"As a specific example the CRISPR-CAS9 study that examined whole Genome editing was conducted through a U.S institution (yes other countries had done other research with other aspects before this, but they didn't conduct this specific study), and I would think it received some funding from some U.S sources. That single study is already and will lead to the greatest changes mankind has ever seen."
I'm a little confused what this has to do with what we're talking about... did this study happen because we have private insurance and profit motives? Or just because the United States spent money on research? Which of course I'm not opposed to...
"I do generally agree though that private insurers are inefficient and have high administrative costs because it benefits their bottom line, and protects them legally. This is a large part of problem that causes high healthcare costs."
This is the main reason why I think that our current system just philosophically is not a good idea.
"To your point that healthcare being free at point of service would reduce the incidence of preventative disease, is a great talking point, but in practice is flawed, and has either already been disproven, or would simply not work. How? Because for years preventive care has been at the forefront of healthcare, but not much has changed, and thus to think that somehow something drastic will come about when people are covered under a universal system is just not the case."
How can we say this has honestly been tried when many people cannot afford a 400 dollar emergency, copays can range from 20-75 dollars, and deductibles can reach in the thousands of dollars? All of these things completely disincentivize people from getting care at early stages.
"Presence of chronic disease does not necessarily correlate with disease severity or relative amounts of money spent on care, it just indicates that those people qualified as having had the disease. I do agree that better care is afforded to those that can pay for it, but how is that a bad thing, that people with money can spend it on themselves to improve their health? And what do you consider preventative care because I believe that to be an issue more related to education, and personal choices/culture/environment than it does to healthcare."
Of course people with money can spend money on themselves, that makes sense. But what I am getting at is your implication that the vast amounts of money and resultant outcomes in america are due to patients' poor overall health rather than the nature of our healthcare system. And yet, when you look at people with the most chronic diseases (proxy for overall health), we see that their overall health is not as bad as we would think when compared to those with less chronic diseases, implying that there must be something else resulting in the observations we have. As a result, I think it makes sense that, even with relatively poor health, changing the healthcare system to give everyone the benefit that those of higher socioeconomic status have currently would result in improved outcomes.
"Have you experienced any clinical medicine, or studied any pathology or epidemiology? It is very well know that minorities are at risk for several preventable disease simply due to genetics. As an example, African Americans are at risk for cardiovascular disease, and this predisposition is worsened when you put that individual in an environment where a Western diet is followed."
I am aware of this but I still believe that our insane healthcare spending is not due to the increased likelihood of disease of a small percentage of our population, and rather due to the nature of the system itself.
"You say this as if vast swathes of people are unable to see a PCP. Can you be more specific and provide data for what you mean?"
Poll: 44% Of Americans Skip Doctor Visits Because Of Cost
In particular though I am talking about those who can afford to see a physician BUT cannot see the one they prefer because they were out of network, etc. This can happen all the time and all the fragmentation from insurance agreements, in network/out of network drastically cuts down on actual competition and free choice that could result in better service and preferred choices.
"Under a universal system, you would literally have no choice, and unlikely any options to change if you were not happy."
Who would have no choice? Physicians or patients? Physicians could opt out although that probably wouldn't make a lot of sense, but patients would be able to see nearly any physician they wanted without fear of insurance agreements, in network status, etc. It would be the ultimate choice for patients.
"What? That not how billing works. This is not even an argument you are making, it literally just a random comment."
What are you talking about? For instance, if you are out of network, you choose the amount that you bill the insurance company. Not that you're going to get that of course, but you can send it. And there is nothing stopping one surgeon from valuing their services at 25k and another at 30k. And then of course the negotiation begins. I worked at a private practice that changed prices all the time based on what they thought they could get away with.
"I'm a little confused what this has to do with what we're talking about... did this study happen because we have private insurance and profit motives? Or just because the United States spent money on research? Which of course I'm not opposed to..."
This issue here that I'm trying to point out is that the method and systems in place that allow for such research to be conducted would be drastically changed, and for the worse under the system you are espousing. Just like what happened with NASA, funding would become tightly controlled, and the R&D the U.S is so well respected for would be dismantled as soon as it is realized that there is not enough money to support such a system.
"This is the main reason why I think that our current system just philosophically is not a good idea."
Looking at the information from
@sb247 's article, here is a quote the explains why your information is misleading
“Medicare’s administrative cost percentages look illusorily low in large part because they are percentages of per-capita expenditures that are atypically high, relative to those seen in the private sector,” said Charles Blahous, a former public trustee for Medicare and Social Security. “Seniors have higher health expenditures per capita than the younger individuals insured in private sector plans. Thus, the lower administrative cost percentages in Medicare don’t by themselves imply that extending a Medicare-style system to participants of all ages would produce a system with similarly low administrative costs. In fact, one can predict fairly certainly that wouldn’t be the case.”
I still agree though that administrative costs are playing a huge role in the cost of healthcare, and I think I can say confidently that most people here, would agree. But to suggest that universal care will fix the problem is just false, disingenuous, and is just being used as a way to trick people.
"How can we say this has honestly been tried when many people cannot afford a 400 dollar emergency, copays can range from 20-75 dollars, and deductibles can reach in the thousands of dollars? All of these things completely disincentivizes people from getting care at early stages."
@VA Hopeful Dr 's post shows an article that suggests that even more access does not change physical health outcomes, which obviously means there would be relatively little change in a majority of preventable disease. That same article does suggest some improvement in particular mental health issues, but when you factor in the rationing of care in a universal system, I again doubt that access would increase, and in fact would have a negative impact on most health measures. The question is why was that the case? The answer comes back to the fact that in many cases, health outcomes are the direct result of the patients choices, or societal/environmental influences. While anecdotal, I've been guilty of this myself.
You still haven't completely addressed this point, and I'm waiting for you to show me evidence that this is not the case. Btw, when I say the patients choices, I recognize that it is not always a choice, or they have not received proper education on a particular issue, which is more the fault of our education system (run by gov cough cough) than their lack of self care.
"Of course people with money can spend money on themselves, that makes sense. But what I am getting at is your implication that the vast amounts of money and resultant outcomes in america are due to patients' poor overall health rather than the nature of our healthcare system. And yet, when you look at people with the most chronic diseases (proxy for overall health), we see that their overall health is not as bad as we would think when compared to those with less chronic diseases, implying that there must be something else resulting in the observations we have. As a result, I think it makes sense that, even with relatively poor health, changing the healthcare system to give everyone the benefit that those of higher socioeconomic status have currently would result in improved outcomes."
This argument has too much fluff. The problem stems from the fact that our education system fails at teaching children how to properly take care of themselves nutritionally and physically.
If you want my take on it, the way to fix our system going forward is to
#1 ensure all children from ages 0-18 receive FREE
comprehensive health coverage using a very similar model to MEDICARE. After that they would get a 1-2 year buffer period to get coverage, by getting a job, through their parents, through their college, through the military, etc. This would foster better self care, prevent early bad habits, and lead to an overall positive influence in all aspects of U.S life. This also would not be as ridiculously expensive as what you are proposing.
Please note though, that I am only for this plan if government stays out of the actual healthcare process and medical decision making process, where they have no right to be making any decision for a patient (obviously emergency and life saving situations excluded where children SHOULD be saved no matter what.) Under this system parents should still be able to choose a private plan for their children if they wish, and if they did they would receive a slight benefit of some sort. Of course, this would result in an influx of patients, and training of Pediatric/Family Physicians would have to increase to meet the demand, but thats a whole other topic.
If you look at studies only ~8.4% of ALL healthcare spending goes towards treating children. (
Spending on Children’s Personal Health Care in the United States) It doesn't take much to realize that the major issue issues in healthcare must therefore start in childhood, and the causative factors are lack of education on self care, early intervention,
#2 Keep the current overall framework, with some obvious fixes in administrative costs, reduction in stringent regulations, reduction in drug prices, reduction in corporatization of medicine, and a return to where Healthcare providers are in charge of running Medicine.
ADULTS SHOULD PAY FOR THEMSELVES, and while Medicare and Medicaid should stay in place for adults, just because an adult is negligent in their self care, other adults should not have to pay for it.
That is why I see your plan as as wrong, because it puts in place an action that does not focus on the root problem, and only worsens the problem by spreading resources thin.
If someone has a study on why free care for children would not work, I'd also be happy to read it to understand why.
"I am aware of this but I still believe that our insane healthcare spending is not due to the increased likelihood of disease of a small percentage of our population, and rather due to the nature of the system itself."
I've addressed this issue and don't see us agreeing. Again I feel the major costs of healthcare are hugely due to preventable disease, in all races, and all socioeconomic class, but obviously at differing rates/severities/costs. To suggest preventable disease is not the driving cause in the high cost of healthcare is to completely ignore the data.
"Poll: 44% Of Americans Skip Doctor Visits Because Of Cost
In particular though I am talking about those who can afford to see a physician BUT cannot see the one they prefer because they were out of network, etc. This can happen all the time and all the fragmentation from insurance agreements, in network/out of network drastically cuts down on actual competition and free choice that could result in better service and preferred choices."
I've also addressed this comment by citing other posters on this forum. While what you post might be true, even when costs is taken out of the equation, health measures do not change given increased access.
"Who would have no choice? Physicians or patients? Physicians could opt out although that probably wouldn't make a lot of sense, but patients would be able to see nearly any physician they wanted without fear of insurance agreements, in network status, etc. It would be the ultimate choice for patients."
This is not the case because under such a system, as I've mentioned many times, drained resources and lack of providers would prevent any actual benefit.
You can look at the failures of the NHS in U.K to understand this issue, and especially how many people who are less educated and do not have money have very little choice, and when they are given a choice, they are unable to determine if it is better to get one service over another, because there is so much complexity in care.
"What are you talking about? For instance, if you are out of network, you choose the amount that you bill the insurance company. Not that you're going to get that of course, but you can send it. And there is nothing stopping one surgeon from valuing their services at 25k and another at 30k. And then of course the negotiation begins. I worked at a private practice that changed prices all the time based on what they thought they could get away with."
Yes but they are not randomly throwing a dart at a board and saying "Ohhhh dammmm it hit 30k" or "Crap it hit 10k". You yourself said in not so many words that those practices charged based on what they legally thought they could, so essentially based on what they did with the patient. How would these billing practices be curtailed in your universal care plan?
The answer is that they wont, and practices will conform to the new rules, but just still bill the maximum they can for the work they do. The difference is that the government won't be able to deny them payment like insurance can, and you might actually see a rise in costs. Why do you think many Physicians are pro-Single payer? Because they get more money out of it.
And before you answer to this point, I can already predict that you counter will be that the prices will be negotiated down, but that will be based on false numbers that would not account for the decrease in denied payments, and actual real costs of everyone being covered. This would also lead to a collapse of the system, the shuttering of many community hospitals and clinics, people loosing work secondarily, Providers not working because they aren't getting paid, and in the end a complete failure of all of Healthcare. The U.K is not too far from this scenario.
