The strange greatness of Donald Trump

[carpedm9587]

Or, as in the case of my pinched nerve in my back, they tell you stuff you could have gotten for FREE.....

After careful examination:

Well, Mr. Poke, you have 3 things going on.
A) you're getting older
2) you're overweithg
C) you're out of shape

I PAID for that!!!!

I would have told you that for a lot less.

[Cow Poke]

Ever notice how old people die at a higher rate than young people? I wonder why that might be...?

We had an older African-American lady at a plant where I once worked who had astounding wisdom.

Upon hearing of the death of a coworker, and having two others who had died within the past 2 months, she declared, "Lordy, Lordy, People is dying what never died before!"

ya think?



(She was a very intelligent lady who, from time to time, would slip into this "wise old negro" persona for emphasis - I wish I had written down all her declarations)

[Cow Poke]

I would have told you that for a lot less.

Now I'm only 2 of the 3!

[carpedm9587]

Now I'm only 2 of the 3!

You got younger?

[Mountain Man]

I don't agree with your list. First, if you cover everyone under a single payer system, you can get a handle on costs to the consumer. The model is well established. Businesses all over the U.S. have been moving to the "self-insured" model because they find if they aggregate their people into a common pool and put commonsense rules in place*, they save a great deal of money. If a business with fewer than 150 employees can achieve this, imagine the savings if we can pool 350M people into that pool.

Beyond that, the rest is a balancing act. As you raise quality (for everyone) you simultaneously raise cost. So the question is, what is the cost/quality balance that works best for most. That often results in triaging procedures on a scale of criticality, and those who get pushed out are less than happy. I've been looking a bit at the UK system since the discussion yesterday. My initial impression is, "not the best one out there."

*One such rule I have always admired is: 100% coverage for the first $1,000 in expenses, 80% coverage for the next $15,000 in expenses, then 100% for anything above. Putting a small band of 100% at the front encourages people to minimize their unnecessary use of trivial medical services because they know they start paying OOP at $1,000. It has an amazing impact on overall costs.

I find it interesting that your "common sense rule" that "has an amazing impact on overall cost" is one that actively discourages people from taking advantage of the services offered.

And you claim to disagree with my list but you actually affirm it when you say, "As you raise quality (for everyone) you simultaneously raise cost." And if you don't want the costs increasing out of control and bankrupting the system, limits have to be placed on the services at some point. In the case of the UK, that has resulted in an ever decreasing quality of care.

[carpedm9587]

We had an older African-American lady at a plant where I once worked who had astounding wisdom.

Upon hearing of the death of a coworker, and having two others who had died within the past 2 months, she declared, "Lordy, Lordy, People is dying what never died before!"

ya think?

(She was a very intelligent lady who, from time to time, would slip into this "wise old negro" persona for emphasis - I wish I had written down all her declarations)

[Mountain Man]

Or, as in the case of my pinched nerve in my back, they tell you stuff you could have gotten for FREE.....

After careful examination:

Well, Mr. Poke, you have 3 things going on.
A) you're getting older
2) you're overweithg
C) you're out of shape

I PAID for that!!!!

Reminds me of the old joke:

Doctor: "I'm afraid you're going to need an operation."
Patient: "I want a second opinion!"
Doctor: "Okay, you're ugly, too."

[guacamole]

"Lordy, Lordy, People is dying what never died before!"

Was she expressing, somewhat darkly, the obvious, or was she expressing, still somewhat darkly, the painful truth of people who shouldn't die yet under normal circumstances who are nevertheless dying?

[Cow Poke]

I saw that coming!

Man goes to the doctor, doctor is surprised to see the man has a carrot protruding from his ear.

Patient: Doctor, I'm not feeling so good.
Doctor: No wonder, you're not eating right!

[guacamole]

I saw that coming!

Man goes to the doctor, doctor is surprised to see the man has a carrot protruding from his ear.

Patient: Doctor, I'm not feeling so good.
Doctor: No wonder, you're not eating right!

This sounds better if you say it because, written, it is dependent upon a punctuation error:

I went to the doctor and he told me I was overweight. I asked him what I should do, and he said, "Don't eat anything fatty."

I said, "Like cookies and chips."

He said, "No, fatty, I mean don't eat anything."

[carpedm9587]

I find it interesting that your "common sense rule" that "has an amazing impact on overall cost" is one that actively discourages people from taking advantage of the services offered.

I don't have data for the country as a whole - so all I have is anecdotal from two companies I had direct experience with that did this - the company my dad worked for, and the company I used to work for. In both cases, what happened was people were simply less likely to make those optional/less important trips just because they were free. They used doctor's offices instead of emergency rooms, and so forth. I don't know of a single incident (at least in those two scenarios) where someone did not get healthcare that was important and needed, especially for children. I realize that's just anecdotal - so it doesn't provide a national view. It's possible the behavior differs by region or vertical, and both my examples were from the northeast.

And while you claim to disagree with my list but you actually affirm it when you say, "As you raise quality (for everyone) you simultaneously raise cost.". And if you don't want the costs increasing out of control and bankrupting the system, limits have to be placed on the services at some point. In the case of the UK, that has resulted in an ever decreasing quality of care.

I disagree with your "2 out of 3" claim. The list was correct - so I said that badly. As written the list implies that I give up one if I want the other, and those are my choices. The reality is that it is a continuum. As you raise quality, you raise cost - making the choice more nuanced then your model suggests. In other words, your list implies the choices are:

High quality, everyone, high cost
High quality, some people, low cost
Low quality, everyone, low cost

But there are other options. If you accept "everyone should have access to healthcare" as a baseline, then the other two parameters become a sliding scale between them.

And why don't we just accept that "everyone should have access to healthcare" is already in place. No doctor or hospital I know of will turn away a person in need of critical medical help. If a poor person is having a heart attack and is taken to the emergency room, they will do the surgery and care for them. Then we will pay for their bill in our inflated premiums. It's an ad hoc system with no real controls. Putting a system in place that acknowledges the universal coverage that exists (for some things) and then creates a structure to actually pay for it is something I would welcome. Healthcare costs are ballooning and out of control.

[carpedm9587]

This sounds better if you say it because, written, it is dependent upon a punctuation error:

I went to the doctor and he told me I was overweight. I asked him what I should do, and he said, "Don't eat anything fatty."

I said, "Like cookies and chips."

He said, "No, fatty, I mean don't eat anything."

OK - THAT made me laugh...

[seer]

But there are other options. If you accept "everyone should have access to healthcare" as a baseline, then the other two parameters become a sliding scale between them.

I thought the Affordable Health Care Act already fixed all this? Made affordable health care accessible to all.

[tabibito]

I don't have data for the country as a whole - so all I have is anecdotal from two companies I had direct experience with that did this - the company my dad worked for, and the company I used to work for. In both cases, what happened was people were simply less likely to make those optional/less important trips just because they were free. They used doctor's offices instead of emergency rooms, and so forth. I don't know of a single incident (at least in those two scenarios) where someone did not get healthcare that was important and needed, especially for children. I realize that's just anecdotal - so it doesn't provide a national view. It's possible the behavior differs by region or vertical, and both my examples were from the northeast.



I disagree with your "2 out of 3" claim. The list was correct - so I said that badly. As written the list implies that I give up one if I want the other, and those are my choices. The reality is that it is a continuum. As you raise quality, you raise cost - making the choice more nuanced then your model suggests. In other words, your list implies the choices are:

High quality, everyone, high cost
High quality, some people, low cost
Low quality, everyone, low cost

But there are other options. If you accept "everyone should have access to healthcare" as a baseline, then the other two parameters become a sliding scale between them.

And why don't we just accept that "everyone should have access to healthcare" is already in place. No doctor or hospital I know of will turn away a person in need of critical medical help. If a poor person is having a heart attack and is taken to the emergency room, they will do the surgery and care for them. Then we will pay for their bill in our inflated premiums. It's an ad hoc system with no real controls. Putting a system in place that acknowledges the universal coverage that exists (for some things) and then creates a structure to actually pay for it is something I would welcome. Healthcare costs are ballooning and out of control.

I'm not sure why that gave me a sudden thought but

Australia switched from a "free" medical system at doctors surgeries to a "co-payment" (where the patients pay part of the bill) system a few years ago. Hospitals still provide free care, and a scant few doctors continue with the underpaid government funding. Ramping suddenly became a problem here a couple of years ago: it ballooned suddenly from an almost unheard of event to nearly a daily event. Just did a check of national news for hospital ramping, same thing happened earlier in other states, which seem to have had a bit more of a problem with ramping before the change in health policy. Not that it is possible to draw a cause and effect conclusion - but it is food for thought.

[carpedm9587]

I thought the Affordable Health Care Act already fixed all this? Made affordable health care accessible to all.

The ACA was a good first start, but had some significant flaws. Instead of setting out to fix those flaws, Trump and the Republicans have been exacerbating them, creating confusion in the healthcare market and skyrocketing costs. They are badly misreading their constituents. ACA popularity has been generally increasing since the end of 2013, moving from less than 37% at that time to over 53% at the end of last year, and that despite the ways it has been undermined. Imagine how much more popular it can be if we get someone in office that focus efforts on fixing its poorly structured parts!

Now "single payer" has become popular with anywhere from 50 to 70% of the electorate, with some polls showing even a majority of GOP constituents favoring it. We'll have to overcome the massive lobbying of the healthcare industry, and the steady drumbeat of the anti-government crowd, but the tide appears to be shifting.