Announcement

Collapse
No announcement yet.

The Continuous Fight Over Health Care

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • The Continuous Fight Over Health Care

    https://www.msn.com/en-us/news/elect...cid=spartandhp

    A court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

    At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.


    But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.
    We are not now that strength which in old days
    Moved earth and heaven; that which we are we are; One equal temper of heroic hearts
    Made weak by time and fate but strong in will
    To strive to seek to find and not to yield.

  • #2
    I suppose we are intended in this thread to focus primarily on the this one court ruling. The problem with that is the article itself goes off on a tangent of how a defeat for the proponents of universal health care could be the basis for rejuvenating their agenda. It is almost but not quite double think. It speaks to the almost cult like faith that followers of equity, diversity and inclusion are possessed by.

    Like almost every issue the left has taken up in recent years health care has been more about ideology purity than practical solutions. This lack of practicality extends even to political choices. The abandoned of labor in favor of identity politics and intersectionality has proven to be the Achilles heel of left wing politics. Trump and Brexit being the most obvious consequence. In terms of health care "medicare" for all is a direct assault on unions who have spent a century improving working conditions and providing their members with quality health care. The new crop of "socialists" no longer represent labor or as they refer to labor the "deplorables and clingers" .

    Ideological purity is and has always been the enemy of progress. The progressive movement understood this in the late 19th and early 20th century. When the focus was on jobs and working conditions society benefited. Today because so much progress has been made the temptation to go too far has proven almost irresistible. Having lost sight of the practical equity, diversity and inclusion combined with identity politics is cannibalizing itself. Their seems to be no safe space for moderate, practical and patient left wing politicians.

    Improving health care is one area where a great deal of patience will be required. This is especially true in the U.S. which hasn't had 75 years to evolve a workable public option. In fact progress over the last 75 years in medical innovation and quality of care is the enemy of the public option.

    Back when European countries were evolving public health care health care was largely ineffective, and rudimentary. For example all forms of cancer were a death sentence until fairly recently. What the impractical left fails to comprehend is the basic economics of modern health care. When health care was rudimentary and ineffective cost and demand was low. With improvement in effectiveness there is now no practical limit to demand. Along with unlimited demand comes an almost unlimited cost. Investment in new equipment, procedures, and specialists will continue to drive up the cost until it theoretically consumed most of the economy. It will inevitably be rationed either by cost or supply.

    On the supply side one area that the impractical left has not considered is doctors. Importing doctors from the third world is a short term solution at best. Countries such as India and the Philippines are rapidly developing and moving to the West will over time become increasingly unattractive. On the domestic front the availability of high paying but less demanding jobs makes going into medicine increasingly less attractive to the intellectually gifted.

    Pushing ideological solutions does not solve problems. Problems are solved by hard working individuals not ideologues. Ideologues such as those that "work" at MSN.



    We hunt the hunters

    Comment


    • #3
      Originally posted by wolfhnd View Post
      I suppose we are intended in this thread to focus primarily on the this one court ruling.
      What you focus on is your business. The subject here is health care. But you may talk about what you wish to talk about. I would think, though, that concentrating on 'ideology' is chasing rainbows.

      We are not now that strength which in old days
      Moved earth and heaven; that which we are we are; One equal temper of heroic hearts
      Made weak by time and fate but strong in will
      To strive to seek to find and not to yield.

      Comment


      • #4
        Much of the cost of medicine, however, is artificial, being pt in place to make medicine a for-profit enterprise rather than a service to humanity. The true purpose of medicine is to aid others, no to get rich and not to fund endless super-corporations whose only interest is in profit rather than actual health care.

        Health care is now worse that it was under the old system due to the shift in interest from health care to money. No practitioner can adequately serve two masters, and the Rule of Medicine is "First do no harm".

        Makes me glad in one way that I'm retired and no the cause of this betrayal of patient care, but angry on the other hand because I know what it can be and should be. Problematically, neither private industry nor the government are fit to operate or control health care, since neither profit nor politics have any valid role in medicine, and yet those are the primary forces behind the travesty we have today. Even the military has fallen victim to deteriorating health care, and the VA system has become the shame of the nation.

        Quis Custodiet Ipsos Custodes? Who is watching the watchers?

        Comment


        • #5
          Originally posted by Mountain Man View Post
          Much of the cost of medicine, however, is artificial, being pt in place to make medicine a for-profit enterprise rather than a service to humanity. The true purpose of medicine is to aid others, no to get rich and not to fund endless super-corporations whose only interest is in profit rather than actual health care.

          Health care is now worse that it was under the old system due to the shift in interest from health care to money. No practitioner can adequately serve two masters, and the Rule of Medicine is "First do no harm".

          Makes me glad in one way that I'm retired and no the cause of this betrayal of patient care, but angry on the other hand because I know what it can be and should be. Problematically, neither private industry nor the government are fit to operate or control health care, since neither profit nor politics have any valid role in medicine, and yet those are the primary forces behind the travesty we have today. Even the military has fallen victim to deteriorating health care, and the VA system has become the shame of the nation.
          You are going to have to be more specific than just a vague reference to profits. While it is true that medical services that were once provided by a self employed family doctor are now provided by corporations, doctors have traditional been in the top earning professions compared to say engineers. The switch to corporate medicine has probably negatively effected the doctors more than the patents as the work place environment becomes more "assembly line". The difference in private and corporate profits are a factor but a minor cause of the increase in medical costs.

          There are a whole host of factors that have contributed to increasing medical costs but demand is right up there at the top.

          https://www.investopedia.com/insuran...s-keep-rising/
          Last edited by wolfhnd; 26 Dec 19, 22:13.
          We hunt the hunters

          Comment


          • #6
            Originally posted by Massena View Post

            What you focus on is your business. The subject here is health care. But you may talk about what you wish to talk about. I would think, though, that concentrating on 'ideology' is chasing rainbows.
            Health care costs have been made outrageous in the US by continued and increasing involvement by government in the marketplace. The one portion of health care that hasn't seen this catastrophe forced on them by government is cosmetic surgery and such. That portion of the health care market has seen a decrease in costs and overall has risen in pricing slower than inflation.

            But, it's a pay-as-you-go / cash market and one where government interference and price controls aren't being applied. It also generally doesn't operate through insurance middlemen.

            Comment


            • #7
              Thank you Obama and Pelosi, I work in the hospitality industry, I appreciate being able to get Hep A vaccination at an affordable copay.

              Comment


              • #8
                An important question is if Obamacare reduced the rate of health care inflation. Many would argue that the reduction seen were a result of weak economic growth.

                https://www.washingtonpost.com/news/...d/?arc404=true

                Weak economic growth could be associated with reduced demand and classical economic theory.
                We hunt the hunters

                Comment


                • #9
                  Originally posted by wolfhnd View Post

                  You are going to have to be more specific than just a vague reference to profits. While it is true that medical services that were once provided by a self employed family doctor are now provided by corporations, doctors have traditional been in the top earning professions compared to say engineers. The switch to corporate medicine has probably negatively effected the doctors more than the patents as the work place environment becomes more "assembly line". The difference in private and corporate profits are a factor but a minor cause of the increase in medical costs.

                  There are a whole host of factors that have contributed to increasing medical costs but demand is right up there at the top.

                  https://www.investopedia.com/insuran...s-keep-rising/
                  Actually, lawyers and technology have driven costs more than anything else, coupled with the unreasonable expectations of the public.

                  Corporate profits also drive costs upwards, as do the increasing salaries of the entire spectrum of staff, from CNA's to RN's to lab techs, to even the Housekeeping staff. This, in stark contrast the to the limits imposed by things like Medicare, have led to "drive-in medicine" and extremely short hospital stays, leading corporate providers to charge as much as possible for the limited in-patient days allowed.

                  Pax recently underwent a total hip replacement. Total authorized hospital stay: 3 days. And everyone involved from the radiologist to the anesthesiologist to the actual surgeons billed separately. the hospital only got to bill for their specific services such as room, board ad nursing care plus initial physical therapy. (why the military thinks it can convince Congress that it is cheaper to contract all retired care out to civilian agencies is beyond rational comprehension., but that's another issue entirely)

                  Meanwhile, outpatient care is rigidly controlled to keep costs down and is programmed to seek the lowest common denominator.

                  Sorry I am not "specific" enough for you, but this is a discussion, not a formal lecture on medical costs versus profits, and I speak from thirty years of experience as a physician assistant who has worked in everything from military medicine to prison medicine to teaching hospital-level medicine to the creation of the primary care system as practiced today (The Fitzsimons Model), to the ultimate in cheap and meaningless medical care practiced by the US government at ICE facilities and even a stint in private practice, where the insurance company that my physician was associated with annually dropped the top 10% of its most costly physicians in favor of cheaper and cheaper medical care. That was the point at which I retired from medicine, because if it's not all about helping those who need it, then where is the satisfaction for practitioners like me? Doctors may be among the highest paid, but their associates like myself never were. When I worked private care I made $40 per hour, while his minimum from the US Government was $120 per hour and his civilian rate a lot more than that. He only saw ten detainees per day, and only visited twice per week for two hours each while I saw thirty to forty patients per day routinely.


                  Health Care/Insurance corporations must support entire populations of executives, supervisors, regional supervisors and other well paid types, all with their own clerical and support staff who produce no medical care and see no patients but require their own office complexes and other infrastructure, while still providing a decent return to the almighty investors,who guaranteed returns supercede even human illness, misery and death. Profits are the only way to make that happen, and part of that is strictly controlling the way in which applicants are selected and the numerous exclusions and "permissions" required in every aspect of care. Medicine has become a very dirty business, but it pays those at the top very well.

                  https://www.careerbliss.com/centura-health/salaries/

                  Information on the salaries of the top employees such as the CEO and the president of Centura Helath are not immediately available... I wonder why, and whether or not is has anything to do with the mass departures from the Canon City outpatient care facilities.

                  However, here is the new president here in Colorado, and I'll bet he didn;t come cheaply:

                  Prior to joining CHI, Mr. Banko served for four years as chief operating officer and vice president of CHRISTUS Spohn Health System in Corpus Christi, Texas. He also served for three years as senior vice president for PhyAmerica Physician Group, Durham, N.C., a privately held, $1.5 billion health care organization that included a large primary care physician group and the nation's largest emergency medicine revenue cycle company.
                  FYI: Centura calls itself a "non-profit" corporation.
                  Quis Custodiet Ipsos Custodes? Who is watching the watchers?

                  Comment


                  • #10
                    Four factors -- three germane to the US, one is universal:

                    4) resistance to tort reform;
                    3) lack of labor cost control;
                    2) lack of professional discipline (corollary to No 4);

                    and the No 1, and universal factor contributing to health care's disproportionate rise:

                    1) the graying of the population / lack of health care rationing.

                    The average American will consume 90% of his lifetime's health care in the last ten years of his life. The military tactics analogy would be Lee attacking Cemetery Ridge. From a cost/benefit point-of-view, it's called throwing good money after bad. As long as the US' population pyramid more resembles an arrowhead than a pyramid



                    we will not be able to get on top of our ever-increasing health care costs. We won't even be able to imagine it.

                    Nevertheless, each of those factors enjoys their own political champions, special interests and lobbyists who are expert at twisting policy makers around their little fingers. The ABA, AMA, and SEIU fight like lions against professional discipline, labor cost, and tort reform. Add to that AARP, and the notion of rationing health care is politically a nonstarter. As long as we can't overcome the special interests, the special interests will win. We're simply saddling our children with the debts that arose from our lack of political will, and our own selfishness. Some example we're setting.
                    I was married for two ******* years! Hell would be like Club Med! - Sam Kinison

                    Comment


                    • #11
                      an estimated five percent of the population accounts for 50 percent of total medical costs.
                      https://www.theatlantic.com/health/a...000000/530355/

                      You can't reduce health care to a formula and do a cost benefit analysis.

                      The elderly are a significant proportion of the 5 percent mentioned above. From any "rational" cost benefit perspective we are wasting a significant proportion of our health care expenditures on them. Rational and waste however are emotionally loaded terms when discussing health care.

                      Health care like everything else is rationed by ability to pay. In the U.S. the elderly can pay because the government promised them old age benefits. Even then it isn't a fair system if you consider the elderly as a distinct demographic.
                      Life expectancy increases continuously with income. At the age of 40 years, the gap in life expectancy between individuals in the top and bottom 1% of the income distribution in the United States is 15 years for men and 10 years for women.
                      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/. It isn't just that the rich can afford better health care life style plays a significant factor in health maintenance and life expectancy.

                      Most elderly people would choose the hospice route as an end of life strategy if advances in technology in recent years had not provided alternatives. As I argued earlier effectiveness, even the minor increase in life expectancy for the elder, increases demand and demand increases cost. This is just one example of the vicious circle that improvement in outcomes and spiraling cost increases produce. Additionally the more money spent and thus profit there is the more rapidly technology will evolve.



                      We hunt the hunters

                      Comment


                      • #12
                        Originally posted by slick_miester View Post
                        Four factors -- three germane to the US, one is universal:

                        4) resistance to tort reform;
                        3) lack of labor cost control;
                        2) lack of professional discipline (corollary to No 4);

                        and the No 1, and universal factor contributing to health care's disproportionate rise:

                        1) the graying of the population / lack of health care rationing.

                        The average American will consume 90% of his lifetime's health care in the last ten years of his life. The military tactics analogy would be Lee attacking Cemetery Ridge. From a cost/benefit point-of-view, it's called throwing good money after bad. As long as the US' population pyramid more resembles an arrowhead than a pyramid



                        we will not be able to get on top of our ever-increasing health care costs. We won't even be able to imagine it.

                        Nevertheless, each of those factors enjoys their own political champions, special interests and lobbyists who are expert at twisting policy makers around their little fingers. The ABA, AMA, and SEIU fight like lions against professional discipline, labor cost, and tort reform. Add to that AARP, and the notion of rationing health care is politically a nonstarter. As long as we can't overcome the special interests, the special interests will win. We're simply saddling our children with the debts that arose from our lack of political will, and our own selfishness. Some example we're setting.
                        I was hoping you would come along and provide an economic analysis. I was somewhat disappointed however that you blamed the "system".

                        From a broader perspective the situation we face was unavoidable considering the social dynamics and improvements in effectiveness. Increasing demand is naturally followed by increases in cost. Health care today is simply more valuable than it was in the past.

                        What we need to find out is why the economics of scale do not seem transferable to health care. It seems to me we are looking for a Henry Ford to make health care affordable. I believe that automation and AI are the answer but we can't break out of the paradigm of personal care. Our children will likely benefit from these kind of advances but not if we can't move through the current economic phase of labor intensive care.
                        We hunt the hunters

                        Comment


                        • #13
                          Originally posted by wolfhnd View Post

                          I was hoping you would come along and provide an economic analysis. I was somewhat disappointed however that you blamed the "system".

                          From a broader perspective the situation we face was unavoidable considering the social dynamics and improvements in effectiveness. Increasing demand is naturally followed by increases in cost. Health care today is simply more valuable than it was in the past.

                          What we need to find out is why the economics of scale do not seem transferable to health care. It seems to me we are looking for a Henry Ford to make health care affordable. I believe that automation and AI are the answer but we can't break out of the paradigm of personal care. Our children will likely benefit from these kind of advances but not if we can't move through the current economic phase of labor intensive care.
                          There's a reason why our forebears called the study "political economy": sometimes it's impossible to tease the politics from the economics. Issues like professional discipline and tort reform -- while really political in nature and in process -- their impact is felt economically. Likewise, the same holds true for health care rationing, especially chronic care. That's proving to be a crushing issue worldwide. If you think it's bad in the US, it's downright apocalyptic in places like Italy and Japan, where total fertility rate is well below 2.0.

                          Regarding the development of labor-saving technologies, chronic care -- at least as yet, can't be performed by automated means. I know that in Japan they're working on robots that will fill the role of caregivers for elderly patients, but setting aside the elderly's dislike of robots providing such intimate care, the technology just isn't up to the task. That's sure to change in the future, but not immediately, and not without significant R&D costs -- and even then, it'll be many many more years before the scale is upped to the point before it's affordable for the masses. We're likely looking at another two decades -- another generation, just in time for my retirement. Long story short, there are no easy answers, and without the political will to throw some segment of the population under the proverbial bus, we stand to commit the greatest of sins: committing our children to clean up our mess.
                          I was married for two ******* years! Hell would be like Club Med! - Sam Kinison

                          Comment


                          • #14
                            Originally posted by slick_miester View Post

                            There's a reason why our forebears called the study "political economy": sometimes it's impossible to tease the politics from the economics. Issues like professional discipline and tort reform -- while really political in nature and in process -- their impact is felt economically. Likewise, the same holds true for health care rationing, especially chronic care. That's proving to be a crushing issue worldwide. If you think it's bad in the US, it's downright apocalyptic in places like Italy and Japan, where total fertility rate is well below 2.0.

                            Regarding the development of labor-saving technologies, chronic care -- at least as yet, can't be performed by automated means. I know that in Japan they're working on robots that will fill the role of caregivers for elderly patients, but setting aside the elderly's dislike of robots providing such intimate care, the technology just isn't up to the task. That's sure to change in the future, but not immediately, and not without significant R&D costs -- and even then, it'll be many many more years before the scale is upped to the point before it's affordable for the masses. We're likely looking at another two decades -- another generation, just in time for my retirement. Long story short, there are no easy answers, and without the political will to throw some segment of the population under the proverbial bus, we stand to commit the greatest of sins: committing our children to clean up our mess.
                            By cleaning up our mess you mean the fantastic improvement in medical technology over the last two decades? There may need to be an economic reset but that process certainly doesn't just apply to our generation and it was put in motion before Europeans settled on the continent. It is almost narcissistic to suggest could have done better when you consider what previous generations have done. It assumes that someone was in charge and actually understood the consequence of their actions. The question is always compared to what non hypothetical alternative.
                            We hunt the hunters

                            Comment


                            • #15
                              Originally posted by slick_miester View Post


                              Regarding the development of labor-saving technologies, chronic care -- at least as yet, can't be performed by automated means. I know that in Japan they're working on robots that will fill the role of caregivers for elderly patients, but setting aside the elderly's dislike of robots providing such intimate care, the technology just isn't up to the task. That's sure to change in the future, but not immediately, and not without significant R&D costs -- and even then, it'll be many many more years before the scale is upped to the point before it's affordable for the masses. We're likely looking at another two decades -- another generation, just in time for my retirement. Long story short, there are no easy answers, and without the political will to throw some segment of the population under the proverbial bus, we stand to commit the greatest of sins: committing our children to clean up our mess.

                              Comments like this convince me that people are in denial of the human condition.

                              Is genius in the individual or in the culture? Without thousands of years of cultural development the most intelligent person would be lucky to invent the wheel yet alone quantum physics. The same principle applies to AI. Our brightest people cannot compete with what is essentially random selection. What AI does is turn evolution on it's head by eliminating the time constraints. To a large extent what genius is is pattern recognition. Computers don't so much solve problems by clever reduction as use the brute force of reiteration. They allow us to do things such as resolve DNA sequences that cannot be done by traditional scientific reduction. As evolutionary principles are applied to complex chemistry problems we see the limits of human imagination being overcome by random brute force modeling.

                              Many people seem to be stuck in a Newtonian paradigm. A world in which everything is necessarily ordered and stable. This is largely due to our inability to comprehend four factors, zero, time, size and randomness. We our determinists because it is impossible to move through a totally random space. Zero, time, size and randomness are all abstract relative terms. They are abstract but at the same time real. Real enough that they add nearly infinite complexity to cause and effect relationships. What AI does is shrink the limitations of the infinite, time, dimension and put randomness to work for us instead of against us.

                              As it relates to the cost of medicine AI is not limited to robotics but problem solving. Automated scanning and diagnosis is the key to putting the spiraling effectiveness cost relationship back in the bottle. Treatments that are tailored to the near infinite variation in individuals cannot be achieved by traditional approaches. The one size fits all assembly line mode of operation that made the industrial revolution so powerful by taking advantage of the economy of scale has counter intuitively made medicine expensive. The huge industrial complex that medicine has become has reached it's logical limits. Getting over the effectiveness hurtle to truly individual care by genetic screening and manipulation is key to cost reduction.The

                              What we should be worried about is not the abstract debt we leave our children but a deficit in imagination. The human condition is as the cultural ape. Culture including the language we are using here are technologies. Technologies that are not just represented in physical artifacts but abstract thinking tools. We have the "freewill" to transform "reality".
                              Last edited by wolfhnd; 28 Dec 19, 09:05.
                              We hunt the hunters

                              Comment

                              Latest Topics

                              Collapse

                              Working...
                              X