...and has subsidized public universities as well
Despite a pretty significant border problem.
Link: https://www.tabletmag.com/jewish-news-and-politics/245989/israel-universal-health-care
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...and who don't pay into the system.
Got it.
.....at least half of the middle class people don’t go to Dr visits anymore because it costs them too much ( a direct result of Obamacare which shifted to cost of indigent care away from the already non taxpaying hospitals and the insurance companies to the middle class) while the poor choose the ER’s because it’s one stop shopping and they aren’t paying for it. No waiting for appointments, see a Dr & get tests at same time, consults from specialists at time of visit also, sent home with meds from prescriptions filled at hospital pharmacy before leaving, all at a schedule of their choosing so that they can not be inconvenienced. (Obamacare requires hospitals and particularly ER’s to meet patient satisfaction survey levels in order to be fully reimbursed, that’s why you always get those emails asking about your visit after the fact, and many of the patients who pay nothing have quickly picked up on it and are often the most demanding of patients). Trust me, they all know it too.
Btw, hospitals and doctors with high ratings - esp in ER are the ones who give the patients what they want, so what kind of doctors and ER’s do you think that encourages?
And also, the big hospital system makes it hard to get in to be seen with impossible phone trees, plus too few Drs cuz they left the field rather than put up with the new administrative and EMR BS regulations thatnow let them only see 1/2 of the people they used to see.
I predicted you’d someday bitch about the system you facilitated with Obamacare while being unable to see that you d it. I was right. It encouraged all of the worst aspects of the system.
Why go to an office visit to see some nurse practitioner that can’t really help with anything you can’t alreadygoogle, and who orders a bunch of expensive tests because of it as well as a consult thereafter with the real doctor?
As a patient, it scares me. I know people because of my job, but people like you who aren’t so lucky are going to pay the price. You may be temporarily protected by a sweet work policy, but those are in the process of changing as well as I’m guessing you’ve noticed.
ERs have become the primary care physician for large swaths of the population. They cannot be turned away and is one-stop shopping.
I get the connection now.
I do think the uninsured had used the ER as their primary care physician before Obamacare. Baron makes a case the some of the Obamacare policies might encourage others to go to emergency rooms first. That sounds like that can be tweaked, though.
...just as well as voting for people who lower spending has worked to lower spending.
The main difference between you and me is that you have confidence that this time it will be different...you see the possible, and reach for it. As for me, I see the likely because the possible never happens. Lucy pulls the football away, and you adust your kicking style and say, "One more time!" I have zero confidence she won't pull the football away next time. That's what she does. Maybe we shouldn't let her hold the football anymore.
I think the Democrats passed a flawed bill, but it got us moving in the right direction. It is extremely complex, and it obviously was going to take iterations to get it working well. I think some bipartisan repair could be done, and frankly has to be done. So I don't really care who passes the tweaks - it can be the people that passed the bill, or others, or a combination of both.
The only thing I know for sure is that there doesn't seem to be any appetite from our current leader to fix it. It seems that his main goal is to dismantle it for the purpose of sticking it to Obama. That's probably not a good way to make decisions on health care policy.
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No matter how mad I get that nobody would listen to people who really understood (and medical school deans who have neve r worked in the real world do not count as experts).
We need fixes now that both sides can agree to. I have great ideas, but nobody will do a damn thing because even if I were important enough to be heard, the lobbyists would resist. Here are again (I posted it somewhere a couple of years ago) a couple of ideas that should be palatable to both sides - but consider the lobby pressure they would create by threatening the status quo...
1). Pharma reform - fact US citizens pay th highest price for meds in the world, even thogugh we develop most of them ourselves. Why? Because the HCR was written to allow them to do it - Big Pharma was the first group Obama went to get on board with his fiasco, and he unconscionably gave them the sky.
The same drug is cheaper in Mexico, Canada, and everywhere else. I am talking not about the new high level R&D drugs, I am talking about longtime , generic available standards like the inhalers, antibiotics, etc.
Problem: the US can’t regulate these companies because even if they could escape their paralyzing lobby group in Washington, the companies are international.
Solution - US forms a drug buying consortium of real experts this time who negotiate prices for massive bulk purchases on the international market and the. Make these drugs available at the cost of the great purchase price plus the added cost of the new branch of govt. US citizens would save trillions over the next decade.
Libs would love this because it expands foot, but I would also build in restrictions from the start so that this branch cannot grow beyond a specific size and scope. Drug companies would be forced to make deals because their would be competition for getting the US contract. We would essentially be both creating govt and at the same time bringing the free market capitalism back into play - but at the world level.
2). Eliminate the regulations requiring doctors and hospitals to use electronic medical record.
Fact - it is the single biggest healthcare cost on the buget at every office or hospital, yet it has never even been shown to improve care.
fact - the EMR was developed for hospitals to maximize “billing opportunities”. Fact - it slows productivity by 1/3 in facile providers and 1/2 in others.
Fact - the EMR companies like EPIC were able to name the moon for their product- and then they got it because the govt forced the medical community to get it by cutting reimbursements if it didn’t. It costs about 60 thousand dollars per provider to set up and then about 20 to 30 thousand dollars a year per provider to maintain and secure (it is much much more expensive per provider I. The hospitals).
Fact - it was a system that was designed to shar info she. HIPPA was calling to restrict info. Further it was very insecure given the sensitivity of it’s data, and there were incredible numbers of easy targets for hackers so that now the new burgeoning additional expense ad area of med liability is system security.
Fact - the hospital lobbies strongly supported the EMR push in Washington DC because they knew it would force all of the Doctor practices into their arms which included their practice itself, their purchasing, their accounting, their rental of buildings...all other additional profits that would be enjoyed by the hospitals.
Solution- eliminate the EMR which will again in this case re introduce capitalism by giving peopl alternative to the hospitals. If you don’t like it, don’t go there. But you will like it.
Fact
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I can't imagine this is all due to "efficiency."
Good read.
......and egregiously overpaid EMR companies who have their business guaranteed by govt regulations
.......and an HCR that allowed Big Pharmacy to charge anything that they want which is always a lot.
I'm just spitballing here, but do you think they have those things?
To my esteemed lawyer friends on this board, I fully recognize your value, but the medmal tort reform is long overdue, and a generous hourly rate rather than the incentive of quick settlements for 33% awards to people who suffered and need it or 50% when it goes to trial is absurd on multimillion dollar settlements.
I know docs and lawyers are familiar with caps on pain & suffering argument,and we know the usual response evoking the victim. But how about no caps for victim, but caps on what plaintiff lawyers can receive on big settlements? At least on settlements... make them earn and prove it in court if not also on verdicts. This would cut down on the quick bypass of justice that is now occurring in the game of quick settlements for big cash and little effort.
It is gross that a plaintiff lawyer can get 33% of a giant settlement for simply having a minion file papers esp in slam dunk cases.
Take the financial motive out of it for them because they have abused it to the point of everyone else's detriment. Decisions are being made on money, not merit in I do have funding ideas as well,
Also, let the victims keep the lion share of their settlement.
There is no doubt in my mind that we need some litigation reforms in the US. Within the past several years, I've had a civil litigation in the US, one in Germany, and one in China.
Costs:
China: X cost; Y months
Germany: 4X cost; 2Y months
US: 40X cost; 5Y months
So, US litigation is 40 times the cost and 5 times the time of a China litigation...and 10 times the cost and 2.5 times the time of a Germany litigation.
Level of Justice Provided:
China: Total roll of the dice. Of course, the dice only cost $100k, and the can cost less than that. And, justice is swift. Bad but quick and cheap justice can be better for a business than prohibitively costly and delayed justice. At least the business can fish or cut bait.
Germany: Closer to true justice.
US: No closer to true justice than Germany, but an order of magnitude more expensive, and a more lengthy process that requires more resources of the parties (e.g., discovery). In the US, the courts allow the parties to chase down every blind alley in the search for truth, but in the end, I don't think we get any closer to the truth than than the admittedly more arbitrary German courts get. We need to explore the concept of "good enough" in the US.
...well, there is a modifier for a really complex case which pays a little more if specific criteria are met.but it is trivial. And I loved through the reimbursement change. It did not change my motivation whatsoever. Get in, do the best job possible, and get out.
Perhaps, again, if the fee structures were changed, it would discourage these practices. If your getting the same amount either way, im betting you’d see a whole different timeline pretty quickly. There would be a desire to head the investigation directly to the likely source and then to move on.
It dovetails with what I was posting about. What about legal reform in the form of a change in attorney reimbursement. Again, make them really well paid, burn change it so that the main advertising at Lions home games is the Bernstein Law Practice. That is just stupid that a few individuals who are doing nothing spectacular other than knowing their niche are able to reap more income than an auto factory.
But I can tell how shitty this system in other areas of law over a beer or three.
Let's start with Biglaw and the old-boy network. Corporate lawyers spending shareholder money to pay his or her pals' $800/hr billable rate to do what a $350/hr lawyer can do just as effectively.
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The socialized medicine countries take the drug and make the generic often for pennies...because all of the R&D cost is sunk here....and is often being paid here.
Once again, the US is taking care of the world through capitalism, but the Dems would have you believe it is unchecked capitalism that is the problem, when really it is unfair trade practices which allow free loading abroad.
And, pharma research is expensive. They run down a lot of blind allies before they find the hit drug.
First, I could certainly support some form of basic care. At the same time, I travel quite a bit internationally and am astounded at just how fat and unhealthy we are as a nation. The meme of a fat American riding a Little Rascal into Walmart would be funny if it were not so close to the truth. How do we (or do we?) address the medical issues that are a function of lifestyle?
Not sure I could support the knee replacement (or the Little Rascal) for someone who is 150 pounds overweight.
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Link: https://www.youtube.com/watch?v=8qW1YwJdnPE
Cost-wise, the Israeli system is considered parsimonious to the point of being underfunded. The country spends less than 8 percent of its GDP, and about US$2,600 per capita on health, beneath the Organization for Economic Co-operation and Development (OECD) average. The equivalent numbers for the United States in 2016 under Obamacare rules were 17.8 percent of GDP and US$10,345 per capita. As a result, more than 80 percent of the population holds supplemental policies—which are relatively cheap due to the large risk pools of the health plans, the smallest of which has over 700,000 members. About 40 percent of the population also holds private commercial health insurance, which is much more expensive and not guaranteed.
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