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Thread: American healthcare

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    Default American healthcare

    It's really difficult to find an objective and comprehensive history of healthcare in the U.S., without it becoming a multi-chapter dissertation. Here's one from the NIH, and Here's another from the Kaiser foundation.

    For the purpose of this thread, this summary is perhaps a happy medium.

    From the last link:

    As the U.S. entered World War II after the attack on Pearl Harbor, attention fell from the publicly-provided health insurance debate. Essentially all government focus was placed on the war effort, including the Stabilization Act of 1942, which was written to fight inflation by limiting wage increases.

    Since U.S. businesses were prohibited from offering higher salaries, they began looking for other ways to recruit new employees as well as incentivizing existing ones to stay. Their solution was the foundation of employer-sponsored health insurance as we know it today.

    Employees enjoyed this benefit, as they didn’t have to pay taxes on their new form of compensation, and they were able to secure healthcare for themselves and their families.

    America’s entry into World War II also brought tens of thousands of workers pouring into the Henry Kaiser Shipyards in California, Washington, and Oregon, to meet the county's demand for warships.

    Facing the same issue he did with his dam project, of providing healthcare to more than 30,000 employees working in fairly remote areas, Kaiser once again contracted with Dr. Garfield (who President Roosevelt has to release from his military obligation) to organize and run a pre-paid group practice for these shipyard workers. This pre-paid arrangement of care would eventually become the Kaiser Permanente Health Plan, which would eventually evolve into our present-day managed care system of HMOs and PPOs.
    That portion of American health care history is usually cited as a pivotal moment, and (as noted in the last paragraph) became the "standard" system we have used since.

    Critics rightly point out that the problem with that system is that it "hides" the true costs of healthcare. Employees paid nothing, or a pittance, for their healthcare as compared to the costs. Very few people have any idea of what healthcare costs, until they get an astronomical bill from a hospital. The system worked, until it didn't. Democrats largely tried to implement healthcare reform, and Obama was successful at getting it done although at great cost in political capital.

    The Obama solution has solved very little, and republicans aren't interested in much but throwing it out with no real replacement. It's a wicked problem, and shouting hyperbole and buzz-phrases at each other certainly won't solve it; so let's try not to do that in this thread, please.

    I think there is merit to the "pivot" issue - that healthcare is one of the few (if not only) expenses the average American is completely ignorant of (myself included). You have no doubt what the cost of your groceries, utilities, mortgage, car payment, etc... is, but you go to a doctor and wait to see what you will end up owing - and are often shocked (and sometimes bankrupted) at/by the bill. 30 years ago my father was charged $1500/day for a hospital room. Just the bed space. A Tylenol was billed at $7.50 per pill. That's outrageous.

    One solution is nationalized healthcare, which has many problems which we can address. One is a return to the system we had before Obamacare, which also has problems we can address (namely that it is too expensive when not covered by an employer). A more recent trend is variations of a healthcare co-op. I can provide more information on that for those that need it.

    I'm not really sure how to present the question here. What is the "best" solution, and what are the pros/cons? What responsibilities does the individual have, and how do we get the citizen on board? There are reasonable options, and reasonable objections. Can we discuss those reasonably?
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    This LINK should provide a quick overview of the common healthcare models. Useful as a starting point I think.

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    Chip (December 13th, 2021), dneal (December 12th, 2021)

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    Default Re: American healthcare

    Quote Originally Posted by Empty_of_Clouds View Post
    This LINK should provide a quick overview of the common healthcare models. Useful as a starting point I think.
    It is indeed. Thank you.
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    When I lived in New Zealand, I was impressed by the healthcare and accident insurance system.

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    Default Re: American healthcare

    Also, for our international friends, an addition.

    It seems to me that the U.S. is a (if not the) global leader in pharmaceutical and treatment innovations, and that the profits are gained in the U.S. market. If that assumption is true (and please correct me if I'm wrong), do other beneficiaries (i.e. other first world nations) bear a responsibility for sharing those costs?

    The hypothetical drug Xanaduium is sold for $50 a pill in the U.S., but available in Canada for $15 for whatever reason (laws, international agreements, blah blah). I mention this because it is not uncommon to try to get this hypothetical drug through the Canadian market and import or smuggle it back into the U.S.
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    Not sure about that. If pharmaceuticals are researched and created by big pharma then I suspect it's just a market issue rather than being beholden to the US as a national entity. But I could be wrong. Not all drugs are available everywhere, and here in NZ we have an overarching agency called Pharmac (Pharmaceutical Management Agency) which negotiates (I believe) on new drugs and also stipulates which drugs get govt. subsidies applied to the consumer cost.

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    Default Re: American healthcare

    In the US, the drug industry pours so much money into lobbying and bribes (aka campaign contributions) that Medicare is not allowed to negotiate costs and private insurers are discouraged from doing so. While Republicans are the biggest recipients of bribes (aka donations), there are quite a few Democrats with their snouts in the trough.

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    dneal (December 13th, 2021)

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    Default Re: American healthcare

    Chip hits on one of the key problems (and not just in healthcare) - lobbyists. There's a reason the richest counties in America are just outside of D.C. Loudon and Fairfax counties in Virginia (#1 and 3) are wealthier than the tech regions of California (Marin and San Francisco counties, #13 and 14). Apple, Alphabet, Microsoft, Amazon and Facebook, the top 5 richest companies in the world; don't have the regional economic impact that the U.S. Federal Government does.

    The problem isn't just the political graft, but the crafting of bills. Congressmen and Senators don't write bills. Their staffs usually don't write bills. Teams of lawyers from various industries do. This was a large problem with Obamacare - it was written by the people with the largest incentive (not counting citizens/taxpayers). Pharma, insurance companies, etc...

    To EoC's point on Big Pharma and markets... exactly. There is a lot of money spent (and lost) developing drugs. Those costs have to not only be recouped but there also needs to be a profit if they're to survive. Most people who visit the U.S. are surprised at the number of drug commercials we have on TV. You rarely see that abroad, and it was always a shock and source of humor for the wife and I after a tour in Germany when we were insulated from that for 3 years. Want a miracle cure for minor annoyance X? We've got a wonder drug for that. Ask your doctor about it. Side effects include: explosive diarrhea, projectile vomiting, bleeding from the eyeballs, seizures, and occasional death. 10 years later, there's a class-action lawsuit and lawyers are inundating the airwaves with the "did you or a loved one experience something from said former wonder drug? You may be entitled to compensation..." It's insane.

    And to come full circle to Chip's point, the regulatory agency that approves these drugs receives nearly half of its funding from the companies that produce the drugs, via "user fees".
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    I can only speak for my experience, I worked for a local supplier straight commission in the '70's and it seemed the insurance was affordable. THen later with a large pharmaceutical company where we had a good family policy. Honestly never heard people complain.

    Those that got approved for Medicaide probably had access to the best healthcare because everything was covered. If you're retired military Tri-Care appears to be one of the best.

    Generic pharmaceuticals are very affordable and paying cash for a 10 course of antibiotics possible using older agents.

    Even later with healthcare agencies I had decent insurance experiences. The least popular with me was the ACA, but I came to appreciate because it alllowed annual checkups and the companies had to cover pre-existing(s).

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    Default Re: American healthcare

    The best solution, from the individual's vantage point, is to get elected to Congress. Members of Congress & their families have the best and most comprehensive healthcare imaginable. And, to the best of my knowledge, it continues after they leave Office.

    Of course, that is not the best solution from a population vantage point. Providing the kind of healthcare they get to all US citizens would likely result in healthcare cost comprising about 85% of our GDP.

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    Default Re: American healthcare

    So what system is advocated? What are the benefits and drawbacks?

    EoC's link categorizes pretty well. There are other market ideas, like Co-ops, Direct Primary Care, Association plans, etc...

    Direct care, where doctors only accept direct payment from individuals has the advantage of transparent pricing, better service, and reasonable cost. $150/month or so for a family plan that covers the majority of preventative and routine care. The problem is when you need a larger facility, and the equipment they bring. Surgeries, MRI's, etc... Some direct care physicians have discounted rates arranged for their patients, you can purchase "regular" healthcare insurance for those larger issues, etc...

    It solves the administrative cost problem, and makes routine care affordable; but doesn't account for more serious problems.
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    Fly and Covid vaccines are either covered or free. Hard to complain about healthcare if it’s free and you won’t take it.

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    Default Re: American healthcare

    Chuck, we disagree on some things. We've reached an impasse on those things. Neither of us owes the other an explanation why we have come to our individual conclusions, and continued gibes benefit no one; particularly in new threads. Please don't derail this one.
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    My comments are directly related. Don’t read or put me on your ignore list if it bothers you so much.

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    Default Re: American healthcare

    Ok Chuck.

    What system do you advocate? What are the benefits and drawbacks?
    "A truth does not mind being questioned. A lie does not like being challenged."

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    Default Re: American healthcare

    Quote Originally Posted by dneal View Post
    Ok Chuck.

    What system do you advocate? What are the benefits and drawbacks?
    Medicare for all with supplements available.

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    Default Re: American healthcare

    I'd also propose a consumer protection agency to oversee both the drug industry and healthcare in general. I've seen several articles that compare the cost of a common surgical procedure at different hospitals, with a wide variation. Part of that owes to the rise in private for-profit hospitals and part to overcharging (and simple greed) among doctors. People who are ill and need care don't usually shop around.

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    Default Re: American healthcare

    How much should I get paid to do a carpal tunnel surgery Chip?

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    Default Re: American healthcare

    Quote Originally Posted by Richardtractorguy View Post
    How much should I get paid to do a carpal tunnel surgery Chip?
    How about $150?

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    Default Re: American healthcare

    You have to provide your own sutures.

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