Yeah of course, lifestyle, location, vocation etc
Same as here in Ireland except the level of care goes up quite a bit with private , public system can be rough, you also are not entitled to a medical card, dependant on means.
Society Why America is missing a great opportunity with Bernie
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Same as here in Ireland except the level of care goes up quite a bit with private , public system can be rough, you also are not entitled to a medical card, dependant on means.
You still have to pay the tax though, so technically it isn't free at any stage.
What's insurance cost you per year?
and you guys get mad at me for changing my name
lmao this is a mess
Most of the threads make about as much sense as this to me now...
View: https://youtu.be/aW2LvQUcwqc?t=41
lmao this is a mess
Most of the threads make about as much sense as this to me now...
View: https://youtu.be/aW2LvQUcwqc?t=41
The gist of it is people with fuck all don't pay and the tax payers foot the bill, insurance premiums go up for those same tax payers who get screwed twice.
Thats the fear?
But Sanders reckons he can somehow keep the price under what most Americans pay currently and still offer a public system that doesn't cripple low and middle income earners if they fall ill.
Where does that money come from?
Currently the prices for procedures and insurance can't be where the are purely based on greed.
Thats the fear?
But Sanders reckons he can somehow keep the price under what most Americans pay currently and still offer a public system that doesn't cripple low and middle income earners if they fall ill.
Where does that money come from?
Currently the prices for procedures and insurance can't be where the are purely based on greed.
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I was in the same boat Johnno, thats why I said fuck it I will join the madness.
He is not taking bernies super tuesday failure very well
Many countries have anti-competition laws to prevent private competition. That is the crux of most people's problem with the Medicare for all push. Canada is an example of this kind of anti-private insurance environment.
On the other hand countries like Germany have a vibrant private and public marketplace. This is very similar to what Obama was originally pushing with a public option and Pete butti(so????) Was also pushing. Bided has signaled interest in this.
As an employer give me anything. Offload this responsibility from me so that it doesn't hit my bottom line. As somebody who has had private insurance for most of my life, I've consistently had better insurance than is being offered by Medicare for all. On top of this most of America had better insurance. The nightmare compromise of Obamacare with the Republicans led to requirements but limited subsidies....it was kind of the worst of the Republicans and worst of the Democrats put together. There are a few broadly popular options like not being able to stop people with pre-existing conditions. But at the end most people that fall in the registered voting class saw their deductibles go up and their coverage go down. Now go tell those same people that we should go bigger with what they just did. They are rightly suspicious.
You mentioned depending on how long wait. This seems a nod towards having a public system and a private system. This is actually what killed Hillary Care in the '90s. We would have probably had a universal system but one of the sticking points was whether everybody had to participate or if you could opt out and only be part of a private system as a physician or hospital. Many countries offer a two-tier system like this and there's lots of pros and cons and many people will argue about the ethical compromises. I don't personally see a problem with it and view it very much like the post office versus FedEx but that's just me. Regardless that's not exactly what's being put forward.
Insurance companies do in fact have some profit margin built in. That can often be about 15%. But there's all this other stuff that's much bigger. I will highlight some pieces if I don't want to be clear that I'm not trying to give a total answer because it's many many pieces and much longer than a post can do. Again full degrees based on this stuff.
Average waste in the United States system is potentially 25 or even 33%. This isn't just me as a doctor coming in and being sloppy. A new patient shows up to me and I need information about a scan they've had done in the past. I make a records request to the previous hospital and never get a response. The patient and I have a visito or two and I explain that I still don't have the previous records and we'll need to do that CT scan or MRI again. This patient is now going to have $1,000 item All because of bad communication between different parties. To me I view this as a failure of nothing but technology. For me to proceed helping this patient I have to spend some more money on the system that I never wanted to. And maybe that patient has seen me once or twice where I just simply explained I'm still shooting in the dark. Are those also wasted visits? In a way I think so.
Then there's a bunch of anti-competitive laws that have come into place thanks to hospital lobbying.
Hospitals have something called facility fees. This is made to pay nurses in the room and all the sterilization and whatnot. If I do a colonoscopy in my office I can charge $600. I will have to pay my staff and my overhead and all the stuff out of that. Take home will be about 300 bucks. if I do that same colonoscopy in a hospital the cost will be closer to 1800. The physician fee will still be about $300. But now that will be about $1,500 of other fees and you can get the anesthesiologist to come over and sedate your patient instead of using a nurse. Some patients need this but not all of them. Oh the anesthesiologist has to charge their fee too. If you're the one doing the colonoscopy this is great. you don't have to worry about anything the patient's extra sedated you just rock and roll and move quickly. But the system just paid a lot more. This is just a microcosm of facility fees and cost differences in incentives on why things get pushed into the hospital system which is very expensive.
When Obamacare came along there was a push, very happily by hospitals I'm sure, to create regional monopolies. you will see this in your local hospitals where it seems like all the hospitals just bought up each other all of a sudden. The thought was that this would create economies of scale and lower the overall cost. Instead this was pretty terrible for physicians and patients. You could have a private practice that's doing well, but if a hospital purchases you they can then charge more for the exact same work. The government insurance laws view a hospital owned clinic, even 50 miles away from the main campus, as part of the main hospital. As such they get to charge extra money. So you're a private practice physician offering a good deal. You're making a salary. The hospital purchases you and they can give you a bigger salary because they can charge more. You cannot compete against this forever. So everybody started selling their practices. But at the end of the day same practice, same physician working there, suddenly the insurance can get billed higher.
Here's my disclaimer: I support a public option. If insurance companies can't compete then move over to the public side. If they can compete keep your insurance that might give you Cadillac healthcare. I believe this is a much better system then forcing everybody to take and pay for a Medicare system and then hopefully not have laws preventing too many supplemental plans (hi Canada). I do not think it's immoral to prevent somebody from spending more money on their own health care if they want to. I also am against giving poor people rot gut health care like we currently do with Medicaid.
No matter which system we pick the biggest barrier that I have is a physician is sharing information universally. Many privacy advocates do not want this to happen. Countries like Taiwan allow portable medical records with secure card access.again there has to be a great technology fix here that can find a balance between privacy and efficiency. I am not as good of a doctor as I could be if I had access to everybody's previous records in a useful and organized fashion. Our electronic medical records look like the freaking Stone age and they do not usefully communicate to each other. And when I do get records it's a bunch of laborious convoluted mess because of lawyers and insurance obligations for billing (these obligations and requirements are set by Medicare and followed by everybody else). The actual useful medical data in these records is often a minority of the text on the screen.
Oh yeah and then there's laws like Medicare not being allowed to negotiate drug prices even though they are the largest purchaser of drugs...what??? Almost like the pharmaceutical lobby asked Congress to write them a blank check
On the other hand countries like Germany have a vibrant private and public marketplace. This is very similar to what Obama was originally pushing with a public option and Pete butti(so????) Was also pushing. Bided has signaled interest in this.
As an employer give me anything. Offload this responsibility from me so that it doesn't hit my bottom line. As somebody who has had private insurance for most of my life, I've consistently had better insurance than is being offered by Medicare for all. On top of this most of America had better insurance. The nightmare compromise of Obamacare with the Republicans led to requirements but limited subsidies....it was kind of the worst of the Republicans and worst of the Democrats put together. There are a few broadly popular options like not being able to stop people with pre-existing conditions. But at the end most people that fall in the registered voting class saw their deductibles go up and their coverage go down. Now go tell those same people that we should go bigger with what they just did. They are rightly suspicious.
You mentioned depending on how long wait. This seems a nod towards having a public system and a private system. This is actually what killed Hillary Care in the '90s. We would have probably had a universal system but one of the sticking points was whether everybody had to participate or if you could opt out and only be part of a private system as a physician or hospital. Many countries offer a two-tier system like this and there's lots of pros and cons and many people will argue about the ethical compromises. I don't personally see a problem with it and view it very much like the post office versus FedEx but that's just me. Regardless that's not exactly what's being put forward.
There are entire books built on this and in fact a degree in public health only starts to scratch the surface of all the answers.
Insurance companies do in fact have some profit margin built in. That can often be about 15%. But there's all this other stuff that's much bigger. I will highlight some pieces if I don't want to be clear that I'm not trying to give a total answer because it's many many pieces and much longer than a post can do. Again full degrees based on this stuff.
Average waste in the United States system is potentially 25 or even 33%. This isn't just me as a doctor coming in and being sloppy. A new patient shows up to me and I need information about a scan they've had done in the past. I make a records request to the previous hospital and never get a response. The patient and I have a visito or two and I explain that I still don't have the previous records and we'll need to do that CT scan or MRI again. This patient is now going to have $1,000 item All because of bad communication between different parties. To me I view this as a failure of nothing but technology. For me to proceed helping this patient I have to spend some more money on the system that I never wanted to. And maybe that patient has seen me once or twice where I just simply explained I'm still shooting in the dark. Are those also wasted visits? In a way I think so.
Then there's a bunch of anti-competitive laws that have come into place thanks to hospital lobbying.
Hospitals have something called facility fees. This is made to pay nurses in the room and all the sterilization and whatnot. If I do a colonoscopy in my office I can charge $600. I will have to pay my staff and my overhead and all the stuff out of that. Take home will be about 300 bucks. if I do that same colonoscopy in a hospital the cost will be closer to 1800. The physician fee will still be about $300. But now that will be about $1,500 of other fees and you can get the anesthesiologist to come over and sedate your patient instead of using a nurse. Some patients need this but not all of them. Oh the anesthesiologist has to charge their fee too. If you're the one doing the colonoscopy this is great. you don't have to worry about anything the patient's extra sedated you just rock and roll and move quickly. But the system just paid a lot more. This is just a microcosm of facility fees and cost differences in incentives on why things get pushed into the hospital system which is very expensive.
When Obamacare came along there was a push, very happily by hospitals I'm sure, to create regional monopolies. you will see this in your local hospitals where it seems like all the hospitals just bought up each other all of a sudden. The thought was that this would create economies of scale and lower the overall cost. Instead this was pretty terrible for physicians and patients. You could have a private practice that's doing well, but if a hospital purchases you they can then charge more for the exact same work. The government insurance laws view a hospital owned clinic, even 50 miles away from the main campus, as part of the main hospital. As such they get to charge extra money. So you're a private practice physician offering a good deal. You're making a salary. The hospital purchases you and they can give you a bigger salary because they can charge more. You cannot compete against this forever. So everybody started selling their practices. But at the end of the day same practice, same physician working there, suddenly the insurance can get billed higher.
Here's my disclaimer: I support a public option. If insurance companies can't compete then move over to the public side. If they can compete keep your insurance that might give you Cadillac healthcare. I believe this is a much better system then forcing everybody to take and pay for a Medicare system and then hopefully not have laws preventing too many supplemental plans (hi Canada). I do not think it's immoral to prevent somebody from spending more money on their own health care if they want to. I also am against giving poor people rot gut health care like we currently do with Medicaid.
No matter which system we pick the biggest barrier that I have is a physician is sharing information universally. Many privacy advocates do not want this to happen. Countries like Taiwan allow portable medical records with secure card access.again there has to be a great technology fix here that can find a balance between privacy and efficiency. I am not as good of a doctor as I could be if I had access to everybody's previous records in a useful and organized fashion. Our electronic medical records look like the freaking Stone age and they do not usefully communicate to each other. And when I do get records it's a bunch of laborious convoluted mess because of lawyers and insurance obligations for billing (these obligations and requirements are set by Medicare and followed by everybody else). The actual useful medical data in these records is often a minority of the text on the screen.
Oh yeah and then there's laws like Medicare not being allowed to negotiate drug prices even though they are the largest purchaser of drugs...what??? Almost like the pharmaceutical lobby asked Congress to write them a blank check
Tldr...not really...
So why do we cost so much?
because hospital systems wanted to cost a lot because they make a lot of money doing that. The laws are set to enlarge them and shut out anyone that doesn't own a hospital system.
insurance companies that are for profit have a shareholder model instead of a stakeholder model and some money is siphoned off into the stock market. But they're not the only devil. Insurance companies including Medicare have a goal to keep prices down because that allows them to offer a more competitive product. Insurance companies do not want health care to be expensive. they just want to charge as much overhead on top of it as they can. Cheaper healthcare means they can keep more in their pocket. Hospitals do want it to be as high as can be charged to the insurance companies. Doctors want our professional fees to be as high as we can get too but doctors professional fees are a significant minority of the entire healthcare pie (about 13% overall). I would make just as much and maybe a little bit more if I worked in Canada. Many of my specialist colleagues would make less but overall you could cut off 33% of Dr pay and you would still have only saved about 4% of healthcare cost while dramatically increasing physician shortage.
Potentially as much as twice the profit from private insurance companies is the cost of "waste". To me this seems like the no-brainer. Some people think 33% overhead due to inefficient communication bad information technology and extra test due to a litigious environment. We repeat soooooooo much stuff it's nuts.
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You have no idea the mad house it is trying to get patients care they need.
Unless your Medicare for all is going to suddenly switch the way Medicare (and pretty much all insurances) currently blocks referrals and drugs, it won't help the overhead. You need a technology fix here.
Sometimes my nurse is calling 10 or 15 different people and the insurance company just to find somebody who will both take the patient's insurance and is accepting new patients. Really...this is done like this?!! we can't just click it in an efficient system and have it move forward?
I will order a generic drug and the insurance companies will block it because they only pay for the tablet and I ordered the capsule. Instead of sending me an easy to read message that says you've ordered this and here are the same class of drugs that we cover, I receive a 4-5 page fax full of legal mumbo jumbo and a web link for my nurses to go online to find out what drugs are covered. Only to find out that it's tablet versus capsule which takes 5 seconds of my thinking to resolve but took 20 minutes of my nurse's time.
It was bout the wall of text
I actually do have an idea, I have heard my Dad, his Brothers, and my Father in Law(all doctors) talk about it a lot.
My Gif was just because you made a wall of text that would make knee block blush...No disrespect intended.
It is beyond ridiculous IMO...That shit would frustrate me to know end...Makes me glad I am the boss, book keeper, Grunt, and Foreman of my own business.
I simply could not and would not deal with that type of illogical system and stay sane...I am patient, but not that patient.
And I posted a Video outlining most of what you typed a few days ago from Dr. Shiva...Medical system is crazy town
I read it man, I was hoping you'd answer my question.
I am half cut but I understand what you are saying, ish.
The system seems to be broken, greed being a factor with the monopolies that have been created by hospital systems
along with the insurance companies capitalising on the inefficiency in communication and the pharma companies selling at what ever rate they want to the governments own healthcare system, how did congress get bent over by the pharmaceutical companies like that is the main question there.
So how do fix the broken bloated system, it sounds like an overhaul of patient data storage is needed both in access and in how the data is actually stored for a start, but removing all the gouging that is going on seems to be impossible.
What is Bernies plan, throw more money at it. Edit, this is a stupid statement and a different conversation, you already answered that question and I should do my own research.
Nice one for the breakdown
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Great to see you finally come around mate. I understand you didn’t take advantage of all the higher education opportunities but I can tell this hasn’t stopped you from winning in life.
plus you don’t need to be a doctor to understand that if something has been sucking for 40 years and doesn’t generate nothing good then it must be changed.
plus you don’t need to be a doctor to understand that if something has been sucking for 40 years and doesn’t generate nothing good then it must be changed.
Unrelated but have you ever had anyone OD on your boat during a sex party?
Splinty does it himself all the time. That's why he keeps a boat load of Narcan.
M
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He told me that on the yacht alone he has given at least 7 adrenaline shots to the heart, Pulp Fiction style.
Sounds like he has been partying with ed buck
How many folks you got up there in Canada?
Zero spatial awareness. Obviously demented.