The health care industry is bound to collapse soon, experts say

[pgg]

We can't tax income, we can't tax estates, and now we can't tax unnecessary products like cigarettes and soda. What the heck can we tax?

First, a distinction can and must be made between different "unnecessary products" -

Sin taxes are intended to engineer behavior, and raise money on the side. They target the poor. Luxury taxes are intended to raise money. They target the wealthy. Surely you can see the fundamental difference between the two, even though both are a tax on "unnecessary products".


Income taxes are OK. Property taxes are OK too, though they ought to fund local infrastructure and little if anything else.

What should we tax? Transactions are probably the best overall option, but care must be taken to not make them too regressive.

---

Members don't see this ad.

 

[psychbender]

The more I read, the more it seems that both GOP and democratic views are flawed.

GOP wants less taxes, less government, private insurance. Rich keep more of their money. Less is offered to the masses (such as healthcare). With less regulation, prices soar above inflation, due to corporate greed, and supply/demand economics (people who can pay, are willing to pay anything to save their or their loved ones life).

Democrats want more of a single payer type system, so that 'maximizing profit motive' is not a part of healthcare. However, just like with government backed tuition, and proposed free college for all, the 'blank check' mentality rears its ugly head, and again prices soar, because they know the people paying, will pay regardless.

So is there not a third option that can actually control costs, reduce how much of a profit motive there is, and still provide quality care? It doesn't appear so.

You're understanding of deregulation and supply/demand interplay is flawed. Deregulation lowers barriers to entry, increasing options (supply) and competition, lowering prices. One reason many think otherwise is because of the housing crash of a few years ago, which many analysts inappropriately blame solely on deregulation of financial markets, while ignoring other government policies that heavily influenced the events.

Sent from my SM-G930V using SDN mobile

 

[psychbender]

But there is quite the tendency on here to promote libertarianism as the answer to all of our problems. Somehow if we were to just follow the principles of libertarianism, we would all be happy and free. The biggest problem with libertarianism is that in order for it to work then everyone has to follow the so-called "non-aggression" principle. The corporations of the world have shown time and time again that they are not willing to do that. There is too much temptation to take advantage of the illusion of freedom.

That's the role of the state in a more minarchist system. By violating the NAP, the use of force is justified. One problem is, our government is in bed with the very corporations that are lying to the public. How do you think those nutritional guidelines promoting carbohydrates over fats and protein got in there in the first place? This is why giving the state more power in the hopes that they'll look out for our interests over those of special interest groups is destined to fail.

Sent from my SM-G930V using SDN mobile

 

[GravelRider]

First, a distinction can and must be made between different "unnecessary products" -

Sin taxes are intended to engineer behavior, and raise money on the side. They target the poor. Luxury taxes are intended to raise money. They target the wealthy. Surely you can see the fundamental difference between the two, even though both are a tax on "unnecessary products".


Income taxes are OK. Property taxes are OK too, though they ought to fund local infrastructure and little if anything else.

What should we tax? Transactions are probably the best overall option, but care must be taken to not make them too regressive.

Fair enough. My point was more to the fact that it is an indictment on our society that "sin" taxes disproportionately affect the poor. Why are the poor smoking more cigarettes and drinking more Big Gulp sodas instead of purchasing local produce and going for bike rides? "Sin" taxes are intended to engineer behavior, but corporations are already pretty good at engineering behavior for profit.

 

[Planktonmd]

Fair enough. My point was more to the fact that it is an indictment on our society that "sin" taxes disproportionately affect the poor. Why are the poor smoking more cigarettes and drinking more Big Gulp sodas instead of purchasing local produce and going for bike rides? "Sin" taxes are intended to engineer behavior, but corporations are already pretty good at engineering behavior for profit.

You know why poor people smoke and drink sodas more than rich people? They just don't know better, and the reason they don't know better is lack of education.
Now why do they lack deduction? That's the question.
Could it be because we don't put enough resources into education and prevention?

 

[FollowTheMoney]

You know why poor people smoke and drink sodas more than rich people? They just don't know better, and the reason they don't know better is lack of education.
Now why do they lack deduction? That's the question.
Could it be because we don't put enough resources into education and prevention?

Everyone is a victim and no one is capable of making a smart health decision. Sure.

Just curious, but what makes you an expert on the social behavior of poor people? Was there a study on the causation and correlation between educational level and smoking? Sounds like you are making an unfounded assumption and making an unverified excuse for a group of people so that you can advocate for more government. Did I miss something?

 

[Planktonmd]

Everyone is a victim and no one is capable of making a smart health decision. Sure.

Just curious, but what makes you an expert on the social behavior of poor people? Was there a study on the causation and correlation between educational level and smoking? Sounds like you are making an unfounded assumption and making an unverified excuse for a group of people so that you can advocate for more government. Did I miss something?

Do you need to be an "expert" to conclude that people who continue to smoke are likely not sufficiently educated to understand the impact of smoking on their health?

 

[deleted126335]

Do you need to be an "expert" to conclude that people who continue to smoke are likely not highly educated to understand the impact of smoking on their health?

I find it very hard to believe that there are more than a tiny amount of adults that don't know that smoking, eating junk food, drinking soda, not maintaining a healthy weight are bad choices. Not to mention using drugs and abusing alcohol.

 

[Planktonmd]

I find it very hard to believe that there are more than a tiny amount of adults that don't know that smoking, eating junk food, drinking soda, not maintaining a healthy weight are bad choices. Not to mention using drugs and abusing alcohol.

Well... they apparently don't know and there are 2 possible explanations:
1- They are not sufficiently educated
2- They are ******ed
I have trouble admitting that all these people are ******ed so i tend to accept that they might be uneducated.

 

[deleted126335]

Well... they apparently don't know and there are 2 possible explanations:
1- They are not sufficiently educated
2- They are ******ed
I have trouble admitting that all these people are ******ed so i tend to accept that they might be uneducated.

Or maybe just willing to accept the consequences for a short term pleasure.

 

[Planktonmd]

Or maybe just willing to accept the consequences for a short term pleasure.

You mean they are suicidal?

 

[psychbender]

Well... they apparently don't know and there are 2 possible explanations:
1- They are not sufficiently educated
2- They are ******ed
I have trouble admitting that all these people are ******ed so i tend to accept that they might be uneducated.

Apathy is another option. They know, but they don't care. This describes most of my old VA patients, and many of the patients I dealt with in my prehospital days in rural SW Virginia.

Sent from my SM-G930V using SDN mobile

 

[Planktonmd]

Apathy is another option. They know, but they don't care. This describes most of my old VA patients, and many of the patients I dealt with in my prehospital days in rural SW Virginia.

Sent from my SM-G930V using SDN mobile

If you know that what you do will kill you but you don't care that makes you either a ****** or ignorant IMHO.

 

[deleted126335]

You mean they are suicidal?

That is not what I said. Plenty of educated people make bad choices about lots of things that they know are unwise. Obesity, infidelity, driving drunk, gambling, etc. Are they all suicidal?

 

[Planktonmd]

That is not when I said. Plenty of educated people make bad choices about lots of things that they know are unwise. Obesity, infidelity, driving drunk, gambling, etc. Are they all suicidal?

Self destructive behavior is a form of suicide provided that you are not ******ed and you are sufficiently educated to understand the impact of your behavior.

 

[deleted126335]

Self destructive behavior is a form of suicide provided that you are not ******ed and you are sufficiently educated to understand the impact of your behavior.

If that is your definition, then yes, many many millions of Americans are suicidal. I just simply believe that many are willing to "pay the price". You gotta die of something. Are you an a organic, vegan, fitness buff who meditates daily? If not, you must be suicidal. Those things will prolong your life. We do know that you like your Scotch.

 

[Planktonmd]

If that is your definition, then yes, many many millions of Americans are suicidal. I just simply believe that many are willing to "pay the price". You gotta die of something. Are you an a organic, vegan, fitness buff who meditates daily? If not, you must be suicidal. Those things will prolong your life. We do know that you like your Scotch.

I guess if not being suicidal involves no Scotch then I am Suicidal :-(
I do get your point but don't you think that if people knew better they are less likely to pick a terrible option like smoking?

 

[deleted126335]

I think that there are undoubtedly some people that don't know better. (Excluding mentally challenged). I just think that number is pretty small.

 

[GravelRider]

It also helps (the corporations) that many of the aforementioned products are highly addictive. It's hard to talk about free will when addiction is involved.

 

[pgg]

Well... they apparently don't know and there are 2 possible explanations:
1- They are not sufficiently educated
2- They are ******ed
I have trouble admitting that all these people are ******ed so i tend to accept that they might be uneducated.

3- Few options or opportunities to better themselves in life, so they settle for simple pleasure and enjoyment of alcohol, tobacco, or other drugs. When every day is a struggle, when you're surrounded by violence and poverty, long term possible consequences of a cigarette aren't big factors in the decision to smoke. Substance abuse among the poor is rooted in hopelessness and despair. Not ignorance or stupidity, or even lack of education. They know the stuff is bad for them. But they are stuck in circumstances that they feel are worse. So why not smoke?

Their risk/benefit calculus is different than yours or mine. They are not stupid.

For a champion of the poor and the addicted, you sure seem to lack understanding or empathy for them.

 

[Planktonmd]

It also helps (the corporations) that many of the aforementioned products are highly addictive. It's hard to talk about free will when addiction is involved.

This reminds me of when Tramadol first came out and we were informed by the manufacturer that this drug is just fantastic. It has excellent analgesic properties, it does not cause addiction, and it's not scheduled!
The result was that we started handing Tramadol to every one at the pain clinic like peanuts. They made serious money and it took us years to realize that we were duped. They knew that it was highly addictive but they did not tell us.

 

[Planktonmd]

3- Few options or opportunities to better themselves in life, so they settle for simple pleasure and enjoyment of alcohol, tobacco, or other drugs. When every day is a struggle, when you're surrounded by violence and poverty, long term possible consequences of a cigarette aren't big factors in the decision to smoke. Substance abuse among the poor is rooted in hopelessness and despair. Not ignorance or stupidity, or even lack of education. They know the stuff is bad for them. But they are stuck in circumstances that they feel are worse. So why not smoke?

Their risk/benefit calculus is different than yours or mine. They are not stupid.

For a champion of the poor and the addicted, you sure seem to lack understanding or empathy for them.

What makes you think that I am a champion of anyone?
I simply believe that you can improve people by education and if the results are not satisfactory then the first thing to question is the adequacy of that education.

 

[deleted682700]

Do you need to be an "expert" to conclude that people who continue to smoke are likely not sufficiently educated to understand the impact of smoking on their health?

May be its not the education that motivates people to lead healthier life style. Going to the gym, quitting smoking, eating healthy portions. These are hard to adhere

 

[deleted682700]

Isn't this the Dunning-Kruger effect? We are seeing this big league now in our society. Expertise no longer has value because everyone can be an "expert" with the powerful computers we carry in our pocket. This has contributed to the devaluing of our own profession. The poster @FollowTheMoney above even refers to experts as being "egotistical and big on credentials." These experts are now called "elites" by politicians feeding off that very mindset.

The Death Of Expertise

Awesome post, the death of expertise. That's exactly what is happening in hospitals.

 

[BLADEMDA]

Krauthammer Predicts Single-Payer Health Care in Less Than 7 Years

Krauthammer Predicts Single-Payer Health Care in Less Than 7 Years

 

[DrCommonSense]

Krauthammer Predicts Single-Payer Health Care in Less Than 7 Years

Krauthammer Predicts Single-Payer Health Care in Less Than 7 Years

Considering Anesthesia rates under Medicare are approximately 33% that of Private Insurance, what will happen to salaries?

 

[zero0]

Isn't this the Dunning-Kruger effect? We are seeing this big league now in our society. Expertise no longer has value because everyone can be an "expert" with the powerful computers we carry in our pocket. This has contributed to the devaluing of our own profession. The poster @FollowTheMoney above even refers to experts as being "egotistical and big on credentials." These experts are now called "elites" by politicians feeding off that very mindset.

The Death Of Expertise

Actually gave this a read in a fit of boredom between classes. I agree with the accountability aspect and annonimity, that's an issue. People should be held to the stupid things they say because it discourages them from doing it again. But the whole idea of I'm an expert because I paid for this degree and am involved in this field has to go. What if the educational system is flawed or even corrupt? What if the field is ruled by private interests or ulterior motives? Depending on an elite tier of supposedly trustworthy individuals to make your decisions for you is just asking for trouble. I.e. the sorry state of affairs of the modern era

 

[pstrick]

See I thought this too but then I realized that a public defender is the **** tier of the legal system. It would be like if Medicaid patients had used needles and unsupervised resident care. Nobody has ever floated the idea of making the law single payor so why are we doing it for medicine?

Untrue. Do you know any lawyers working in a public defenders office?
They aren't there because they have no other options, and it's pretty telling that you believe that they are.

 

[Onefellswoop87]

Untrue. Do you know any lawyers working in a public defenders office?
They aren't there because they have no other options, and it's pretty telling that you believe that they are.

But they are overworked and relatively underpaid (compared to the volume of work they do with respect to salary vs private practice), which overloads the system and makes it an uphill battle for "fair" representation in contrast to representation by private attorneys. Are outcomes statistically in favor of private attorneys? I don't know and haven't ever seen/looked for data. I can't comment on the "tier" as it relates to end results. But the public defender system as a whole is arguably a step below based on time allotted per case.

Public defenders are overworked and underfunded. That means more people go to jail

Overworked And Underfunded, Mo. Public Defender Office Assigns Case — To The Governor

 

[GravelRider]

Actually gave this a read in a fit of boredom between classes. I agree with the accountability aspect and annonimity, that's an issue. People should be held to the stupid things they say because it discourages them from doing it again. But the whole idea of I'm an expert because I paid for this degree and am involved in this field has to go. What if the educational system is flawed or even corrupt? What if the field is ruled by private interests or ulterior motives? Depending on an elite tier of supposedly trustworthy individuals to make your decisions for you is just asking for trouble. I.e. the sorry state of affairs of the modern era

Isn't that the same argument the CRNAs use?

 

[urge]

Considering Anesthesia rates under Medicare are approximately 33% that of Private Insurance, what will happen to salaries?

Collections will drop and subsidies will have to make up for lost income. Supply and demand will dictate how much subsidy will be.

Eventually all your salary will be a subsidy anyway since they are moving to bundled payments.

 

[DrCommonSense]

Collections will drop and subsidies will have to make up for lost income. Supply and demand will dictate how much subsidy will be.

Eventually all your salary will be a subsidy anyway since they are moving to bundled payments.

Why give subsidies when they can increase the CRNA to Anesthesiologist ratios and decrease salaries across the board?

 

[Planktonmd]

Collections will drop and subsidies will have to make up for lost income. Supply and demand will dictate how much subsidy will be.

Eventually all your salary will be a subsidy anyway since they are moving to bundled payments.

Isn't bundled payment a result of Obama care that they are going to" repeal and replace"?

 

[DrCommonSense]

Isn't bundled payment a result of Obama care that they are going to" repeal and replace"?

Dont know what the hell is going to be repealed and replaced lol

 

[urge]

Isn't bundled payment a result of Obama care that they are going to" repeal and replace"?

It's a Medicare thing. Not related to Obamacare.

 

[urge]

Why give subsidies when they can increase the CRNA to Anesthesiologist ratios and decrease salaries across the board?

It doesn't work that way.

ICU nurses have had zero collections since the beginning of time and their salary per hour is likely as good as yours.

 

[BLADEMDA]

If I wasn't born in the USA then my next two picks would be Canada and Australia. Australia's healthcare system is pretty good and may be a model for the USA:

 

[Ignatius J]

If I wasn't born in the USA then my next two picks would be Canada and Australia. Australia's healthcare system is pretty good and may be a model for the USA:

But we all know and understand that there are huge differences between Austrailia and American demographics that affect the logistics, correct? Yeah, I would like to have half the diabetic rate as we have now like Austrailia does. But due to American unaccountability, that will never happen.

Americans will continue to subsidize the sequelae of other Americans' poor lifestyle decisions.

The dirty secret is that the system right now is socialized in America. Poor, old, and disabled folks have their care subsidized via rich, young, tax-paying folks both in government mediums and the private insurance market. The only debate is to whether make the government running the social system official or not.

 

[deleted126335]

When you look at Medicare, Medicaid, Tricare, the VA, the amount of federal, city, county, state employees getting their care paid for by government entities, we ain't that far away from having virtually all care at least paid for by government.


Sent from my iPhone using SDN mobile app

 

[Ignatius J]

When you look at Medicare, Medicaid, Tricare, the VA, the amount of federal, city, county, state employees getting their care paid for by government entities, we ain't that far away from having virtually all care at least paid for by government.


Sent from my iPhone using SDN mobile app

Ding ding ding!

In many ways the ACA is an example of a failed social system. Healthy people never intended to sign up or be coerced into a system to be taken advantage of and in part subsidize other strangers' healthcare. The easy answer is to lessen regulations and privatize more in order to reduce costs and drive more people from the government side into the private side. Unfortunately, we will do the opposite and completely hand control over to perhaps the most cost-inefficient vehicle imaginable- the government.

 

[Ignatius J]

What makes you think that I am a champion of anyone?
I simply believe that you can improve people by education and if the results are not satisfactory then the first thing to question is the adequacy of that education.

Education is a cop out and an excuse to kick the can down the road. Almost every obese person knows why they are obese and unhealthy. My 4 year old understands that.

I'm a cash-pay guy outside the insurance system (cost-sharing plan at 10% the costs of previous insurance). For $60, I can get a complete history and physical at my PCP, including assessment, counseling, prescriptions, potential referrals, and follow-up direction. That is hardly a high price tag to pay for my health. But statistics say hardly anyone cares to do that. At one point can we emphasize accountability?

 

[deleted126335]

Education is a cop out and an excuse to kick the can down the road. Almost every obese person knows why they are obese and unhealthy. My 4 year old understands that.

I'm a cash-pay guy outside the insurance system (cost-sharing plan at 10% the costs of previous insurance). For $60, I can get a complete history and physical at my PCP, including assessment, counseling, prescriptions, potential referrals, and follow-up direction. That is hardly a high price tag to pay for my health. But statistics say hardly anyone cares to do that. At one point can we emphasize accountability?

What happens to you if you get diagnosed with Rheumatoid Arthritis and get hit with $30,000 per year bill for a biologic?

 

[urge]

(cost-sharing plan at 10% the costs of previous insurance).

Can you elaborate on this?

Who administers the plan? Is it a BCBS, UnitedHealth, etc plan? Or is it a pool of money that your group holds in case someone gets catastrophically ill?

 

[Ignatius J]

What happens to you if you get diagnosed with Rheumatoid Arthritis and get hit with $30,000 per year bill for a biologic?

$30,000 a year? Estimated costs on Rheumatoid Arthritis are $2000-$10000/year. Taking the high number, I would be spending $1700/year for cost-sharing plan (essentially catastrophic coverage) plus $10,000 for RA= $11,700/year

I was paying $1610/month for a BCBS HDHP. Taking into the $5000 deductible, I would be paying about $24,000/year. (Last year between premiums, deductibles, and coninsurance I paid $28K. Makes that $30K a year a little more in perspective).

So even with a chronic disease, I will save money.

I saw insurance as a casino blackjack game 4 years ago. You know odds are not in your favor but you could come out on top in a healthcare situation if you needed it. $1610/month for a HDHP was not enough of a "potential win" situation for me to sit down at the blackjack table.

One last mention is that remember that pre-existing conditions aren't discriminated against if I wanted to pursue a plan.

 

[Ignatius J]

Can you elaborate on this?

Who administers the plan? Is it a BCBS, UnitedHealth, etc plan? Or is it a pool of money that your group holds in case someone gets catastrophically ill?

Message me. Don't want to use the forum to plug plans and what not.

 

[BLADEMDA]

Democrats' single-payer health-care dream just became a nightmare

• A new study by the California State Senate shows that single payer health care would cost more than the entire current state budget.
• That means everything else that Californians want from their government would have to take a backseat to health care.
• Hopefully, this report will start to make our national health care debate more economically realistic.

Op-Ed: Democrats' single-payer health-care dream just became a nightmare

 

[doctalaughs]

$30,000 a year? Estimated costs on Rheumatoid Arthritis are $2000-$10000/year. Taking the high number, I would be spending $1700/year for cost-sharing plan (essentially catastrophic coverage) plus $10,000 for RA= $11,700/year

I was paying $1610/month for a BCBS HDHP. Taking into the $5000 deductible, I would be paying about $24,000/year. (Last year between premiums, deductibles, and coninsurance I paid $28K. Makes that $30K a year a little more in perspective).

So even with a chronic disease, I will save money.

I saw insurance as a casino blackjack game 4 years ago. You know odds are not in your favor but you could come out on top in a healthcare situation if you needed it. $1610/month for a HDHP was not enough of a "potential win" situation for me to sit down at the blackjack table.

One last mention is that remember that pre-existing conditions aren't discriminated against if I wanted to pursue a plan.

Where are you getting 10,000? Humira and enbrel are 20-30k a year. The newer biologics (stelara, cosentyx etc) will run you 60k.

You are well aware of the cost if you need surgery or a hospital stay. Going with zero insurance is risky.


Sent from my iPhone using SDN mobile

 

[Ignatius J]

Where are you getting 10,000? Humira and enbrel are 20-30k a year. The newer biologics (stelara, cosentyx etc) will run you 60k.

You are well aware of the cost if you need surgery or a hospital stay. Going with zero insurance is risky.


Sent from my iPhone using SDN mobile

Of course it is risky. Everything has risks. Driving to work yesterday was a risk. It's a matter of how much I am willing to risk to not pay the premium. My question would be: how much do you have to pay annually to assume the risk and not have insurance? Every man has a number. You clearly won't be paying premiums to infinity. So at your number are you being risky? Or are you just smartly balancing risk/reward?

Regarding the question, it was a Google search.

The broader rebuttal to your scenario would be: say I get rheumatoid arthritis in a hypothetical scenario. What does the ACA say about pre-existing conditions?

 

[doctalaughs]

Of course it is risky. Everything has risks. Driving to work yesterday was a risk. It's a matter of how much I am willing to risk to not pay the premium. My question would be: how much do you have to pay annually to assume the risk and not have insurance? Every man has a number. You clearly won't be paying premiums to infinity. So at your number are you being risky? Or are you just smartly balancing risk/reward?

Regarding the question, it was a Google search.

The broader rebuttal to your scenario would be: say I get rheumatoid arthritis in a hypothetical scenario. What does the ACA say about pre-existing conditions?

Sure, I agree in theory.

I'm willing to carry insurance at the current price point mainly because there is a small risk of almost infinite costs, too much for even a wealthy person to bear (what if your kid needs a stem cell transplant etc - you going to pay 2 mill for the treatment and ongoing care?). If I could guarantee costs of < 100 or even 150k a year I'd consider going without insurance.


Sent from my iPhone using SDN mobile

 

[epidural man]

You know why poor people smoke and drink sodas more than rich people? They just don't know better, and the reason they don't know better is lack of education.
Now why do they lack deduction? That's the question.
Could it be because we don't put enough resources into education and prevention?

At my moonlighting gig, I was interviewing someone that did daily crystal meth. I couldn't believe how little he understood about the dangers of this drug. He thought it was great because it made him loose weight. I was likely unprofessional and probably too condescending because this blew me away. I eventually showed him the website "faces of meth" and we went through all those pictures as I kept saying..."Meth is horrible. It is perhaps the worst thing on this planet you could do to yourself."

I doubt it got him to stop, but sheesh. Maybe education could help in a small way.