BigBallinStalin wrote:PLAYER57832 wrote:Phatscotty wrote:PLAYER57832 wrote:Phatscotty wrote:I'ts actually pretty simple. Freedom and Liberty is too large a burden to bear for some people. I only ask them why they want to live in a free country?
What you propose is selling our country to big corporations.
That's a pretty fucking huge assumption. You are getting nuttier by the day. I propose nothing close to that, yet you continue to tell me that is what I propose.
What reason do I have to continue posting with you?
There are two choices. Move healthcare into the government or completely turn it over to private companies.
The same choice exists for every other monetary topic. Your answer is ALWAYS to remove government. The only other choice is to allow just those with money, just those most powerful to be in charge. .. big corporations, or more specifically, those in charge of big corporations.
If the government provides certain goods to a certain type of target market, then couldn't such a move be played to the advantage of large corporations by limiting competition via government intervention?
Why do you think a few particular healthcare corporations held discussions with Obama behind closed doors?
The government is not altruistic, and it will pander to corporate influence at the expense of its own people. So why do you feel that government should be entrusted with the provision of certain goods?
I will answer the last, first: Because we can always vote Obama out of office. We cannot vote CEOs out of office unless we happen to be major stockholders (not sure they always can even then.. though they can do other things to get them ousted). As imperfect as our system is, it is still better (though more and moe the distinctions are shrinking) that simply handing everything over to corporations.
Beyond that, I have to step back a tad. There are several components to our healthcare system and each has very, very different incentives.
1.
Health Isurarers: Their incentive is to collect the most policies and provide the least care. They can do this either both by insuring the most heatlhy people they can
and by allowing sick people to fall off either through denials or simply death. That last does not have to be absolutely intentional. But, when CEOs never have to "see the faces" of patients, see only numbers it becomes all too easy (or at least palatable) to simply require multiple verifications, for example, before a person can get cancer treatment.. never mind that this means the care is often delayed past the point of success. Etc. (I won't go into the litteny again.. but the many stunts pulled by insurance companies are well documented).
2.
Employers. Only an artificial player, and that is part of the problem. Their incentive is to reduce costs.. period. They were noly inserted because, initially, employers could not offer wage increases. This continued becuase tax incentives made offering health coverage far more cost effective fro companies than offering wage increases. Now, the only real incentive for most companies is to follow the law. There really is no tie-in to quality care or quality coverage, except in a few cases (sports stars, union negotiated contracts, etc) where the health of the employee is directly critical. Note.. one exception to this is "general wellness" programs. However, many of those are actually driven by insurance companies who offer reduced premiums becuase the insurance companies see a benefit in keeping people healthy when the effort/cost required is minimal. Now, partially because of the economy, but also because so many more employers are "absentee" owners, remote stockholders and CEOS who never have to truly "see the faces" of their employees, healthcare has become just one more expense up for the "chopping block" whenever possible. It is not really seen as a required service or a necessity for the workers at all. These big employers (for the most part) could care less what their salaries buy, how employees live, whether they are supported by other taxpayers or not. They want their profits.
(let me clarify, each individual within the company, faced with these issues, certainly will "care", but the point is they don't have to and, in fact, are often forced not to think about the impact of their decisions. They need to make the company money to keep their jobs. The people making the "worst" decisions, actually facing the people, have the least say in the matter.. by intention. By the time things get up to real decision makers, all they see are numbers and ignoring the impact of those numbers on real people is all too easy to ignore) To a point, that is "just business". However, when millions of companies are allowed to do this, it means that costs are shifted from these companies.. many of whom are very, very profitable, onto taxpayers.. many of whom are just barely getting by or who are not truly getting by at all except that they recieve supports from other taxpayers. In few areas is the bill for unmet needs so high as in healthcare.
The above colorized portion is the key point, why companies wind up almost always being "greedy, uncaring entities" even though the people who work for them are not necessarily so on a personal level.. yet, the more entrenched it becomes, the more people come to accept that this type of thing is OK or simply "required"..NOTE.. that last blurb about companies can apply equally to insurers and the employer customers. That structure.. the people making the most heart-wrenching proclomations being the ones most removed from the ability to change policies is why the "feedback" you and Phattscotty like to talk about, response to customers et all just don't work here. In fact, it is working less and less in other types of goods and services (unless you want to argue that going from washers that could last 50 years to ones that last only 5, with no real and true increase in quality, is a customer benefit!). Its just hat in other areas the impact is not so great, life-changing/heart-wrenching.
AND, note that this whole bit of removal is exacerbated by the entire "employer is the real insurance customer' structure".
3.
Government. Largely operates as the insurer above, with the overriding incentive to cut costs. However, the "monkey wrench" is that government must respond to voters. This is a tricky mix. People don't like to see grandma dying for lack of care, nor do they like the idea of kids going without vaccinations and crutches because parents are idiots. They also don't like paying more taxes. So, a politicians job has been to convince voters that they could have both --lower taxes AND decent healthcare for all. They did this by pretending that certain costs did not exist or by pretending that any budget shorfalls were "only temporary" or "the fault of the other guy.. almost entirely". Thankfully, some things were set in place.. money from tobacco in PA, for example, to ensure that these programs continued to be funded. However, because politicians have continually heeded the "we won't pay no dam taxes" message, becuase they were too chicken to speak reality and simply tell voters, including the bigwigs, that they had to pay or the entire system would collapse (not just healthcare, but healthcare is one of the places where it becomes most obvious and roads, infrastructure, schools, etc are not the topic here)
The similarity with the above, incentive-wise, is that politicians are largely insulated and removed from the impacts of their decisions. HOWEVER, the difference is that while I cannot call up CEO of company xyz and get an audience, unless I happen to know them personally (and then it had best not be about business!), I CAN (and have) called up and spoken to some of the most powerful politicians in the country, nevermind more local ones (once, at least
). Ironically, this is part of the problem. Politicians are caught in a public that "wants to have its cake and eat it, too". They know they have to serve the public... and as long as the public insists on being irresponsible, so will the politicians they elect.
4.
The overall industry because this overrides all the portions, I list it as if it were a separate entity: From the outset, the general incentive is to provide people with the most expensive equipment, procedures and services. That much is like any other type company, except.. while there is a benefit to the consumer in getting a "fancier refridgerator", there is no benefit in getting a more expensive surgary or implant, unless it truly results in healthier care. The "endpoint" for refridgerators is "the sky". The "end point" for healthcare is just plain "good health."... in fact, rather than moving up, the idea of what "good health" represents even slides as one gets older. However, because people's funds are limited, the costs canot be unlimited. So, the incentive on the one hand has been to offer more and more expensive treatments, but the ability of people to then pay reaches an end.. even if the availability of treatments do not. We "hid" some of this through Medicare. However, the biggest issue is just that medical advances have come so very, very quickly it has been impossible to really adjust any system to "fit."
5.
Doctors/Healthcare providers. The incentives here are varied.
As bove, the overall incentive is to provide the most expensive care possible, for the highest profit. BUT, then you have to start looking at the kind of practice, the insurance payment structure, legal rules, and even things like biotech/pharmaceutical company policies in advertising and incentives, so instead of one incentive for healthcare providers, it really gets down to many incentives that play against each other in various ways.
Offsetting the cost bit are two factors.
a. First the hypocratic oath, which really means that doctors actually do have to face patients and mostly really do care. That significance is something sometimes lost in the above corporate discussion world, but it really does make a difference in how doctors operate. Few CEOs would think too much about, say offering refrigerators for free out side of a few special programs like donations ot habitat for humanity, etc. When they do, it doesn't really come out of their personnal income. (though they may donate on a personal level as well) Most doctors wind up having to provide some type of free or highly reduced care. This is true all along, though sometimes its more direct than in other cases. One nursing home here, for example, routinely gives about $50,000 in free care a year, for a facility with 58 beds (I know the head, so can give accurate figures for that facility). From what I understand, that is pretty typical, perhaps lower than many facilities. People basically expect doctors and healthcare professionals to do this. Some doctors, of course, operate almost wholly on this basis... setting up free clinics (that still cost money usually gained through a combination of government funding and private donations). Some reduced cost care is tied into education of doctors and research programs. That last part is very cost-effective and mostly is taxpayer funded. However, it is not available everywhere and has a limited scope. The "free clinic" care is usually only for basic care. Research programs target new technologies, cures, diseases. Reduced care at educational institutions is mostly for "specialty" or "optional" (as in not generally life threatening issues) care such as dentistry, eye care, plastic surgary, etc. This is not even getting into "missionary" type doctor care, which is happening more now overseas than here in the US. Again, I challenge you to name another industry with such a high percentage of donated or reduced cost products.
b) Limits to payments set by insurance companies, government programs and even patients' ability to pay.
At the same time, of course, doctors "have to eat", are human as anyone else and like to take their "vacations in the Bahamas" (IF they have a practice lucrative enough to allow it). and tend to feel that having gone to school for so long, etc., should entitle them to a higher than average wage, just like company executives... only the education required of a doctor is often more and the return far less than for most company executives. (note, most doctors don't expect an executive salary, but just one that is above average for the area). They deal with this several ways.
1) Cut every corner they can, "work they insurance system". Mostly, I am not talking about fraud, though sometimes that line gets blurred. As much as the lowest paid employees have the least ability to change company policies, so, too, do the doctors have no real and true say in how insurers decide to pay. This can mean a doctor putting down as an actual visit when they talked to the patient on the phone. Is that cheating? Depends on your perspective. If you are a beaurocrat wanting to cut costs, absolutely. If you are the doctor, then you figure you are spending time caring for the patient and why shouldn't you be paid for that. If you can save a few minutes on that patient, without diminishing care, then its more time for other patients who really need it. Insurers respond, in turn, by limiting time for each patient even more. I am told that a physician is now allotted only 15 minutes. To the money-saving beaurocrat looking only at numbers (and remember what I said above about the system forcing people to be blind), that makes sense. To a doctor who spend over a decade in training, it means he won't be able to truly assess each patient the way they need.
2) Put another layer between them and the patient. Every office now needs a minimum of 8 people to support each doctor (according to Ralph Nadaar, about 2 years ago). Doctors usually deal with the patients and leave billing to someone else. Beyond that, they often use billing agencies, which will refer patients to a collections agency. This removes the doctors, but also means errors and other problems increase. I can remember well getting 4 irate phone calls the day before Thanksgiving demanding that I pay a $20 bill IMMEDIATELY!. It did not matter that I had proof of payment in my hand, that the doctor's office was closed...they were paid to collect and collect they would or I would suffer the consequences. It took me 2 hours, when I was supposed to be getting ready for Thanksgiving, dealing with them. And... I had not only paid that, I had paid it TWICE! That was just one example. I have had similar issues with basically every bill we had.
NOTE.. item 2 puts doctors in the same category as the companies, employers above... making decisions that are removed from the patient's needs.
3) limit practice to specialty care. Often times by the time a patient finally gets to, say, an oncologist or surgeon, the "gatekeepers" have already been surpassed. I cannot say this is always true, but the biggest problem seems to be even being allowed to see those people.
4)Not part of the incentives, per se, but impacting all the above is malpractice. The real truth is that malpractice is a cost born by all the legitimate, well practicing doctors. One doctor is an idiot, so insurance pays his costs, he goes on and the policies of every other doctor goes up. The incentive for other doctors is heavy, both from a "personal" level (they tend to know their colleagues as friends) and an "economic/professional" level to not admit errors or to report them in colleagues. This means that one of the supposed "feedbacks" simply doesn't work very well. Added is that malpractice lawsuits are decided by juries who tend to see a the "poor woman with kids to support who lost her leg" and not so much the "overworked doctor under IMMENSE pressure who goofed.. or even who made a
legitimate judgement call that just did not work out the way he hoped"
5) limit who they care for within their practice. This is tricky, becuase a doctor is generally statutorially forbidden from discriminating for a variety of reasons. They cannot simply turn away sick patients... Except.. they can limit the scope of their practice to less costly problems and simply say that patients needing more expensive care have to go to specialists. Mostly, the limits are set up already by the insurance companies. A doctor contracts with specific insurers and is not required to accept other policies. They may not technically turn away patients, but they can absolutely say "we don't take [the lowest tier Blue Cross programs]", We don't take Medicaid" (they usually don't turn down Medicare, though that is happening more and more), etc. The impact to the patient is denial of care, since few have the ability to pay out of pocket (almost no Medicaid patients do.. children on Medicaid because of disabilities, like mine, might be able to, say, pay for a dental or eye visit, but usually not the treatments that make the child eligible for Medicaid from the start).
6) simply get out of the business or don't go into it. When the cost of a doctor's education gets into the hundreds of thousands and the likely return only 40-50K, then it can become plain cost-prohibitive to become a doctor for all but a few.
6.
Healthcare product suppliers:.. biotech, pharmaceutical companies, etc. Overall, again, their incentive is to make money. They either try to sell more expensive products with higher profit margins or more products with lower profit margins (or some combination). These get complicated in various ways.
a. Orphan drug supports. Its one thing when a company decides not to make olive green appliances because the market is too small and something else indeed when they decide there are too few patients to warrant making a life-saving drug for an obscure illness! So, first non-market based impact -- orphan drug laws. Except.. which drugs qualify, etc get to be a complicated political process, decided as much by who has the loudest voice as real needs/cost-effectiveness assessments.
b. advertisement-- in other cases, does society really care if Nintendo or Opherion sell more games? No. In healthcare.. if doctors are encouraging patients to buy "name brand" drugs or just one brand over another, it can matter a lot. It can matter in increased healthcare premiums, in increased taxes, etc. Doctors are human. They are as readily swayed by that nice salesperson who comes to their office as you are in a department store or such.
ETC.. I am tired, this is already longer than I intended and I think I covered the biggest points already.
