.

    In recent years, hospital use has been falling steadily as the population has gotten ever more healthy and surgical procedures have become far less traumatic. The result is a steady increase in empty beds. There were over 7,000 hospitals in the U.S. in 1975, compared to about 5,500 today. But that reduction has not been nearly enough. Because of the cost-plus way hospitals are paid, they don’t compete for patients by means of price, which would force them to retrench and specialize. Instead they compete for doctor referrals, and doctors want lots of empty beds to ensure immediate admission and lots of fancy equipment, even if the hospital just down the block has exactly the same equipment. The inevitable result, of course, is that hospital costs on a per-patient per-day basis have skyrocketed.

    Doctors, meanwhile, were paid for their services according to “reasonable and customary” charges. In other words, doctors could bill whatever they wanted to as long as others were charging roughly the same. The incentive to tack a few dollars on to the fee became strong. The incentive to take a few dollars off, in order to increase market share, ceased to exist. As more and more Americans came to be covered by health insurance, doctors were no longer even able to compete with one another.

    Modern Developments

    During World War II, another feature of the American health care system with large financial implications for the future developed: employer-paid health insurance. With twelve million working-age men in the armed forces and the economy in overdrive, the American labor market was tight in the extreme. But wartime wage and price controls prevented companies from competing for available talent by means of increased wages and salaries. They had to compete with fringe benefits instead, and free health insurance was tailor-made for this purpose.

    The IRS ruled that the cost of employee health care insurance was a tax-deductible business expense, and in 1948 the National Labor Relations Board ruled that health benefits were subject to collective bargaining. Companies had no choice but to negotiate with unions about them, and unions fought hard to get them.

    The problem was that company-paid health insurance further increased the distance between the consumer of medical care and the purchaser of medical care. When individuals have to pay for their own health insurance, they at least have an incentive to buy the most cost-effective plan available, given their particular circumstances. But beginning in the 1940s, a rapidly increasing number of Americans had no rational choice but to take whatever health care plan their employers chose to provide.
    ....
    By 1960, as the medical revolution was quickly gaining speed, the economically flawed private health care financing system was fully in place. Then two other events added to the gathering debacle.

    In 1965, government entered the medical market with Medicare for the elderly and Medicaid for the poor. Both doctors and hospitals had fought tooth and nail to prevent what they called “socialized medicine” from gaining a foothold in the U.S. As a result of their strident opposition, when the two programs were finally enacted, they were structured much like Blue Cross and Blue Shield, only with government picking up much of the tab. And when Medicare and Medicaid proved a bonanza for health care providers, their vehement opposition quickly faded away. The two new systems greatly increased the number of people who could afford advanced medical care, and the incomes of medical professionals soared, roughly doubling in the 1960s.

    But perhaps the most important consequence of these new programs was the power over hospitals they gave to state governments. State governments became the largest single source of funds for virtually every major hospital in the country, giving them the power to influence—or even dictate—the policy decisions made by these hospitals. As a result, these decisions were increasingly made for political, rather than medical or economic, reasons. To take one example, closing surplus hospitals or converting them to specialized treatment centers became much more difficult. Those adversely affected—the local neighborhood and hospital workers unions—would naturally mobilize to prevent it. Society as a whole, which stood to gain, would not.

    Finally, there was the litigation explosion of the last 50 years. For every medical malpractice suit filed in the U.S. in 1969, 300 were filed in 1990. While reforms at the state level (notably in Texas) have reduced the number, lawsuits have sharply driven up the cost of malpractice insurance—a cost passed directly on to patients and their insurance companies. Neurosurgeons, even with excellent records, can pay as much as $300,000 a year for coverage. Doctors in less lawsuit-prone specialties are also paying much higher premiums and are forced to order unnecessary tests and perform unnecessary procedures to avoid being second-guessed in court.
    ...
    ***
    Given this short history, it followed as the night follows day that medical costs began to rise over and above inflation, population growth, and the cost of medical advances. The results for the country as a whole are plain to see. In 1930 we spent 3.5 percent of American GDP on health care; in 1950, 4.5 percent; in 1970, 7.3 percent; in 1990, 12.2 percent. Today we spend 15 percent. American medical care over this period has saved the lives of millions who could not have been saved before—life expectancy today is 78.6 years. It has relieved the pain and suffering of tens of millions more. But it has also become a monster that is devouring the American economy.

    Is there a way out?
    ....
    A far better and cheaper alternative would be to reform the economics of the present system.

    The most important thing to do, by far, is to require medical service providers to make public their inclusive prices for all procedures. Most hospitals keep their prices hidden in order to charge more when they can, such as with the uninsured. But some facilities do post their prices. The Surgery Center of Oklahoma, for instance, does so on its website. A knee replacement there will cost you $15,499, a mastectomy $6,505, a rotator cuff repair $8,260.

    Once prices are known and can be compared, competition—capitalism’s secret weapon—will immediately drive prices towards the low end, draining hundreds of billions of dollars in excess charges out of the system. Posting prices will also force hospitals to become more efficient and innovative, in order to stay competitive.

    Any politician who pontificates about reforming health care without talking about making prices public is carrying water for one or more of the powerful lobbyists that have stymied real reform, such as the American Hospital Association, the American Medical Association, and the health workers unions.

    Second, we should reform how malpractice is handled. We should get rid of the so-called American rule, where both sides pay their own legal expenses regardless of outcome, and adopt the English rule—employed in the rest of the common-law world—where the loser pays the expenses of both sides.

    Third, we need to ensure that the consumers of medical care—you and me—care about the cost of medical care. Getting patients to shop for lower-cost services is vital.

    A generous health insurance policy more or less covers everything from a sniffle to a heart transplant. It shouldn’'t. An insurance policy that covers routine care isn'’t even an insurance policy, properly speaking—it is a very expensive pre-payment plan that jacks up premiums. Just as oil changes are not covered by automobile insurance, annual flu shots and scraped knees should not be covered by medical insurance. One way to achieve this would be for employers to provide major medical insurance plus a health savings account to take care of routine health care. If the money in the account is not spent on health care, it would be rolled over into the employee’s 401(k) account at the end of the year, giving him an incentive to shop wisely for routine medical care.

    Finally, we need to get the practitioners of modern medicine to recognize an age-old reality: there is no cure for old age itself. Maybe someday we’ll be able to 3-D print a new body and have the data in our brain downloaded to it. But for the time being, when the body begins to break down systemically, we should let nature take its course.
    ...
    https://imprimis.hillsdale.edu/short..._hsmi=66476514
    ....
    TANSTAAFL = There Ain't No Such Thing As A Free Lunch

  • #2
    The difficulty for an individual to take on a large corporation in court makes me cautious when it comes to tort reform. While it is true that the typical jury has prejudicial views that work against the powerful the way to fix that is not by discouraging lawyers from taking cases where the plaintiff has limited financial resources. Instead of having the loser pay all court cost we could take a page from police body cams and require all procedures be recorded as part of the patients medical records. Which brings us to my next point.

    The potential savings of automation have been largely squandered by an inefficient administrative system. Last I checked 20 percent of the cost of medical care is book keeping. Private and public bureaucracies are bloated and inefficient. Many administrative positions are little more than welfare for the college educated. Which brings me to my third point.

    Because medical care is the most personal of services people don't shop for the best care but the "best" personalities. Without completely dismissing the value of human interaction the potential for automation of medical services is hardly being addressed. Many medical services could be automated and middlemen eliminated. Even if we return to rational market forces it is unlikely that the potential savings will be realized in time to address the current crisis. While acknowledging that the current crisis is in many ways the result of government intervention research and development paid for with public funds may be needed.

    My last point would be that our educational system suffers from some of the same problems as the health care system. The educational cost for becoming a doctor is a barrier to competition.

    I understand that my thoughts are not terribly helpful but it is a topic that I worry about.
    We hunt the hunters

    Comment


    • #3
      Originally posted by wolfhnd View Post
      ...


      My last point would be that our educational system suffers from some of the same problems as the health care system. The educational cost for becoming a doctor is a barrier to competition.
      Correct!

      I do not know how things are in other EU countries, but one of the things that I found weird in the US was that one could not go directly from high school to medical (or law) school. This was not the case in Greece! Make no mistake that in my time it was VERY difficult to score high enough points to be accepted in a medical school. During the last week of high school, all candidates were to take the same exam in physics, math, biology, chemistry, and Greek composition (essay). Each subject was tested on a different day and all tests were the same and were issued at the same time for all candidates. A typical medical school required a higher score than a typical engineer school. If the perfect score was "20" , a medical school would be in the vicinity of "19" points average in all tests. Still, if one was VERY good student, he could do it and attend school for free!

      By contrast, in the US even the best students have to first get a BA Degree and THEN apply for a medical or law school. Of course, poor students will have already spent most of their financial help they get from feds in the BA program, and since there are not many options for funding post graduate studies , it means that there are less opportunities for candidates of medical schools to find credit for their studies.

      Then bypassing the obvious (and unavoidable) obstacle of the long duration of medical programs, you have to add the fact that there are no public medical schools, and the fact that the accreditation of medical schools is controlled by the AMA which has incentives to keep the profession closed to competition by retaining relatively few medical schools, So, you end up in a situation in which the medical profession in the US is mostly functioning like a medieval Guid designed to protect the interests of its members.

      p.s. Ohh I forgot. Many wealthy students who could not score the points they needed to enter the profession, came to the US to get their medical degree and then retuned to Greece licensed as doctors. One of the things that I always checked in Greece when I was visiting a doctor for the first time was to see his diploma and if it was issued by a Greek or a foreign University. I trusted much more people who got they degrees from Greek universities.
      Last edited by pamak; 08 Oct 18, 18:30.
      My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

      Comment


      • #4
        The US healthcare system is monopolistic. It is why it is so expensive next to socialistic systems such as Sweden, Britain, Germany or France.

        A free market healthcare should be cheaper to most. This may be the USA's biggest failure.
        How to Talk to a Climate Skeptic: http://grist.org/series/skeptics/
        Global Warming & Climate Change Myths: https://www.skepticalscience.com/argument.php

        Comment


        • #5
          Originally posted by Nick the Noodle View Post
          The US healthcare system is monopolistic. It is why it is so expensive next to socialistic systems such as Sweden, Britain, Germany or France.

          A free market healthcare should be cheaper to most. This may be the USA's biggest failure.
          I disagree!

          Free markets are cheap when they have to sell you products that are not essential, so customers have to be convinced to purchase them every couple of years or so like TVs, cars, and iPhones.. Take a look at products which are considered essential and you will see that private markets do not offer cheap products.From Housing, to medicare, to education and childcare, customers find these products quite expensive even in the most developed private markets. The only type of product that does not fit the above pattern is food, But of course, the feds subsidize it in order to keep it accessible to most of the population.

          Also, private markets often tend to concentrate power to fewer and bigger players from Wall Mart], to "too big to fail" banks to healthcare insurance companies.
          Last edited by pamak; 08 Oct 18, 21:12.
          My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

          Comment


          • #6
            The best solution here is probably unobtainable. That would be to allow more medical schools and residency slots to open, even a nearly unlimited amount if possible. The AMA and the medical industry heavily regulates these things now creating artificial scarcity.

            Next, make it much harder for liars... err, lawyers... and their ilk to sue over malpractice. Basically, make it the equivalent of good Samaritan laws. If the doctor tried to do the right thing, then you've got nothing coming. You have to prove gross incompetence, deliberate intent, or that the doctor otherwise royally screwed up and not just that the outcome was bad or unacceptable to you.
            That reduces malpractice insurance costs, and eliminates one of the most costly parts of medicine: Suing over a undesirable outcome. It eliminates doctors doing every test imaginable, looking at every option possible, and gets back to realistic medical decisions.

            Second, get insurance out of the picture for routine medical care entirely. Eliminate it for routine stuff, even most testing and smaller procedures. The cosmetic surgery sector of health care runs on a cash basis as almost no health insurance plan covers it. Costs have declined relative to inflation and economic growth.

            Next, get the government out of the health care business. Government is almost always the most expensive, least efficient, and utterly incompetent means to get something done. Monopoly health care systems such as Europe uses are bloated, expensive, and by comparison not all that efficient. Look at the NHS in Britain. It employs almost as many people in Britain as McDonald's corporation does worldwide. This is for about 65 million people.

            The next item to address is the cost of bringing a drug to market. This is linked in good part to the malpractice problem. The FDA forces manufacturers to perform lengthy and massive testing on new drugs. This drives up the US cost compared to other nations where such drugs gain the benefit of already having been tested and approved. This allows other nations in many cases to keep the cost of a drug down by regulation.
            Eliminating more frivolous lawsuits against manufacturers for minor issues with a drug would greatly decrease the cost of development and bringing it to market. Sure, gross and serious issues should be known, but discovering some minor side effect that might occur one time in a thousand is really not a necessity.

            On the whole, make producing decent doctors in large quantity a reality, give lawyers a serious smackdown, rid the system of insurance for routine costs, and lastly get the damned government out of the picture.

            Comment


            • #7
              Originally posted by T. A. Gardner View Post
              ...

              Next, get the government out of the health care business. Government is almost always the most expensive, least efficient, and utterly incompetent means to get something done. Monopoly health care systems such as Europe uses are bloated, expensive, and by comparison not all that efficient. Look at the NHS in Britain. It employs almost as many people in Britain as McDonald's corporation does worldwide. This is for about 65 million people...[/COLOR]




              Every time you tried to defend this claim in any other thread we participated, you came short of actually showing such evidence. Not only that, but you had no problem to reveal to us that you are one of the people who get a federally subsidized insurance! The facts are very simple, government has two advantages that help to reduce prices. Te first one is that it is very big, so there is the "Walmart effect." The second is that there is no requirement for profit margin to satisfy investors. If there is a problem with the government it is not in the area of affordability. Housing, healthcare and education were affordable to everybody even in the USSR.

              The problem that the government has is in the area of quality since complacency creates a stale environment. However, in the case of INSURANCE SERVICES, the experience shows that the government is actually quite effective! It was the "innovations" of the private industry in insurance which triggered the latest financial crisis. And it was the government which stepped in tisane the system from total collapse at a time when the private insurance companies were collapsing (see AIG) Also, we have real examples from EU systems which combine a mostly governmental health insurance with public and private employees in the healthcare industry which show that it works quite well and provides a healthcare service of high quality which is affordable to almost everybody. They also do this by spending a much lower percentage of their GDP. So, it is obvious that you do not have a case based on evidence. But I think you also know this. Otherwise, you would not have chosen to get the "expensive" insurance of the feds...

              And since I always back up my claims with links, I will repost again the link I used in another thread when we had the same conversation.


              https://www.cbo.gov/sites/default/fi...care_Costs.pdf

              One useful analytic approach, which was most carefully and comprehensively employed by researchers in 2004, estimates what costs would be if private-sector doctors, hospitals, and other health care providers sup- plied the same number and types of services as those actually delivered by VHA. Similar to earlier studies, those researchers concluded that the health care provided by VHA generally cost less than would equivalent care provided in the private sector, even though the compari- son used Medicare’s relatively low payment rates for private-sector doctors and hospitals.
              Last edited by pamak; 09 Oct 18, 00:15.
              My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

              Comment


              • #8
                Originally posted by pamak View Post
                Every time you tried to defend this claim in any other thread we participated, you came short of actually showing such evidence. Not only that, but you had no problem to reveal to us that you are one of the people who get a federally subsidized insurance! The facts are very simple, government has two advantages that help to reduce prices. Te first one is that it is very big, so there is the "Walmart effect." The second is that there is no requirement for profit margin to satisfy investors. If there is a problem with the government it is not in the area of affordability. Housing, healthcare and education were affordable to everybody even in the USSR.
                Let me start by saying I get health insurance through an employer plan, the same as some say, Ford or Boeing worker does and pay a considerable premium per month for it as well. It isn't "subsidized." A subsidy is unearned. That is, you did nothing to warrant it, and in the case of Obamacare it is based on your not making sufficient money to pay the full premium. In my case, it was part of a worker's compensation package the employer offers just as it would be for any other large business or corporation.

                The government is horribly inefficient.

                https://www.heritage.org/budget-and-...vernment-waste

                https://fee.org/articles/the-inheren...t-bureaucracy/

                Your example of "Housing, healthcare and education were affordable to everybody even in the USSR." is a joke. All of this was almost uniformly substandard compared to any Western nation. The quality of any of that depended on where you were in terms of the social order of things too. High ranking officials, military officers, and others in higher status jobs got better than factory workers. In the USSR rationing was the norm. You stood in line, or were in line to get almost anything and everything. This might have been affordable, but it was hardly adequate or even average quality most of the time.
                The best example of this is Chernobyl. That disaster happened because of government incompetence. The government chose a crappy reactor design because it was cheap. They short sheeted much of the construction because of corruption and incompetence. The man supervising the test that caused the accident wasn't paying attention and didn't follow the set procedures. The cover up and clean up that followed were horrific disasters. In fact, most of the world's worst ecological disasters were ones the Soviets created.
                In the West, there wasn't a bread line, a gasoline line, a shoe line, or a ten year wait for a POS automobile you had to pay up front for.


                The problem that the government has is in the area of quality since complacency creates a stale environment. However, in the case of INSURANCE SERVICES, the experience shows that the government is actually quite effective! It was the "innovations" of the private industry in insurance which triggered the latest financial crisis. And it was the government which stepped in tisane the system from total collapse at a time when the private insurance companies were collapsing (see AIG) Also, we have real examples from EU systems which combine a mostly governmental health insurance with public and private employees in the healthcare industry which show that it works quite well and provides a healthcare service of high quality which is affordable to almost everybody. They also do this by spending a much lower percentage of their GDP. So, it is obvious that you do not have a case based on evidence. But I think you also know this. Otherwise, you would not have chosen to get the "expensive" insurance of the feds...
                I've had to use military medicine. The system is horribly slow and inefficient. In England, the NHS is very erratic in quality. It can be good to terrible depending on location. I don't think there's anywhere in Europe where you can get a CAT scan for a couple of hundred dollars and be a walk-in patient with little or no wait and no appointment. You can do that in the US:

                http://cheapimaging.com/

                And since I always back up my claims with links, I will repost again the link I used in another thread when we had the same conversation.

                https://www.cbo.gov/sites/default/fi...care_Costs.pdf
                The VA system is rife with serious issues.

                http://www.modernhealthcare.com/arti...NEWS/305079939

                https://www.cnn.com/2016/07/05/polit...-va/index.html

                https://www.washingtontimes.com/news...s-after-scand/

                CBO analyses are almost always wildly wrong on their figures.

                I know that almost no veteran, myself included, uses the VA as a first choice. It is more often the only or last choice due to the generally poor quality of service and level of care provided. The VA has of late been in the spotlight for its issues in this respect and has had to clean its act up at least some. But, wait times are still long in most cases, care can be very uneven, from quite good to poor. It certainly isn't my first choice even though I'm eligible to use it.

                Then there's Obamacare. In Arizona, there is now just one provider for the state that offers plans on it. You take that provider, or you get nothing. If you live in rural Arizona, your plan doctor might be 100 + miles from where you live. Sure, you can get subsidized coverage, but the quality isn't great as the only remaining provider is a lower tier company. The major, high quality plan insurers pulled out of Obamacare.

                Comment


                • #9
                  Originally posted by T. A. Gardner View Post
                  Let me start by saying I get health insurance through an employer plan, the same as some say, Ford or Boeing worker does and pay a considerable premium per month for it as well. It isn't "subsidized." A subsidy is unearned. That is, you did nothing to warrant it, and in the case of Obamacare it is based on your not making sufficient money to pay the full premium. In my case, it was part of a worker's compensation package the employer offers just as it would be for any other large business or corporation.

                  The government is horribly inefficient.


                  https://www.heritage.org/budget-and-...vernment-waste

                  https://fee.org/articles/the-inheren...t-bureaucracy/

                  Your example of "Housing, healthcare and education were affordable to everybody even in the USSR." is a joke. All of this was almost uniformly substandard compared to any Western nation. The quality of any of that depended on where you were in terms of the social order of things too. High ranking officials, military officers, and others in higher status jobs got better than factory workers. In the USSR rationing was the norm. You stood in line, or were in line to get almost anything and everything. This might have been affordable, but it was hardly adequate or even average quality most of the time.
                  The best example of this is Chernobyl. That disaster happened because of government incompetence. The government chose a crappy reactor design because it was cheap. They short sheeted much of the construction because of corruption and incompetence. The man supervising the test that caused the accident wasn't paying attention and didn't follow the set procedures. The cover up and clean up that followed were horrific disasters. In fact, most of the world's worst ecological disasters were ones the Soviets created.
                  In the West, there wasn't a bread line, a gasoline line, a shoe line, or a ten year wait for a POS automobile you had to pay up front for.



                  I've had to use military medicine. The system is horribly slow and inefficient. In England, the NHS is very erratic in quality. It can be good to terrible depending on location. I don't think there's anywhere in Europe where you can get a CAT scan for a couple of hundred dollars and be a walk-in patient with little or no wait and no appointment. You can do that in the US:


                  http://cheapimaging.com/



                  The VA system is rife with serious issues.

                  http://www.modernhealthcare.com/arti...NEWS/305079939

                  https://www.cnn.com/2016/07/05/polit...-va/index.html

                  https://www.washingtontimes.com/news...s-after-scand/

                  CBO analyses are almost always wildly wrong on their figures.

                  I know that almost no veteran, myself included, uses the VA as a first choice. It is more often the only or last choice due to the generally poor quality of service and level of care provided. The VA has of late been in the spotlight for its issues in this respect and has had to clean its act up at least some. But, wait times are still long in most cases, care can be very uneven, from quite good to poor. It certainly isn't my first choice even though I'm eligible to use it.

                  Then there's Obamacare. In Arizona, there is now just one provider for the state that offers plans on it. You take that provider, or you get nothing. If you live in rural Arizona, your plan doctor might be 100 + miles from where you live. Sure, you can get subsidized coverage, but the quality isn't great as the only remaining provider is a lower tier company. The major, high quality plan insurers pulled out of Obamacare.


                  Let me say that based on what YOU have told us, your wife was quite satisfied with the insurance. THAT shows something since obviously, there was always the choice for her to get insurance through different means in the private market if the government is so inefficient as you claim. And the fact that you pay premiums does not change the fact that the feds offer comparatively a much better deal from an economic point of view You also told us that you use tricare for certain services, and we have already discussed the veryyyyyyy low cost of that sort of insurance, So, you do not sound very credible when you tell us that you do not like to see the government in the healthcare business when in fact it seems that your family seems to be quite satisfied with the governmental insurance you have!

                  My example with the USSR shows exactly what I said.That even in the worst examples of socialism, the issue was NOT the affordability. Everybody could afford to have a house. The issue was quality! So, you have no real life example to believe that somehow a governmental type of insurance is somehow more expensive. Let me be clear that the point is not to defend the USSR system, The point is that you are wayyyy off the mark when you try to claim that the government in healthcare produces a more expensive system since the government is "inefficient".

                  Also, you do you present any facts to show why the CBO (which is NOT partisan). is wrong! If your argument is that nobody is infallible then this is a weak one, especially when you use links from the notorious Heritage Foundation which was predicting how NAFTA would be beneficial for the US workers and continues to support that it is beneficial even during the recent years ( https://www.heritage.org/trade/repor...e-negotiations). You also make unsupported claims based on irrelevant issues.The issue is not if there are examples of inefficiency in the government sector as some of your links claim or if the government can offer better reactors or other technological products compared to private companies. The issue is if despite certain inefficiencies and problems in how a government operates, the government can still provide cheaper INSURANCE services as a result of its size and lack of profit! And it is obvious from real life examples in the US and in Europe that the government sponsored healthcare is cheaper!

                  Also, I know many veterans who use VA as the first choice, Bwaha is one of them here based on what he has posted. Other posters have also posted that they use tricare which is a form of insurance provided to the vets and their families. I also know that there are people who do not even have any option to get any affordable type of insurance in the private market. I also know that even in the socialist Europe, there is a combination of a governmental and private insurance. So, one could certainly imagine a system in the US in which people, just like many veterans, can HAVE the option of a public coverage, and then they can decide if they want to pay for extra benefits and short waiting lists using a private insurance. On top of the above, let's no forget the example of medicare which has become the first and only choice for most of the elders!

                  As for Obamacare, it is not really socialized coverage since the public option was killed in the beginning. Also, the issue with the providers in AZ you mention is about people who do not get insurance through their employer. The big majority of people who get insurance through their employer are not affected by what you say. Also, I explained before in another thread the fact that Trump tries to undermine Obamacare by killing the mandatory option (by making it clear that he will not enforce the collection of penalties). This is something that is factored by insurance companies when they plan if they will participate and the rates they charge for their plans. Regions with more elders and fewer healthy young people (who will have the option to become uninsured without paying any penalty) will make it less lucrative for a business in health insurance to operate in certain areas.


                  We have also talked in previous threads that the premiums increase during Obamacare did not surpass the levels of increase we saw before Obamacare. So, let's cut the BS about Obamacare being somehow more expensive than the available care of the past, and lets stop the games of starting every few months new threads repeating claims that you could not defend in the past threads

                  And by the way, none of the above implies that there should not be changes in Obamacare. But these changes should come as a result of a HONEST dialogue in which people are willing to discuss facts instead of trying to promote partisan ideologies which vilify the government's role in the healthcare section while the same people are quite pleased with getting federally subsidized insurance for their family.
                  Last edited by pamak; 09 Oct 18, 06:16.
                  My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

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                  • #10
                    And since I mentioned the game of some posters here who repeat after a couple of weeks claims that were not defended adequately in past threads, I will have to bring back again some of these past threads since obviously some people here want to continue those conversations we had in the past. It will save us time if we post these threads for quick reference instead of creating a multipage thread repeating again the same things we were discussing in those threads.


                    First, let's see TAG and how dissatisfied he seems to be about both the veteran and the federal insurance he gets about him and his family

                    https://forums.armchairgeneral.com/f...04#post5060004

                    Originally posted by T. A. Gardner
                    Actually, retired Tricare is a lot like FEHB. I'm likely going to take a vision and dental plan on it, while leaving my health insurance with FEHB since the wife likes the plan we're on.

                    With such comments, I cannot take it seriously that TAG is somehow frustrated with the "inefficiency" of the government. He sounds more like some guys who were protesting in 2009 demanding to have the government get out of their medicare. This attitude is either a result of ignorance or a deliberate attempt to promote a partisan political philosophy which is not based on empirical facts.


                    Also, there is a past thread with information about premiums increases before Obamacare. Of course TAG seems to be oblivious about the realities before Obamacare about premium increases and private heath insurances simply because he had the luxury to have a federally subsidized insurance

                    https://forums.armchairgeneral.com/f...21#post5061921


                    And here is another thread with more information about tricare's veryyyy low cost which is used by many members here

                    https://forums.armchairgeneral.com/f...54#post5055154


                    Anyone who can see any refutation in those threads of what I posted there should be free to repost these refutations here, and we can continue the discussion from that point!
                    Last edited by pamak; 09 Oct 18, 06:27.
                    My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

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                    • #11
                      Originally posted by T. A. Gardner
                      I don't think there's anywhere in Europe where you can get a CAT scan for a couple of hundred dollars and be a walk-in patient with little or no wait and no appointment. You can do that in the US:


                      http://cheapimaging.com/

                      What a JOKE!

                      You try to pass as information prices from a service you obviously NEVER used since it applies to uninsured people. You also presented an ad talking about STARTING prices for uninsured people. You also have no clue about the CAT SCAN prices in Europe, but somehow you make claims coming out of thin air making ridiculous comparisons! The fact that you try to argue that somehow the US healthcare system is cheaper based on advertisements you find in internet and despite the fact that you have no idea about the prices in Europe shows that you do not seek a serious conversation! You also have no idea how things work in the US or you deliberately misrepresent them. There are NO walk-in patients asking to get an MRI or CT Scan. In fact, the ad itself makes it clear that it requires a doctor's reference! From your ad...

                      All of our facilities require a referral from a physician before they can begin scheduling.

                      And the doctor who will order such exam will be a specialist. So, the most probable scenario is that an uninsured person will need at least two visits (the physician will send him to the specialist and the latter will send him for an MRI or CT Scan. An uninsured person paying our of pocket for two visits can easily be charged with about $150 per visit in California. This means that before even having an MRI an uninsured person will have to pay an amount in the order of about $300! And most uninsured people simply will not be able to even pass this stage since the cost will be too high for them!

                      https://www.jhsph.edu/news/news-rele...igh-price.html

                      The average price of a new uninsured patient appointment was quoted as $160, with some variation among states (a low of $128 in Pennsylvania and a high of $188 in Oregon).

                      So spare us with your BS claims you create about the supposedly cheap services in the US! By the way, based n PERSONAL experience I said it before, and I will say it again that it is cheaper for me to fly to Greece and have a root canal and a porcelan crown there as UNINSURED than having the same procedure here as INSURED!

                      I also have a personal experience with an MRI when I lost part of my hearing on a certain frequency as a result of my long-time exposure to aircraft engine noise! I had two visits (General physician sent me to nose-ear specialist who in turn gave a referral for an MRI to make sure that the loss of hearing was not a result of brain tumor. I do not recall how much and If I even payed anything for it since my insurance covered the procedure and it was a long time ago, so I do not recall many details, including if I had to pay a deductible. But I DO recall that as an insured person, when I got the statement from the center in which I had the MRI, I saw a price which was close to $1,000.
                      Last edited by pamak; 09 Oct 18, 05:34.
                      My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

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                      • #12
                        The price of a MRI Scan in Belgium can go to 700 Euro, WITHOUT the additional costs as hospitalisation.

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                        • #13
                          Originally posted by ljadw View Post
                          The price of a MRI Scan in Belgium can go to 700 Euro, WITHOUT the additional costs as hospitalisation.

                          Without link you have no case. Stop debasing the conversation by posting unsupported claims!

                          By a way, a link that I found in a Greek site which compared MRI and CT scan prices in Europe shows an MRI scan price of between 107 and 730 EU. These prices were in Germany and Sweden and depend on many factors, including on the location of the body that is scanned!

                          http://www.healthreport.gr/δείτε-πόσ...-αξ/

                          Even if you do not know Greek, you can still read the chart and see the price range.

                          The above also imply that there is not a single price in Belgium for an MRI which means that most probably you offer the highest possible price. As I have said numerous times in the past you are not a trustworthy person to make credible claims that we should accept when you do not give any support. And it certainly does not make sense to compare the highest (or even the average) price in any country with the prices TAG found in an ad about the STARTING price that is charged for an MRI in SOME locations which is also a price that applies ONLY to uninsured customers who pay in cash. Insured people are charged WAYYYY more. And I gave my personal example about it.

                          By the way, there is no need for "hospitalization" to have an MRI. I assume there are diagnostics centers in Belgium, right? If Greece has such facilities, then Belgium must also have them!
                          Last edited by pamak; 09 Oct 18, 07:06.
                          My most dangerous mission: I landed in the middle of an enemy tank battalion and I immediately, started spraying bullets killing everybody around me having fun up until my computer froze...

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                          • #14
                            The USSR is a good example of in theory as opposed to reality. There is the law and then there is how the law actually is in practice.

                            In western Europe you can almost draw a direct correlation between how functional the nations economy is and how strong the protestant work ethic and the capitalist system that supports the welfare state is.

                            Similarly the problems in the U.S. health care systems can be traced to the failures of institutions to police themselves. The AMA does little to police itself as is the case with the American bar association. The obvious is often ignored in so far as government governs best when people govern themselves. The real crisis is a moral crisis and it is naive to think that the solution is government regulation. Rome was strong when most of it's citizens observed it's strict moral codes but weak when morality became the business of the administrative class.

                            When I was a child most Hospitals were charitable organizations. Many of our hospitals still carry that systems values in name only. Locally there is St. Joseph's, St. Luke's, and Children Mercy. Welfare states corrode the moral fabric of a society. Keep in mind that I'm talking about Roman morality not the abstractions discussed by philosophers. When politicians start buying votes either by programs or importing then the fabric of society starts to unravel. Charles Murray in his coming apart book explains the process from a statistical perspective and I recommend everyone read it. What people interested in the topic have glossed over is the difference between personal morality and public morality. There is a reason why the Romans persecuted Christianity, it was a threat to morality. The personal morality of Christianity could not be transferred to public morality and to the extent that is true Gibbon was right. Public morality is about social cohesion, which is under direct attack by identity politics that seem to come to the forefront in the end stages in any civilization.

                            We hunt the hunters

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                            • #15
                              Originally posted by Nick the Noodle View Post
                              The US healthcare system is monopolistic. It is why it is so expensive next to socialistic systems such as Sweden, Britain, Germany or France.

                              A free market healthcare should be cheaper to most. This may be the USA's biggest failure.

                              I'm not sure what you mean by monopolistic as there are numerous health insurance entities.
                              Given that the government mandates (obamacare) certain kinds of coverage can and cannot be offered and insurance is heavily regulated I am not sure we can really call it a "free market" anymore.

                              Otherwise, I would agree. A genuinely "free market" would probably result in cheaper healthcare costs.
                              I believe that there are lots of things that could help address the high cost of healthcare, but giving control of it to the government isn't one of them.

                              Maybe things work better over there, but over here there is no good or service that our government can offer more cheaply or efficiently than its private sector equivalent.
                              The post office comes to mind as an obvious example.
                              Would you rather deal with customer service from the department of motor vehicles or any major US corporation?

                              Private enterprise knows it has to please the customer in order to stay in business. Government doesn't care. If a private business fails to satisfy customer needs it goes out of business.
                              If a government agency fails to do so, it is given more money.
                              Failure is reinforced.
                              Avatar is General Gerard, courtesy of Zouave.

                              Churchill to Chamberlain: you had a choice between war and dishonor. You chose dishonor, and you will have war.

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