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  #251  
Old 07-15-2018, 03:30 PM
k9bfriender k9bfriender is offline
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Originally Posted by Magiver View Post
I've provided a cite showing the delays and have tried over and over again to explain that this is how serious conditions get overlooked. You don't know how serious a lot of conditions are until diagnosed.
Which is why it would be better if we have more people covered. People without insurance, or without insurance that provides affordable coverage, don't go to the doctor until they are able to self diagnose that they have a serious problem, by which time, it is too late for treatment that will be both effective and affordable.

Take your issues, and take away your insurance, or give yourself the type of insurance that many have, that doesn't cover co-pays, that really doesn't even kick in until you've spent several thousand, and tell me how long you would have gone before getting your leg diagnosed. If you had not had the excellent employer sponsored insurance that you do, what are the chances that you would have lost your leg?

Do you feel more beholden to your employer, now that you are aware of how devastating it would have been had you not had their insurance? If someone comes by with a job offer that is the absolute dream for you, but doesn't have as good health benefits as your current employer does, will you take your dream job, or stay with the one that lets you keep your leg?

If your employer ever decides that it no longer needs to offer high end health insurance to its employees, and decides to reduce it down to the coverage equivalent of a bronze plan, do you get any say in that? If your employer decides to no longer subsidize your insurance premium, and instead, have you pay the whole thing, would you be able to afford it?
  #252  
Old 07-15-2018, 05:07 PM
wolfpup wolfpup is offline
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Link: From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).

Where to start. If my doctor isn't available we have after hours medical facilities that you can walk into without an appointment. As for your surgery, you didn't have a choice of surgeons and you lucked out on the ER visit. You should have had that diagnosed ages ago. Instead you stumbled in with a serious condition.
This is neither responsive to what I wrote nor is it medically accurate. You claimed you had no significant wait times after a series of events and procedures. I can make the same claim. I didn't "stumble in", I felt perfectly fine except for minor pains that I thought should be looked at out of an abundance of caution. There is absolutely no medical basis for you to declare that "You should have had that diagnosed ages ago". I have regular doctor visits and had a full checkup not long prior to that. Sometimes the onset of cardiac conditions is just unpredictable. And furthermore, insurance is not likely to pay for many of the precautionary screenings -- Cigna says they're applicable only "when a personal history or physical exam points to risk for a heart problem"; Consumer Reports suggests that CT angiography is pointless and overutilized, and the Mayo Clinic recommends full-fledged catheter angiograms only when indicated by specific symptoms.

Nor did I in any way "luck out" on the ER visit. To me it was a perfect example of the system working exactly as it should, prioritizing urgency and treatment options based only on the balance of medical need and patient preference, not insurance company edicts about what they're willing to pay for. The whole thing to me was a very positive experience, if frightening. My only complaint, to be honest, was just being poked and tested all weekend (I came in late on a Friday afternoon) with no apparent indication of when I could go home. I even complained to the attending cardiologist about it, and he said, yeah, things get slow around here on a weekend, but they're really going to speed up for you on Monday. And they sure did.

ETA: I should mention for what it's worth that your link is from the Fraser Institute, which is a conservative think-tank generally opposed to single-payer and all things liberal. Their actual numbers quoted may not be wrong, but the context and presentation, and information omitted, is often extremely right-wing biased.
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I had open heart surgery which is a lot different than stents or bypass. They just did a stent on a friend of mine in a similar example to yours. Completely different comparison to what I had.
No, you're medically incorrect here. Cardiac bypass surgery (more fully, coronary artery bypass grafting (CABG)) **is** open-heart surgery. The heart is stopped while arteries from other parts of the body are transplanted.

You're quite correct that stenting (PCI) is a much different and much less invasive kind of operation, which is why I was so glad that I was a viable candidate for it. But if I had opted for bypass it would have been done within a day or two. How do I know this? Because I spoke with the bypass surgeon immediately after the angiogram, and because my neighbor in the hospital was taken for his bypass within two days of his arrival, which I think was mostly diagnosis and prep time. In fact he got his bypass before I got my stents, because I went through more diagnostics and decision-making.
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your anecdotal story doesn't match what Canadians are experiencing.
A lifetime of experience isn't an "anecdote".
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No, wait times refer to the time waiting to see a doctor, specialist, diagnostic equipment, and treatment.
I should emphasize that this was in response to my comment "The other obvious point that's often misunderstood is that "wait times" refer to procedures scheduled for outpatients. Once you're admitted to hospital, wait times are generally pretty much how long it takes them to wheel you over to where the procedure is done."

And as a response to that, this is just flat-out wrong, and seems to reveal your deep misunderstanding of how health care works in Canada. For MRIs, for example, outpatient wait times range from one day to some number of weeks depending on urgency. But when one patient I was accompanying was in the hospital and was about to be discharged, a nurse came by and said the doctor wanted an MRI done just as a precaution before they left to ensure that some condition wasn't present, the details of which I can no longer remember. I asked when that could happen, and she said someone would come by in about ten minutes and take them down for the MRI. Yeah, quite the wait.

Last edited by wolfpup; 07-15-2018 at 05:11 PM.
  #253  
Old 07-15-2018, 05:26 PM
survinga survinga is offline
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This is a plan that I freely admit I don't know anything about, but I'd have some serious reservations about it. From a quick read, it appears that the "means test" would be eliminated. But doesn't that mean that already soaring costs would increase tremendously faster, and would become absolutely astronomical if "Medicaid buy-in" came close to being universal without changing anything else? And therefore wouldn't the barbaric aggressiveness of the Medicaid Estate Recovery Program have to get even worse? And how would people feel about being limited to only those providers willing to accept about two-thirds of their normal fees?

You've mentioned both the political difficulties and also things like how different the US is from Saskatchewan (and, presumably, from the rest of Canada, where single-payer now thrives), which I perceive (perhaps unfairly) as talking about political difficulties and operational feasibility all in the same breath. The difference is crucial, especially when those political difficulties are largely based on ideologically motivated falsehoods being promoted in the service of special interests.

With all respect, I don't think most Americans know enough about the difference between private insurance and single-payer or its close equivalents as practiced throughout the civilized world to be able to make that evaluation objectively. Why would anyone NOT want their insurance to cost half as much while having unconditionally guaranteed coverage for everything that was medically necessary? Unless they believe the bullshit that AHIP and the other lobbyists are constantly spewing.

Everyone loves their private health insurance until the first time a claim is denied or the first time they're hit with enormous out-of-pocket costs, like the various cites I've already provided. Some people die because of those factors. I wonder how much they liked their insurance? I'm reminded of lengthy discussions I had with someone on a different board a long time ago, who was a staunch defender of US private insurance. According to him, it could do no wrong, and served his needs with consummate perfection. Then I found a different thread in which this same person was complaining bitterly about the out-of-pocket costs that a hospital was charging him, and which required him to put down a huge deposit on his credit card before they would even treat his child, and asking if that was even legal.

And it's not just the big stories that make the news about claims denials that are relevant -- they happens thousands of times every day across America. My own brother who lives in the US and has an excellent executive-level health care plan has had claims denied. Nothing especially major, but frustrating as hell. One time the insurer refused to pay for a prescribed medication because there was a cheaper alternative, which made his doctor absolutely furious because while the other stuff was cheaper, alright, it was also less effective. And the insurer turned down home care when he was home with an injury, for reasons that were inconsistent the several times that he called them about it. Meantime my elderly mother here in Ontario has had the home services of a nurse, a personal care worker, a dietician, and a hospital technician providing oxygen devices including a portable mobile oxygen system -- all at no cost under the public insurance system. So yeah, I tend to be a cheerleader for single-payer, because experience is a powerful teacher.

And as I've said before, in a democracy you can't kill a system that has overwhelming popular support. That's why single-payer was never at risk in Canada, and the NHS was never at risk in the UK. Even the new ACA, with its many limitations and limited support, managed to mostly survive Trump and Republican lunatics anxious to kill it, because the impacts to those who depended on it were obvious even to some of the more dull-witted voters.
Personally, I doubt that "Medicaid buy-in" will work. I don't want it in my state, for instance. I think a lot of doctors don't like Medicaid, and that's why only 70% take Medicaid patients. But I'm willing to sit back and see how that experiment goes if certain states want to try it. That's one good thing about our system. It's not efficient, but not everything is continent-wide. So, if a mistake is made in one state, it only affects that state. I'm not aware of their estate recovery program, so I can't comment. I know there's some kind of "spend down" of assets required for nursing home care, which I definitely don't like about Medicaid. Is that what you're referring to? I think if Medicaid buy-in was available for all, then people who became age 65 would then move over to Medicare, and maybe not be affected by an estate recovery thing? Not sure, but I will read up on it.

You're right that when something has wide support, it's hard to kill (not impossible, but it would be very hard). However, one of the selling points of the ACA is that once it was implemented, support would be enough to where Republicans wouldn't attack it. And that ended up being wrong. Medicaid has also been well accepted for 50 years, and yet Republicans are now attacking it. I think we have more extremes in our politics in the US than Canada, and that's why I don't think a single-payer in the US would be safe from Trumpist shenanigans. I'm glad that our healthcare system has different insurance targeted for different populations & states. This limits the damage that can come from a nitwit like Trump.

As for private insurance, I've never had issues in my family, and we've had to deal with Type 1 Diabetes and epileptic-like seizures. We've had hospitalizations, and various referrals to different types of doctors. No problems, no hassle. Yeah, we fill out paperwork...but so what. And come to think of it, I'm not aware of anyone in my extended family with issues in their insurance either, except when my brother had issues with Medicaid eligibility....(damn govt bureaucrats).

Anyway, by now I hope you realize that I'm serious in what I'm saying and that I've done research on this topic. I think America needs to improve. I just hope we don't do single-payer.
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Last edited by survinga; 07-15-2018 at 05:27 PM.
  #254  
Old 07-15-2018, 06:29 PM
Magiver Magiver is online now
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This is neither responsive to what I wrote nor is it medically accurate.
Are you saying my cite of delays in Canada is not accurate?
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  #255  
Old 07-15-2018, 06:53 PM
Magiver Magiver is online now
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No, you're medically incorrect here. Cardiac bypass surgery (more fully, coronary artery bypass grafting (CABG)) **is** open-heart surgery. The heart is stopped while arteries from other parts of the body are transplanted..
I missed this. No, the heart is not generally stopped for bypass surgery.
Cite: Approximately every 10 minutes, someone has beating heart or "off-pump" bypass surgery1. Beating heart bypass surgery is — in simple terms — bypass surgery that is performed on your heart while it is beating. Your heart will not be stopped during surgery. You will not need a heart-lung machine. Your heart and lungs will continue to perform during your surgery.
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  #256  
Old 07-15-2018, 08:07 PM
wolfpup wolfpup is offline
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Are you saying my cite of delays in Canada is not accurate?
Your numbers are fine, but significantly devoid of context in a very complex matter where context is critical to understanding. In terms of my experience for myself and loved ones over a lifetime, yes, your cite of delays is deceptive and therefore not accurate. Your argument doesn't accurately represent any meaningful reality. Because if someone like me has chest pains, they are dealt with competently and immediately. If someone breaks a hip, they are dealt with competently and immediately. And if someone has slowly growing pains in his knee because he's getting older and heavier, then he can make an appointment and may have to wait a few months. My friend was shocked with how quickly he got his knee replacement appointment -- he was hoping to avoid the damn thing for at least a year, he really hated the thought of having his knee smashed up in the hospital.

What all of us had in common was full coverage for the best possible quality of medical care* without spending a dime out of pocket.

--

* It's hard to judge quality, obviously, but when my mother got a pacemaker implanted years ago, as a techie nerd I looked up all possible information about it. It turned out to be one of the most sophisticated Medtronic units available, the procedure performed at a world-class Toronto hospital. Total cost: $0.
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I missed this. No, the heart is not generally stopped for bypass surgery.
Cite: Approximately every 10 minutes, someone has beating heart or "off-pump" bypass surgery1. Beating heart bypass surgery is — in simple terms — bypass surgery that is performed on your heart while it is beating. Your heart will not be stopped during surgery. You will not need a heart-lung machine. Your heart and lungs will continue to perform during your surgery.
Yes, it is generally stopped -- according to your own cite: "More than 70% of all bypass surgeries are performed on a stopped heart ... Your heart will usually be stopped for about 30-90 minutes of the 3-6 hour surgery."

I would say that "more than 70%" qualifies as "generally".

But that wasn't even my main point. My main point is that it was it was major open-heart surgery, which indeed it was. Maybe you don't understand what "open heart surgery" is.

But perhaps your point is that in Canada, what with single-payer and all the ice and Eskimos and stuff, they don't know about this advanced stuff and so I would naturally have had this more primitive kind of surgery.

Well, no, the reason I didn't have this major surgery at all was the hospital's catheter lab experience with advanced PCI techniques like fractional flow reserve as a means of optimizing stenting as a viable alternative to life-threatening and major debilitating surgery.

Last edited by wolfpup; 07-15-2018 at 08:09 PM.
  #257  
Old 07-15-2018, 08:24 PM
survinga survinga is offline
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With all respect, I don't think most Americans know enough about the difference between private insurance and single-payer or its close equivalents as practiced throughout the civilized world to be able to make that evaluation objectively. Why would anyone NOT want their insurance to cost half as much while having unconditionally guaranteed coverage for everything that was medically necessary? Unless they believe the bullshit that AHIP and the other lobbyists are constantly spewing.
...and I almost forgot to respond to the pointless shot taken at Americans...

Look, almost anyone in the world you talk to in any country isn't going to be able to analyze the nuance and differences between this or that type of healthcare system. People don't understand macrosystems, whether it be healthcare, or central banks and monetary policy, or military, or, well, any other topic.

But people know if they're getting good healthcare in their own lives. Their own situation is something where we should take their opinion seriously, even if they're not experts in the "field". I think 3 out of 4 is a lot of consensus. I think you're trying to sluff off that with your bias against non-single-payer systems.
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Last edited by survinga; 07-15-2018 at 08:26 PM.
  #258  
Old 07-15-2018, 08:52 PM
Magiver Magiver is online now
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Your numbers are fine, but significantly devoid of context in a very complex matter where context is critical to understanding.
I understand delays just fine. They're not complex unless you're trying to spin them.
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  #259  
Old 07-15-2018, 09:18 PM
Magiver Magiver is online now
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The United States has almost 4 times as many MRI's per person as Canada. As I cited earlier, the delays are increasing rather than decreasing. It's not a function of UHC, it's a function of throttling that occurs in all methods of insurance. Your system has X dollars to spend And it's divided up. What you get is what you get. The same occurs with insurance in the US. We have faster service because we pay more. It's a pretty easy concept to understand.
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  #260  
Old 07-15-2018, 09:20 PM
wonky wonky is online now
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I had open heart surgery which is a lot different than stents or bypass.
Bypass (CABG) is open heart surgery. There are also open heart surgeries that are not CABG, like valve replacement, but CABG is the most common type of open heart surgery and, in my experience, it's the one people mean.
  #261  
Old 07-15-2018, 09:21 PM
wonky wonky is online now
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The United States has almost 4 times as many MRI's per person as Canada.
This is not a plus. But he, the US is also the leader in unnecessary imaging. So we have that going for us.
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Old 07-15-2018, 09:30 PM
Magiver Magiver is online now
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This is not a plus. But he, the US is also the leader in unnecessary imaging. So we have that going for us.
That's not a statement of fact. What is fact is that delays in medical care have consequences.
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  #263  
Old 07-15-2018, 09:52 PM
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That's not a statement of fact. What is fact is that delays in medical care have consequences.
I'm not sure facts are what you're going for right now. I'll leave you to it.
  #264  
Old 07-16-2018, 02:14 AM
wolfpup wolfpup is offline
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The United States has almost 4 times as many MRI's per person as Canada.
Correct. And you know why? Because such enormous fees can be charged for outpatient services that everybody and his dog is rushing into the business, like carnival barkers at a circus sideshow, and imaging centers can be highly profitable while sitting idle half the time -- and performing completely unnecessary imaging much of the rest of the time -- all of which you are paying for. While in Canada, as I said, access is priority based to maintain optimum utilization. In a hospital, access is immediate for everyone; outside, it's based on urgency. In Ontario, for a priority outpatient referral the target time is two days and typical time is one day, and for the lowest priority outpatient referral it might be as long as six weeks.

So what, exactly, is that 4X excess of MRI machines doing for your health? Why don't we check in term of medical outcomes. Emphasis mine in the abstract below:
We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801918/

Last edited by wolfpup; 07-16-2018 at 02:19 AM.
  #265  
Old 07-16-2018, 02:32 AM
Voyager Voyager is offline
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Correct. And you know why? Because such enormous fees can be charged for outpatient services that everybody and his dog is rushing into the business, like carnival barkers at a circus sideshow, and imaging centers can be highly profitable while sitting idle half the time -- and performing completely unnecessary imaging much of the rest of the time -- all of which you are paying for. While in Canada, as I said, access is priority based to maintain optimum utilization.
My understanding is that a lot of the problem in the US is that any respectable medical facility needs an MRI to be competitive, and once you have an MRI your staff is going to be incented to use it. Since doctors are happy to get an image just in case, there is no ethical reason for them not to. However do no harm doesn't seem to extend to harm to wallets.
How does Canada keep from having an excess of MRIs for this reason? I understand how you keep facilities from doing unnecessary mapping.
It seem to me that if the MRIs were not clogged up with unnecessary stuff, true needs could get met faster.

Last edited by Voyager; 07-16-2018 at 02:32 AM.
  #266  
Old 07-16-2018, 03:20 AM
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How does Canada keep from having an excess of MRIs for this reason?
My best guess is that it's because diagnostic imaging centers like those doing MRIs are paid moderate, cost-controlled fees and are therefore not enormous profit centers. This is actually a bit more than a guess -- my unique insight into this is that I have a copy (a few years old) of the Ontario health system fee schedule AND a few years ago I had to pay out of pocket for an MRI for my dog. Pissed me off that our otherwise excellent health plan doesn't cover dogs, who I consider to be legitimate loyal citizens, but that's another story. Anyway, although MRI costing is a bit complicated, because it depends on the procedure and the number of image "slices" that are taken to reconstruct a 3D image of the area in question, my impression was that my dog's MRI cost about twice as much as the health system would have paid for a human. Meanwhile, from what I've heard, MRIs in the US can cost four to ten times as much. Same equipment, same procedure. The difference? Profit$$$.
  #267  
Old 07-16-2018, 11:38 AM
Nava Nava is online now
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How does Canada keep from having an excess of MRIs for this reason? I understand how you keep facilities from doing unnecessary mapping.
Spain does it by putting things in the opposite order: you begin by not doing unnecessary mapping and by figuring out how many slides that means.
How many MRI views are needed in an area? X many.
How many MRI machines does that mean? Y.
If the local hospitals already have that many, there's no need to buy another one.
As X increases, eventually there is a need to buy another machine. Whether this is done by a public hospital or a private one will depend on who makes that decision first, but in the end and since all* MRI machines are used by both public and private systems, that new machine goes into the general pool and that means everybody is covered. Having too many machines just means idle machines, which in turn means the accountants will be real, real cranky next time someone asks for a shiny new machine. You don't meddle in the affairs of dragons, you don't piss off the healer, and you definitely do not want to make the accountants cranky.




* OK, the immense majority. I can't promise there is some private clinic somewhere whose MRI machine is never touched by the plebe but, given how much those machines cost and unless your clients pay supermegaextra for exclusivity, it makes sense to contract your downtimes to the public system or to other private clinics nearby.
Note that this also applies for other expensive diagnostic equipment, such as CATs.
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Last edited by Nava; 07-16-2018 at 11:41 AM.
  #268  
Old 07-16-2018, 11:45 AM
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Meanwhile, from what I've heard, MRIs in the US can cost four to ten times as much. Same equipment, same procedure. The difference? Profit$$$.
You've addressed the revenue side, not the cost side. The difference isn't necessarily profit.

You talk about optimum utilization, but that assumes a certain utility curve. Some folks may be willing to pay more for a different level of utilization to reduce wait times.
  #269  
Old 07-16-2018, 12:22 PM
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You've addressed the revenue side, not the cost side. The difference isn't necessarily profit.

You talk about optimum utilization, but that assumes a certain utility curve. Some folks may be willing to pay more for a different level of utilization to reduce wait times.
I think it's more a case of people being able financially, not "willing". I am more than willing to get better than crappy medical service, but I cannot afford it.
  #270  
Old 07-16-2018, 01:31 PM
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You've addressed the revenue side, not the cost side. The difference isn't necessarily profit.
The difference isn't entirely profit, no, but it's a big component of it, or the US wouldn't have such an excess of MRI machines and private imaging centers that run them. According to one source that was quoting US Census data (I no longer have the link, this is from some notes I took today) the US has about 6,600 diagnostic imaging centers with combined revenues of about $16.4 billion annually, though it's not clear how many of these are in hospitals or are partnerships with hospitals. But when there are more than 11,000 MRI machines in the nation, mostly privately owned -- compared to a grand total of about 320 in Canada -- it's a good bet that they're there to make money, and not for benevolent charitable reasons!

The excessive cost of MRIs in the US medical system is thus due to a combination of profiteering and high administrative costs. This excerpt on hospital costs gives some insight into the latter, and applies as much to diagnostic imaging centers as it does to hospitals in general:
... about $1 of every $4 of U.S. hospital spending goes to bureaucracy rather than patient care. Other countries manage modern, first-rate hospital systems for far less. While administration devoured $667 per capita annually in the U.S., we found that Canada spent only $158, Scotland $164, England $225 and the Netherlands $325. If U.S. hospitals ran as efficiently as Canada’s, the average U.S. family of four would save $2,000 annually on health care.

... Why are U.S. hospitals so inefficient? Our multiple-payer insurance system forces every hospital to negotiate rates with dozens of insurance plans, each with its own coverage rules, billing procedures and documentation requirements. And each hospital must collect deductibles, co-payments and co-insurance from tens of thousands of patients.
https://evidencenetwork.ca/why-canad...u-s-hospitals/
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You talk about optimum utilization, but that assumes a certain utility curve. Some folks may be willing to pay more for a different level of utilization to reduce wait times.
The common meaning of "optimum utilization" of an expensive resource is making the most productive use of it and minimizing the waste of idle time. Like what airlines do with their very expensive aircraft, scheduling them to spend the maximum time in revenue service.

There are two problems with the "willing to pay more for a different level of utilization" argument. One is that there's no evidence that very many of these hypothetical people actually exist. Out of curiosity I looked around for such private clinics in different provinces here, and although at first glance there seem to be a few around (though not many), on closer inspection some are just American centers advertising here, and others are just consulting services. A few are specialized collaborations offering expedited access to MRIs for workmen's compensation claims and other very specific insurance issues only. I imagine that when a major sports star has an injury that requires an MRI, this is the kind of service they use. But in general, from what I could see, there is virtually no demand for an expedited-access service that many people would be willing to pay for.

The other problem with that argument is that any such expedited access scheme has a moral imperative not to weaken or undermine the existing public system, and sometimes that's hard or impossible to do, especially if you're reallocating finite resources. It's a constant worry with any two-tier health care system. The province of Alberta, for example, being of a somewhat conservative mindset, allowed one of the more aggressive intrusions of private MRI centers, partly in the expectation that it would improve wait times for everyone. In fact, wait times only got worse for the public sector, and are now one of the worst in Canada, in part because that same system -- spurred on by the private centers -- has been promoting an American-style culture of over-utilization.
  #271  
Old 07-16-2018, 01:36 PM
wonky wonky is online now
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A nice article on administrative spending: https://www.nytimes.com/2018/07/16/u...mid=tw-nytimes
  #272  
Old 07-16-2018, 08:23 PM
Magiver Magiver is online now
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Originally Posted by k9bfriender View Post
Take your issues, and take away your insurance, or give yourself the type of insurance that many have, that doesn't cover co-pays, that really doesn't even kick in until you've spent several thousand,
I have co-pays, in-network, and out-network costs.

How much is your leg worth to you? Mine is worth the cost of the insurance I have and a considerable amount more. I don't understand why young people today are willing to blow off their responsibilities. Their policies are cheaper and they can bank money in an HSA for when they're older. If they don't need it they get to keep it upon retirement or use it to supplement their medicare.

Quote:
Originally Posted by k9bfriender View Post
Do you feel more beholden to your employer, now that you are aware of how devastating it would have been had you not had their insurance?
I've purchased insurance between good jobs and I've worked 3 jobs at a time to make that happen. I was beholden to me.

It makes no sense for you to argue the middle class should give up the health care afforded the rich. fixing the gap in medical coverage doesn't require that.
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  #273  
Old 07-16-2018, 10:06 PM
Voyager Voyager is offline
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Originally Posted by Nava View Post
Spain does it by putting things in the opposite order: you begin by not doing unnecessary mapping and by figuring out how many slides that means.
How many MRI views are needed in an area? X many.
How many MRI machines does that mean? Y.
If the local hospitals already have that many, there's no need to buy another one.
As X increases, eventually there is a need to buy another machine. Whether this is done by a public hospital or a private one will depend on who makes that decision first, but in the end and since all* MRI machines are used by both public and private systems, that new machine goes into the general pool and that means everybody is covered. Having too many machines just means idle machines, which in turn means the accountants will be real, real cranky next time someone asks for a shiny new machine. You don't meddle in the affairs of dragons, you don't piss off the healer, and you definitely do not want to make the accountants cranky.
That's rational. But I bet hospitals in Spain don't advertise. All the expensive ads for the latest cancer treatment facilities or hot new medical technology must be for a reason. Our local hospital, whose quality numbers could be better, buys up an entire section of the weekly paper.
I assume they think that if you go to hospital H for an MRI you'll try to get yourself admitted to hospital H for the money making stuff. Or choose a doctor who admits patients to hospital H.
  #274  
Old 07-17-2018, 05:44 PM
Magiver Magiver is online now
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Originally Posted by wolfpup View Post
The difference? Profit$$$.
And that profit saved my leg. Just as it puts food on the table and a roof over my head.
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  #275  
Old 07-17-2018, 10:07 PM
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Originally Posted by Bone View Post
You've addressed the revenue side, not the cost side. The difference isn't necessarily profit.

You talk about optimum utilization, but that assumes a certain utility curve. Some folks may be willing to pay more for a different level of utilization to reduce wait times.
Which is fine if we're talking restaurant reservations. If people are paying more to cut in line in front of people with greater need, maybe it isn't such a great idea.
  #276  
Old 07-18-2018, 11:47 AM
k9bfriender k9bfriender is offline
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Quote:
Originally Posted by Magiver View Post
I have co-pays, in-network, and out-network costs.

How much is your leg worth to you? Mine is worth the cost of the insurance I have and a considerable amount more. I don't understand why young people today are willing to blow off their responsibilities. Their policies are cheaper and they can bank money in an HSA for when they're older. If they don't need it they get to keep it upon retirement or use it to supplement their medicare.
You are very fortunate. There are many who, no matter how much their leg was worth to them, were not able to save it due to lack of money. You were beholden to an insurance bureaucrat who could have decided to make a few extra bucks on his bonus and found a way to deny your claim, or just to delay it long enough for it to no longer matter. You know what your leg was worth to the insurance company? Nothing, it was instead a liability, one they would have denied had they found a way.

How much did your leg cost? What are the chances that you could have saved up enough in your HSA to cover it? Even if you had, after it was wiped out, then you wouldn't have been able to cover your heart surgery.

Is your leg worth more to you than your heart?
Quote:
I've purchased insurance between good jobs and I've worked 3 jobs at a time to make that happen. I was beholden to me.
Actual good insurance that would cover any complications with your leg or heart? Are you really saying that people should be required to work 3 jobs in order to have insurance?
Quote:
It makes no sense for you to argue the middle class should give up the health care afforded the rich. fixing the gap in medical coverage doesn't require that.
Honestly, that statement doesn't make any sense from a parsing standpoint. What are you trying to claim that I am arguing here?
  #277  
Old 07-18-2018, 05:21 PM
survinga survinga is offline
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Quote:
Originally Posted by k9bfriender View Post
You are very fortunate. There are many who, no matter how much their leg was worth to them, were not able to save it due to lack of money. You were beholden to an insurance bureaucrat who could have decided to make a few extra bucks on his bonus and found a way to deny your claim, or just to delay it long enough for it to no longer matter. You know what your leg was worth to the insurance company? Nothing, it was instead a liability, one they would have denied had they found a way.

How much did your leg cost? What are the chances that you could have saved up enough in your HSA to cover it? Even if you had, after it was wiped out, then you wouldn't have been able to cover your heart surgery.

Is your leg worth more to you than your heart?

Actual good insurance that would cover any complications with your leg or heart? Are you really saying that people should be required to work 3 jobs in order to have insurance?


Honestly, that statement doesn't make any sense from a parsing standpoint. What are you trying to claim that I am arguing here?
You guys keep talking about insurance company bureaucrats like they're all powerful claim deniers. But these are just people within their own company, dealing with their own population of policyholders, and in the vast majority of cases, doing things the right way and not screwing anyone. For every anecdote you can find, I could probably find a million where there were no problems with claims.

Do you want to turn over the entire US healthcare sysem to the likes of Donald Trump? He's the guy that cut off CSR payments within the ACA framework, which will price hundreds of thousands, if not millions, out of the exchanges. He's also the guy who is not going to argue against a lawsuit that will attack pre-ex protections, which will price millions more out of the exchanges, and increase our uninsured population. His HHS is going along with states that want work requirements on Medicaid recipients.

I'm sorry, but in the US, we don't need single-payer for many reasons. And one big one is to not put the entire system under the thumb of a goon like Trump. And scare tactics about the evils of private insurance hold no weight with me. I have private and I'm doing fine, just like the rest of my family....and the vast vast majority of the other 158 million people in the US who have it.
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  #278  
Old 07-18-2018, 08:29 PM
wolfpup wolfpup is offline
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You know, at this point I have little patience left with this eternally ongoing argument. I just dropped in briefly to correct some very blatant factual errors.
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Originally Posted by survinga View Post
You guys keep talking about insurance company bureaucrats like they're all powerful claim deniers. But these are just people within their own company, dealing with their own population of policyholders, and in the vast majority of cases, doing things the right way and not screwing anyone. For every anecdote you can find, I could probably find a million where there were no problems with claims.
If you're trying to suggest that the ratio of denied claims to paid claims is one in a million, I would inform you that it's more like 1 in 7 for employer health plans overseen by the Department of Labor, which one would expect to be among the best plans. In Vermont where ratios must be reported by law, Cigna reports denying more than 1 in 5 claims, MVP nearly 1 in 6. It's deceptive to suggest that claims denials are a rare occurrence. The Department of Labor employer-plan statistics alone show 200 million denials a year. There's a reason that medical costs are the #1 cause of personal bankruptcies in the US, even among those who thought they were well insured.
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Originally Posted by survinga View Post
Do you want to turn over the entire US healthcare sysem to the likes of Donald Trump? He's the guy that cut off CSR payments within the ACA framework, which will price hundreds of thousands, if not millions, out of the exchanges. He's also the guy who is not going to argue against a lawsuit that will attack pre-ex protections, which will price millions more out of the exchanges, and increase our uninsured population. His HHS is going along with states that want work requirements on Medicaid recipients.

I'm sorry, but in the US, we don't need single-payer for many reasons.
Well I'm sorry, too, since you still don't appear to understand how single-payer works. Look at all those terms you used:
  • CSR payments
  • price hundreds of thousands, if not millions, out of the exchanges
  • price millions more out of the exchanges
  • increase our uninsured population
  • work requirements on Medicaid recipients
Quite simply, none of those terms or concepts exist in single-payer. There are no insurance companies, no exchanges, no "prices" paid for coverage*, no uninsured. The whole concept is completely different than what I think your understanding is, if you're making comparisons like that.

Oh, and one more term that does not exist in single payer: "claim denial".

--
* In some provinces everyone pays a small annual fee, usually geared to income.
  #279  
Old Yesterday, 07:02 AM
SanVito SanVito is offline
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Quote:
Originally Posted by wolfpup View Post
Well I'm sorry, too, since you still don't appear to understand how single-payer works. Look at all those terms you used:
  • CSR payments
  • price hundreds of thousands, if not millions, out of the exchanges
  • price millions more out of the exchanges
  • increase our uninsured population
  • work requirements on Medicaid recipients
Quite simply, none of those terms or concepts exist in single-payer. There are no insurance companies, no exchanges, no "prices" paid for coverage*, no uninsured. The whole concept is completely different than what I think your understanding is, if you're making comparisons like that.

Oh, and one more term that does not exist in single payer: "claim denial".

--
* In some provinces everyone pays a small annual fee, usually geared to income.
I'm glad you picked up on these, because as someone who lives in the ultimate single payer system (UK NHS), I had not a clue what any of those terms meant.
  #280  
Old Yesterday, 07:46 AM
PatrickLondon PatrickLondon is offline
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I'm trying to think of a way, other than simply slashing budgets, any UK government could undo anyone's reasonable expectations of the NHS. It would have to involve a parliamentary majority committed (and presumably with the mandate of a general election manifesto) to rewriting the law to allow ministers to both (a) prescribe and proscribe treatments on any ground other than safety and (b) forbid people from buying private insurance or private medical care and forbid professionals from offering it.

That all that's unthinkable just underlines the importance of broader culture/expectations, which doesn't make it any easier for the US to have any chance of getting from here to there in this case.

Last edited by PatrickLondon; Yesterday at 07:47 AM.
  #281  
Old Yesterday, 08:12 AM
k9bfriender k9bfriender is offline
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Originally Posted by survinga View Post
You guys keep talking about insurance company bureaucrats like they're all powerful claim deniers. But these are just people within their own company, dealing with their own population of policyholders, and in the vast majority of cases, doing things the right way and not screwing anyone. For every anecdote you can find, I could probably find a million where there were no problems with claims.
All powerful? Not really, unless they are all powerful strawmen.

Having power over your personal medical decisions, leaving you in a situation where they effectively are playing god with *your* life. Yes.

And no, you cannot find a million approved claims for every denied one. You can find 5 or 6 approved claims for every denied one, and that is not getting into claims that are partially approved, or approved for a procedure that is cheaper but not what was recommended by your doctor, or other "problems" that are not outright denials.

At the very least, there are delays. When I had pretty good insurance, I still had to wait for the doctor to submit a claim and get it approved by the insurance company before we could schedule a procedure.

They are not doing it to be evil, there is no reason to even think that they are evil. They are doing it because the more claims they deny, the more money they get on their paycheck.
Quote:
Do you want to turn over the entire US healthcare sysem to the likes of Donald Trump? He's the guy that cut off CSR payments within the ACA framework, which will price hundreds of thousands, if not millions, out of the exchanges. He's also the guy who is not going to argue against a lawsuit that will attack pre-ex protections, which will price millions more out of the exchanges, and increase our uninsured population. His HHS is going along with states that want work requirements on Medicaid recipients.
Another strawman. There is no UHC that gives the executive as much power over healthcare as we already have. Yes, because of the compromises that were made in the ACA to appease conservatives, there are little things here and there that the executive can do to deliberatly sabotage the healthcare of millions of people. That's a problem that can be addressed with a more robust bill that doesn't spend as much time trying to appease those who do not want to see any sort of universal healthcare passed.

Trump is also messing with our trade policies and international relations and everything else. Poor governance is not a reason to advocate for non governance, it is only a reason to advocate for good governance. Electing people like trump does more damage to just our healthcare system, which, as has been reminded to you numerous times in this thread, is far more untouchable, both legislatively and politically under every other form of UHC than the ACA is.
Quote:
I'm sorry, but in the US, we don't need single-payer for many reasons. And one big one is to not put the entire system under the thumb of a goon like Trump. And scare tactics about the evils of private insurance hold no weight with me. I have private and I'm doing fine, just like the rest of my family....and the vast vast majority of the other 158 million people in the US who have it.
It is not that insurance companies are evil. Your attempts at anthropomorphizing a non-sentient entity are useless. A company exists to make a profit, and that profit comes at the expense of the health of its customers. The goals are at odds with eachother. You want good health, they want low payouts, and any compromise on that comes at a compromise in health care, not their profits. The entire industry as a whole sucks money out of the healthcare sector, diverting resources that could be used on getting better health outcomes for patients, and instead giving that money to insurance agents who find ways of denying claims.

There are no scare tactics, just pointing out exactly what happens to millions of people every day. Some of whom chose not to get health insurance because they'd rather spend the money on consumer items, some of whom cannot afford a health insurance plan, some of whom have insurance, but don't have a chance to actually find out whether it meets their needs until it fails to. That 75% of people that have insurance answer a survey question as to whether they are happy with it does not mean that we have a good insurance system, it just means that the vast majority of people never have major claims to have to wait on approval for. I had a friend that had insurance through work, and he thought it was pretty good, until he had a heart attack. He survived, they took him to the ER and did all that. But he also went bankrupt due to all the bills that were not covered by insurance. He lost his house, his car, everything he had.

Next time a survey like that is done, the respondents should give a copy of their policy to the surveyors, so that they can determine coverage. Explain exactly what that coverage would look like in a catastrophic situation, and ask them if they still like it. I bet we see a much lower satisfaction score.
  #282  
Old Yesterday, 08:31 AM
JB99 JB99 is online now
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Originally Posted by CelticKnot View Post
Many caregivers in the US will not accept Medicare or Medicaid. In many places, people who purchased plans under ACA discovered that not only was it not affordable, but no local medical providers or facilities would accept it. The plans they paid for became an albatross, because either they had to pay out of pocket or take a day off and drive long distances to see a doctor. If a single-payer system was implemented in the US, the scarcity issues we already have will become much, much greater. Many doctors will not be able to continue to practice because they can't function when the government underpays them. Whenever the government pays for healthcare, demand increases, because many people no longer have to concern themselves with costs and therefore want to see a doctor for every sniffle. How can the government address the scarcity? Rationing. Remember "Death Panels"?
I suppose the government will also try to increase supply of medical personnel by offering to pay for people's medical school and eventually, all the other programs, but that will mean young people will have to be willing to indenture themselves to government service for a long time.
And yet, every other civilized country in Earth has already figured out how to solve these problems. This means one of two things:

1) America’s health care problems are completely unique and no other country in the Western world faces the same problems we do.

2) America’s health care problems are not unique, but we’re just too stupid to implement the solutions that have already been proven to work in other countries.

So you tell me: Which is it? Countries like Britain, Canada, Germany, and Scandinavia have single-payer healthcare and - somehow, inexplicably - they have avoided or resolved all of the challenges you mentioned. Please. Tell me: Is America just that much sicker than other countries, or are they just smarter than us?

(PS: “Death panels?” Seriously? You’re actually repeating discredited claims sold to you by the second-stupidest human being to ever run for public office? Really? Here’s a tip: If it came out of Sarah Palin’s mouth, it’s probably a load of dogshit.)
  #283  
Old Yesterday, 10:04 AM
Northern Piper Northern Piper is offline
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Minor nit-pick: Germany is Universal Health Care, but not single-payer. It relies on a mixture of public insurance and private insurance. However, the statutory requirements for the insurance policies are so detailed (it is Germany, after all ) that the coverage is pretty much the same regardless of the insurance provider.
  #284  
Old Yesterday, 10:10 AM
Northern Piper Northern Piper is offline
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Originally Posted by survinga View Post
I'm sorry, but in the US, we don't need single-payer for many reasons. And one big one is to not put the entire system under the thumb of a goon like Trump.
As has been explained many, many times, single-payer does not necessarily mean it is under the control of the federal government (I appreciate that this thread began talking about Medicare expansion, which is a federal programme, but it's since morphed into a general discussion of health care).

You can have a system that has the general framework set out by the federal government, but the administration and payments are done at the state level. That's how Medicaid works, isn't it?

In other words, take advantage of the federal system, including the checks and balances that come from dividing tasks between the federal government and the state governments.

Plus, the President only has the power to make decisions about a system, as the current President has been doing with ACA, if the Congress gives him that authority. If there's a concern about giving too much discretion to the President, the statute need not do so.
  #285  
Old Yesterday, 10:15 AM
Northern Piper Northern Piper is offline
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Originally Posted by survinga View Post
Personally, I doubt that "Medicaid buy-in" will work. I don't want it in my state, for instance. I think a lot of doctors don't like Medicaid, and that's why only 70% take Medicaid patients. But I'm willing to sit back and see how that experiment goes if certain states want to try it. That's one good thing about our system. It's not efficient, but not everything is continent-wide. So, if a mistake is made in one state, it only affects that state.
Exactly. Design a single-payer system where the actual payments are made at the state level, and the regulation of the hospitals, doctors, nurses, etc is also at the state level, with the general public funding framework set by the federal government. That approach takes advantage of the role of the feds in setting national standards, but leaves the implementation, both of the payment system and the medical regulation, to the states, to implement to meet local condition.

Take advantage of the federal system, in other words, and don't have a system that uploads everything to the federal government. That can be done, and provide a single-payer system.
  #286  
Old Yesterday, 11:26 AM
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What?!? You mean actually leverage the uniqueness of the American governmental system in order to make things better? It'll never work!
  #287  
Old Yesterday, 12:30 PM
Northern Piper Northern Piper is offline
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Federalism isn't unique to the United States.
  #288  
Old Yesterday, 05:40 PM
wolfpup wolfpup is offline
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Quote:
Originally Posted by Northern Piper View Post
Minor nit-pick: Germany is Universal Health Care, but not single-payer. It relies on a mixture of public insurance and private insurance. However, the statutory requirements for the insurance policies are so detailed (it is Germany, after all ) that the coverage is pretty much the same regardless of the insurance provider.
Nitpick on your nitpick: You're correct, but JB99 is effectively correct, too.

Germany doesn't have single-payer in the technical sense that there are multiple regulated payers in the public system, not just one. The public system has a large number (somewhere around 120 or more) separate "sickness funds" constituting a "statutory", or public, insurance system (Gesetzliche Krankenversicherung). One might argue that these sickness funds aren't even "public" but non-governmental non-profits that might even be mistaken for US-style insurance companies. But they totally are not. The key difference is that they are highly regulated in every respect and they are community-rated, meaning that everyone pays the same and gets the same benefits. So the net result is a public system that works just like single-payer, and just happens to be structured differently.

Also, it's true that Germany has a mix of public and private insurance, but that needs some clarification because some here have tried to imply that such a "mix" means that public insurance must be terrible and there's a need for private insurance to supplement it. In fact, private insurance exists in Germany as a substitute, not a supplement -- mainly as an alternative to the public system. It's available only to those above a certain income bracket and subscribed by only about one-tenth of the population; of those who are eligible for it, most elect to stay with the public system.
  #289  
Old Yesterday, 06:56 PM
survinga survinga is offline
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Originally Posted by Northern Piper View Post
As has been explained many, many times, single-payer does not necessarily mean it is under the control of the federal government (I appreciate that this thread began talking about Medicare expansion, which is a federal programme, but it's since morphed into a general discussion of health care).

You can have a system that has the general framework set out by the federal government, but the administration and payments are done at the state level. That's how Medicaid works, isn't it?

In other words, take advantage of the federal system, including the checks and balances that come from dividing tasks between the federal government and the state governments.

Plus, the President only has the power to make decisions about a system, as the current President has been doing with ACA, if the Congress gives him that authority. If there's a concern about giving too much discretion to the President, the statute need not do so.
Medicaid is not single-payer, because state governments also are a payer, as well as the Feds. I think there are some private plans in Medicaid, too, where the recipient has to pay something in some states (maybe). Not as sure on how all that works. But in any event, no, it's not single-payer.

The only true single-payer we have in the US is Medicare for age 65+. That's essentially single-payer for the elderly.
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  #290  
Old Yesterday, 07:31 PM
survinga survinga is offline
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You know, at this point I have little patience left with this eternally ongoing argument. I just dropped in briefly to correct some very blatant factual errors.

If you're trying to suggest that the ratio of denied claims to paid claims is one in a million, I would inform you that it's more like 1 in 7 for employer health plans overseen by the Department of Labor, which one would expect to be among the best plans. In Vermont where ratios must be reported by law, Cigna reports denying more than 1 in 5 claims, MVP nearly 1 in 6. It's deceptive to suggest that claims denials are a rare occurrence. The Department of Labor employer-plan statistics alone show 200 million denials a year. There's a reason that medical costs are the #1 cause of personal bankruptcies in the US, even among those who thought they were well insured.


Well I'm sorry, too, since you still don't appear to understand how single-payer works. Look at all those terms you used:
  • CSR payments
  • price hundreds of thousands, if not millions, out of the exchanges
  • price millions more out of the exchanges
  • increase our uninsured population
  • work requirements on Medicaid recipients
Quite simply, none of those terms or concepts exist in single-payer. There are no insurance companies, no exchanges, no "prices" paid for coverage*, no uninsured. The whole concept is completely different than what I think your understanding is, if you're making comparisons like that.

Oh, and one more term that does not exist in single payer: "claim denial".

--
* In some provinces everyone pays a small annual fee, usually geared to income.
I think when we see "1 out of 5" or "1 out of 6", that should be taken with a grain of salt. Politifact busted an ad that over-stated the true denials rates, where they found data to support just a few %.

http://www.politifact.com/truth-o-me...rance-denials/

It's more than 1 in a million (I was exaggerating to make a point). But I think what gets accepted as a common number is overstated, and that's without even getting into the reasons.

Medicare is single-payer for the elderly, and they deny claims. You have said repeatedly that claim-denial doesn't exist in single-payer schemes, but that's not true at all. You should drop that as a talking point:

https://bottomlineinc.com/money/medi...laim-is-denied

As I've said repeatedly on this thread, my comments about Trump and his attacks on the ACA are an example of a government doing something to hurt people, in bad faith, in the healthcare arena. You correctly mention that these items impacted are not in single-payer systems. And that's exactly why I'm glad we don't have single-payer in the US. If we only had single-payer, and an idiot like Trump attacked it (he would attack it, because Obama liked it), it would hurt everyone, not just some. Our fragmented system limits the damage Trump can do to health insurance in the US, precisely because it's not single-payer. I think my point is pretty straight forward. I'm not sure why you keep arguing it, unless you're arguing against something I'm not even saying.
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  #291  
Old Yesterday, 09:45 PM
wolfpup wolfpup is offline
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Originally Posted by survinga View Post
I think when we see "1 out of 5" or "1 out of 6", that should be taken with a grain of salt. Politifact busted an ad that over-stated the true denials rates, where they found data to support just a few %.
Those rates came directly from insurers. Are you suggesting that where required by law to state denial rates, Cigna and other major insurers are lying about the true rates, and are actually overstating their own denial rates?

And that the Department of Labor is lying, too?

Come on, you've got to try harder! The thing that you debunked was a stupid TV ad that I never cited.
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Originally Posted by survinga View Post
Medicare is single-payer for the elderly, and they deny claims. You have said repeatedly that claim-denial doesn't exist in single-payer schemes, but that's not true at all. You should drop that as a talking point:
That combination of sentences bears no relation to anything I've ever said or to any reality on this planet. And I would ask you, first of all, to kindly not refer to my lifetime of experience with true single-payer as a "talking point". It is not a fucking "talking point" that I have never had a claim denied and never will have a claim denied under single payer. You know how I know? Because there's no fucking claims adjudication process with which to do so. When I see I doctor I get treated and go home. The billing to single-payer happens days or weeks later, the payment is completely automated, unconditional, and it has nothing to do with me. Do you think the doctor is going to later come after me for payment? If you think that, you are once again clueless about how single payer really works. Canadian doctors with some exceptions generally don't even HAVE patient billing systems, because they always get paid in full by the public system. It's an intrinsic, foundational part of how the system works.

Secondly, I've never claimed that Medicare doesn't deny claims. I know it does, though I believe the denial rate is much lower than private insurance. The root of your misunderstanding with Medicare is that "single payer" is a bit of a misnomer. It actually has less to do with how many payers there are than with how the system is structured: community-rated, universal, non-discretionary. That's why, as I noted above, Germany's public system is functionally single-payer even though it really has hundreds of payers, and Medicare functionally is not, even though it nominally only has one. The problem with Medicare is that it's inextricably mired with the totally fucked-up structural mess created by the private insurance system. Even Medicare Part A is entangled with private so-called "intermediaries", part B with private "carriers", and with others like QIOs, all of which meddle in the clinical process. It's a totally different system from the way true single payer works.
Quote:
Originally Posted by survinga View Post
As I've said repeatedly on this thread, my comments about Trump and his attacks on the ACA are an example of a government doing something to hurt people, in bad faith, in the healthcare arena. You correctly mention that these items impacted are not in single-payer systems. And that's exactly why I'm glad we don't have single-payer in the US. If we only had single-payer, and an idiot like Trump attacked it (he would attack it, because Obama liked it), it would hurt everyone, not just some. Our fragmented system limits the damage Trump can do to health insurance in the US, precisely because it's not single-payer. I think my point is pretty straight forward. I'm not sure why you keep arguing it, unless you're arguing against something I'm not even saying.
I'm going to be charitable and assume that you just didn't understand my point. With true single payer the way I've described it and the way I've lived it, there aren't a lot of levers for the government to pull, because all those awesome complexities that you keep mentioning don't exist and it's a simple "pay in full for all medically necessary procedures" principle enshrined in law. Other than foundational changes that would be political suicide, the only things evil governments could really do would be to reduce funding or delist covered services, and that, too, would be politically risky because in a UHC system everybody depends on them.

Your argument is also philosophically rather shallow. You appear to be saying that because governments can do bad things, or they can do good things and then undo them, that therefore governments shouldn't be relied on to do anything much at all. This is, frankly, a uniquely stupid attitude found almost exclusively in America, where suspicion of government is a sort of hallowed tradition, and nowhere else in the world, where governments can and do provide robust health care and social services and have been doing so for a very long time.
  #292  
Old Today, 06:26 AM
wolfpup wolfpup is offline
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Just a quick clarification: when I referred to Medicare Part A intermediaries and Part B carriers above, I was using outdated terminology. Since 2003 they've been called Medicare Administrative Contractors (MACs) but for purposes of this discussion the point remains the same. Here in fact is an outline of what they do, which includes "Determines whether the claim should be paid" and "Conducts redetermination on appeals for claims". This is necessary because the system is so staggeringly complex and so loaded with conditions and limitations and potentially intertwined with other payers.

True single-payer, as in Canada, is fundamentally designed to be the opposite. The Canada Health Act lays out five foundational principles for all the provincial health plans: public administration, comprehensiveness, universality, portability, and accessibility. "Comprehensiveness" simply and very significantly means that all medical procedures performed by doctors and hospitals must be covered if a doctor deems them medically necessary. It's a fundamentally different approach to health care that is simply unknown in private insurance, or in Medicare. It's not a "talking point". Significantly, it moves the responsibility for clinical decisions about your health care away from some faceless insurance bureaucrat or contractor, and empowers your doctor -- whoever is looking after you -- to decide what's best for you, regardless of cost.
  #293  
Old Today, 06:31 AM
survinga survinga is offline
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Quote:
Originally Posted by wolfpup View Post
Those rates came directly from insurers. Are you suggesting that where required by law to state denial rates, Cigna and other major insurers are lying about the true rates, and are actually overstating their own denial rates?

And that the Department of Labor is lying, too?

Come on, you've got to try harder! The thing that you debunked was a stupid TV ad that I never cited.

That combination of sentences bears no relation to anything I've ever said or to any reality on this planet. And I would ask you, first of all, to kindly not refer to my lifetime of experience with true single-payer as a "talking point". It is not a fucking "talking point" that I have never had a claim denied and never will have a claim denied under single payer. You know how I know? Because there's no fucking claims adjudication process with which to do so. When I see I doctor I get treated and go home. The billing to single-payer happens days or weeks later, the payment is completely automated, unconditional, and it has nothing to do with me. Do you think the doctor is going to later come after me for payment? If you think that, you are once again clueless about how single payer really works. Canadian doctors with some exceptions generally don't even HAVE patient billing systems, because they always get paid in full by the public system. It's an intrinsic, foundational part of how the system works.

Secondly, I've never claimed that Medicare doesn't deny claims. I know it does, though I believe the denial rate is much lower than private insurance. The root of your misunderstanding with Medicare is that "single payer" is a bit of a misnomer. It actually has less to do with how many payers there are than with how the system is structured: community-rated, universal, non-discretionary. That's why, as I noted above, Germany's public system is functionally single-payer even though it really has hundreds of payers, and Medicare functionally is not, even though it nominally only has one. The problem with Medicare is that it's inextricably mired with the totally fucked-up structural mess created by the private insurance system. Even Medicare Part A is entangled with private so-called "intermediaries", part B with private "carriers", and with others like QIOs, all of which meddle in the clinical process. It's a totally different system from the way true single payer works.

I'm going to be charitable and assume that you just didn't understand my point. With true single payer the way I've described it and the way I've lived it, there aren't a lot of levers for the government to pull, because all those awesome complexities that you keep mentioning don't exist and it's a simple "pay in full for all medically necessary procedures" principle enshrined in law. Other than foundational changes that would be political suicide, the only things evil governments could really do would be to reduce funding or delist covered services, and that, too, would be politically risky because in a UHC system everybody depends on them.

Your argument is also philosophically rather shallow. You appear to be saying that because governments can do bad things, or they can do good things and then undo them, that therefore governments shouldn't be relied on to do anything much at all. This is, frankly, a uniquely stupid attitude found almost exclusively in America, where suspicion of government is a sort of hallowed tradition, and nowhere else in the world, where governments can and do provide robust health care and social services and have been doing so for a very long time.
You said in #278 that "claim denial" does not exist in single payer. That's simply not true. You saying it over and over doesn't make it so.

https://www.reuters.com/article/us-c...8AC16F20121113

As for your last paragraph, I'm actually arguing for an increase in Medicaid coverage and for more subsidies. I'm not arguing for less government, but more government. You're misrepresenting my argument (again). I don't say, nor have I ever said, that government shouldn't be relied on to anything. I just think there are limits to what we need from our government in the US. I don't want Medicare for All. It's that simple. And I've explained my point on Trump many times. We're living through a real-life experiment of what happens when a demagogue is elected, and it's very ugly. It has real consequences. And the only reason he hasn't wrecked our entire healthcare system is that there are so many parts to it. He's focused on the easiest part to demonize, and he's going after it. I'm insulated from his wrath because I live in the private side of healthcare, not public.

I can explain all of these things to you, whether it be Medicare claim denials refuting your talking point on single payer, whether it be the Trump factor, whether it be that most people in the US like their healthcare. I can also repeatedly show that I'm not anti-government by advocating for a rounding-out of th ACA to what it was truly meant to be.

I can explain all of that. But getting you to understand it, or even admit if you do understand it, is apparently not possible.
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  #294  
Old Today, 06:34 AM
survinga survinga is offline
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Quote:
Originally Posted by wolfpup View Post
Just a quick clarification: when I referred to Medicare Part A intermediaries and Part B carriers above, I was using outdated terminology. Since 2003 they've been called Medicare Administrative Contractors (MACs) but for purposes of this discussion the point remains the same. Here in fact is an outline of what they do, which includes "Determines whether the claim should be paid" and "Conducts redetermination on appeals for claims". This is necessary because the system is so staggeringly complex and so loaded with conditions and limitations and potentially intertwined with other payers.

True single-payer, as in Canada, is fundamentally designed to be the opposite. The Canada Health Act lays out five foundational principles for all the provincial health plans: public administration, comprehensiveness, universality, portability, and accessibility. "Comprehensiveness" simply and very significantly means that all medical procedures performed by doctors and hospitals must be covered if a doctor deems them medically necessary. It's a fundamentally different approach to health care that is simply unknown in private insurance, or in Medicare. It's not a "talking point". Significantly, it moves the responsibility for clinical decisions about your health care away from some faceless insurance bureaucrat or contractor, and empowers your doctor -- whoever is looking after you -- to decide what's best for you, regardless of cost.
Doesn't matter. Medicare is single-payer. It denies claims. Period. End of story. It's just as much of a "true" single-payer as Canada, except it's limited to ages 65 and above. Your earlier talking point was wrong. Just admit it and move on.
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  #295  
Old Today, 07:22 AM
Magiver Magiver is online now
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Quote:
Originally Posted by SanVito View Post
I'm glad you picked up on these, because as someone who lives in the ultimate single payer system (UK NHS), I had not a clue what any of those terms meant.
And yet your PM felt it necessary to apologize for the delays in medical treatment.
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  #296  
Old Today, 08:17 AM
wolfpup wolfpup is offline
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Quote:
Originally Posted by survinga View Post
You said in #278 that "claim denial" does not exist in single payer. That's simply not true. You saying it over and over doesn't make it so.
That's correct, single-payer doesn't deny claims because it doesn't meddle in the doctor-patient relationship on a case by case basis. This is a very important feature of single-payer and most UHC systems in general. Medicare is completely different. Show me where I have ever, here or anywhere else, claimed that Medicare doesn't deny claims.
Quote:
Originally Posted by survinga View Post
Doesn't matter. Medicare is single-payer. It denies claims. Period. End of story. It's just as much of a "true" single-payer as Canada, except it's limited to ages 65 and above. Your earlier talking point was wrong. Just admit it and move on.
You'll recall that in #277 you stated "I'm sorry, but in the US, we don't need single-payer for many reasons."

You've repeated this frequently. For example, #132 "Keep in mind that I'm not arguing against what other countries do. Single-payer works great in many places. I'm just saying that the US could get to universal coverage without throwing out the systems we have."

Or how about #163 (emphasis mine): "But for the US (for many reasons I've laid out), I just want to keep what we have, and tweak the ACA to get us to our own version of UHC. I don't want single-payer. I want what we have ..."

So, you say again and again that you don't want single-payer, you want what you already have. But now you claim Medicare is single-payer!

You're clearly just playing games now and wasting everyone's time. You know and I know what is meant by "single-payer": a universal public health coverage system with non-discretionary coverage for all medically necessary procedures. Medicare as it exists today is nowhere even close to that, and you obviously know that.

I've spent a good deal of time presenting the facts and trying to educate you and I see that it was a complete waste of time. You clearly have no interest in arguing in good faith and just want to play stupid word games. I hope that other folks learned something, though, and will continue to do so. But I am done discussing this with you. If I happen to add anything further to this or any other thread please don't bother to respond as I will not be wasting my time with you further.
  #297  
Old Today, 08:56 AM
survinga survinga is offline
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Quote:
Originally Posted by wolfpup View Post
That's correct, single-payer doesn't deny claims because it doesn't meddle in the doctor-patient relationship on a case by case basis. This is a very important feature of single-payer and most UHC systems in general. Medicare is completely different. Show me where I have ever, here or anywhere else, claimed that Medicare doesn't deny claims.

You'll recall that in #277 you stated "I'm sorry, but in the US, we don't need single-payer for many reasons."

You've repeated this frequently. For example, #132 "Keep in mind that I'm not arguing against what other countries do. Single-payer works great in many places. I'm just saying that the US could get to universal coverage without throwing out the systems we have."

Or how about #163 (emphasis mine): "But for the US (for many reasons I've laid out), I just want to keep what we have, and tweak the ACA to get us to our own version of UHC. I don't want single-payer. I want what we have ..."

So, you say again and again that you don't want single-payer, you want what you already have. But now you claim Medicare is single-payer!

You're clearly just playing games now and wasting everyone's time. You know and I know what is meant by "single-payer": a universal public health coverage system with non-discretionary coverage for all medically necessary procedures. Medicare as it exists today is nowhere even close to that, and you obviously know that.

I've spent a good deal of time presenting the facts and trying to educate you and I see that it was a complete waste of time. You clearly have no interest in arguing in good faith and just want to play stupid word games. I hope that other folks learned something, though, and will continue to do so. But I am done discussing this with you. If I happen to add anything further to this or any other thread please don't bother to respond as I will not be wasting my time with you further.
Medicare is single-payer for people above age 65. That's a stone-cold fact, whether you like or not.

When I say I don't want single-payer for the US, I'm talking about the entire system. I don't want "Medicare for All".

I've been very consistent in what I'm been saying. And I've argued in good faith.

I'm fine if you don't want to engage any further. I'm tired of constantly correcting your misrepresentations of my arguments.
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  #298  
Old Today, 09:04 AM
Magiver Magiver is online now
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Quote:
Originally Posted by wolfpup View Post
I've spent a good deal of time presenting the facts and trying to educate you and I see that it was a complete waste of time. You clearly have no interest in arguing in good faith and just want to play stupid word games. I hope that other folks learned something, though, and will continue to do so. But I am done discussing this with you. If I happen to add anything further to this or any other thread please don't bother to respond as I will not be wasting my time with you further.
We've discussed in good faith our preference for on-demand health care yet you ignore the delays inherent with a UHS system.

Personally I don't understand this incessant need to inflict this on other people. It's great that the wealthy people in your country can afford to go outside the system and seek treatment in the US or other countries. We would prefer the same care afforded those people and we get that with private insurance.
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  #299  
Old Today, 09:40 AM
k9bfriender k9bfriender is offline
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Quote:
Originally Posted by Magiver View Post
We've discussed in good faith our preference for on-demand health care yet you ignore the delays inherent with a UHS system.

Personally I don't understand this incessant need to inflict this on other people. It's great that the wealthy people in your country can afford to go outside the system and seek treatment in the US or other countries. We would prefer the same care afforded those people and we get that with private insurance.
I have not see a single time that wolfpup has ignored your claims of delays. Every single time you have made these claims, they have been thoroughly debunked. That you ignore this and continue to make claims that have already been shown to be false is on you, not on him.

We do not have an on demand health care system, we have a healthcare system that is available to you when an insurance bureaucrat decided it is ready. I have had to wait for procedures for weeks waiting on the insurance company to approve a procedure before it could even be scheduled.

It's great that wealthy people of our country wanting elective procedures can afford to cut in front of the sicker people with less means who need life saving procedures, but some of us would prefer the same care afforded to those people, which we do not get with our system that puts profits over health outcomes.
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