I am amazed at how many sheep are controlled by mainstream media

[Acebb]

Talk about sheep....to freaking funny. How the fuck can you blame the creation of Isis on the withdrawal of forces that began AFTER ISIS and the Taliban were already formed???? What were we supposed to do, stay in Iraq for ever and run the police and government for them? Give me a break. Classic "conservative" rhetoric. Why did Bush invade Iraq in the first place? Talk about one of the biggest lies, disaster and human tragedy ever bestowed on the American public.

Iraq fell into despair when we invaded for no reason.

And the other classic conservative rhetoric- Obamacare. It's a shame that you and all of the other conservatives don't believe that ALL Americans should have access to health insurance. Not saying that it's perfect, and it does need reform. Problem is. I haven't heard anything from the conservatives on how they plan on doing that. It's been a nice talking point though.... the Obamacare boogie man which by the way has only been in effect since 2014.

I say this in all seriousness, I thank God every day I’m not this dimwitted and uninformed.

1. ISIS was not barnstorming through the Middle East during the Bush Presidency (nor were their sympathizers gunning down people in the streets of America). The reason why is quite clear and that is how one can blame Obama for ISIS

2. The United States did not “invade Iraq for no reason” In fact, the reasons for the invasion were articulated quite clearly in an AUMF that was supported by the entire leadership of the Democratic party.

3. Iraq was in such disrepair due to President Bush that Obama descried Iraq in 2011 as “stable and self-reliant” And, VP Biden said Iraq may very well turn out to be one of Obama’s biggest success stories. (because it wasn't in despair)

4. Your healthcare is not anyone’s problem but your own. I’m sorry that you don’t understand this, but Republicans don’t view it as the government’s job to provide every citizen healthcare. Mainly because it isn’t the government’s job and it isn’t something the government can do.

5. It is utterly comical (and sad) people like you actually believe that getting a government healthcare card means you will get to see a doctor. Well that is clearly not the case at all and these people aren't well served by the shitty ACA. Of course you know as much about healthcare as you do ISIS, economics, and well, anything political. Which is to say, nothing.

 

[ML Dog]

I say this in all seriousness, I thank God every day I’m not this dimwitted and uninformed.

1. ISIS was not barnstorming through the Middle East during the Bush Presidency (nor were their sympathizers gunning down people in the streets of America). The reason why is quite clear and that is how one can blame Obama for ISIS

2. The United States did not “invade Iraq for no reason” In fact, the reasons for the invasion were articulated quite clearly in an AUMF that was supported by the entire leadership of the Democratic party.

3. Iraq was in such disrepair due to President Bush that Obama descried Iraq in 2011 as “stable and self-reliant” And, VP Biden said Iraq may very well turn out to be one of Obama’s biggest success stories. (because it wasn't in despair)

4. Your healthcare is not anyone’s problem but your own. I’m sorry that you don’t understand this, but Republicans don’t view it as the government’s job to provide every citizen healthcare. Mainly because it isn’t the government’s job and it isn’t something the government can do.

5. It is utterly comical (and sad) people like you actually believe that getting a government healthcare card means you will get to see a doctor. Well that is clearly not the case at all and these people aren't well served by the shitty ACA. Of course you know as much about healthcare as you do ISIS, economics, and well, anything political. Which is to say, nothing.

"Oh SNAP."

​

 

[ML Dog]

 

[PatsFan1283]

eh, anyone advocating for MSA is incredibly short sighted
even if you're making double the current minimum wage, that isn't much money at all, and you will still be unable to pay for healthcare

and he offers no plans for what to do when someone shows up at an emergency department critically ill and cannot pay. because those people already flood the ERs and they will continue to at a higher rate. they are sick as shit because these are super old or homeless or alcoholics or iv drug abusers or disabled who cannot work and cannot take care of themselves. and while he might be soul less and be able to turn them away, i'm pretty sure all of my collegues would not be able to do so.

he wants incentives to be healthy...lol. again, i have no idea what this guy is talking about. it's like he only wants to see 18-45 year olds in his private practice office. also, this just goes back to the point that the cost of healthcare is far beyond what most people can pay out of pocket, and i would go so far as to saying that the majority of the middle class probably couldn't pay for a 3 day hospitalization out of pocket or with his stupid MSA plan.

what he also needs to realize is that not everyone's disease is preventable and for preventable diseases not everyone has equal access and time to things like a gym or healthier foods. hell, some people can't even read or have never gotten past middle school b/c they dropped out and have been working ever since. he obviously is clueless as to what some people in poverty are doing to hustle, ie. working two part time jobs just to make ends meet. they are trapped with a glass ceiling b/c they probably already have kids and at that point in life it's most likely 'checkmate, have fun grinding pennies out for the rest of your life' kind of situation. have they made bad decisions contributing to their situation? sure. but his retarded policy isn't going to help any. it also won't prevent socioeconomic inequality either. black people are already poor with the harshest penalties for non violent crimes like crack and weed, and they still are WORSE off with the highest rates of reincarceration (there's also a police bias in there but still). i feel that he is blaming people for their health problems and relabeling it with PC words like "empowering individuals" and "independent advocacy" is 100% a sham. at the end of the day, there is no power without money. and most people don't have money.

bottom line is health care costs have exceeded to such an extent that the middle class cannot to afford it. that is a huge problem. and no, privatization of health care is not going to improve the situation. yes it means more dollars in docs pockets, but it severely limits access to a select few. and honestly, who the fuck is going to be soul less enough to turn away a dying man or woman because he or she doesn't have insurance? his ideas are only going to get doctors in trouble and there will not be any sacred patient to doc relationship b/c no person could ever trust guys like him.

I couldn't read the post you are replying to because it didn't format well, but don't you think if more people paid for services out of pocket with insurance only used for catastrophic purposes that costs would go down?

Obviously some people are too sick for the insurance model and they just need to be subsidized but they shouldn't really be a part of the private insurance market.

I realize that isn't ideal for a lot of people, but a lot of stuff isn't ideal for a lot of people and we can't keep penalizing the rest of society for bad decisions. Otherwise you just create a culture where bad decisions aren't properly discouraged.

 

[halekulani]

I couldn't read the post you are replying to because it didn't format well, but don't you think if more people paid for services out of pocket with insurance only used for catastrophic purposes that costs would go down?

Obviously some people are too sick for the insurance model and they just need to be subsidized but they shouldn't really be a part of the private insurance market.

I realize that isn't ideal for a lot of people, but a lot of stuff isn't ideal for a lot of people and we can't keep penalizing the rest of society for bad decisions. Otherwise you just create a culture where bad decisions aren't properly discouraged.

depends what you want people to pay out of pocket for. and no that would be awful because most people dont want to pay for primary care, which is why the whole ACA and universal healthcare was started. the idea was to get people connected into primary care clinics to PREVENT diseases. first, nobody pays primary care well so nobody wants to do it, including myself. so what happens? the guy who has diabetes and high blood pressure doesn't go to a primary care because a) he wants to save money (paying a primary care visit for routine annual checkup is easily 200 bucks if not more) b) is not symptomatic (or at least not yet/ignoring symptoms) and he will end up in the emergency department with a heart attack, stroke, kidney failure, and ulcers on his skin leading to a severe infection requiring hospitalization. and again, there is a large misconception of what is the true problem in driving health care costs. the link i posted in my original reply says that 5% of people are responsible for 50% of health care costs. the top 1% of spenders account for 20+% of healthcare costs. the people that cost a lot are already sick as shit and constantly require advanced care. think about it, 95% of the population accounts for HALF of the money spent on healthcare. making people pay more out of pocket is really just punishing the 95% that don't really use medical services that much. but let me get back to your question. why is it important for everyone to have the basic insurance? the theory is that if everyone gets preventative care, we can reduce spending by the top 5% of users. the rising costs of private insurance spending often have to deal with the preventable diseases (ie. obesity) that plague the country.

https://archive.ahrq.gov/research/findings/factsheets/costs/expriach/

the older you get, the more medical expenditure you will have. that is an undeniable fact. how do you minimize expenditure? make sure old people have well managed chronic problems and keep them to the minimum. the emphasis is on primary care. remember, healthcare is good at resisting darwinism. we can keep people alive alot longer than they deserve, and trust me when i say that population is growing. as medicine advances, we will continue to improve on extending life. however, that is a price the country is going to have to pay exponentially. not just for preventative diseases, but for chronic serious ones as well that include the war against cancer. chronic myeloid leukemia used to kill at a decent rate but when gleevec came out (costs about 100k/year), i've had patients on it for over 10 years who are doing just fine. these prices aren't getting any cheaper. lives can be saved but i can't guarantee every life i save can repay society the cost of their treatment, even in their lifetime. when you start putting a price tag on a human life, the healthcare spending issue can be solved in a totally unethical manner. until then, good luck solving this incredibly complex problem.

 

[PatsFan1283]

Yeah, I understand what you are saying. Clearly we're good at keeping people alive even if they are sick and require tons of care. This drives up costs.

I would say medicare was flawed from the start and HSA's should've been covering peoples healthcare costs a long time ago and insurance covers high cost stuff, but obviously nobody really had a problem with being told the government would pick up the tab for them. Ponzi schemes are nice if you can get in on the ground floor. Sure a lot of people can't spend $3 on coffee or 60k a on a car anymore or live like slobs, but it is more sustainable long-term. I just don't know what other solution there would be. The healthy/working weren't going to be able to support the old and sick forever. It was a demographic time bomb waiting to happen but nobody cared since it didn't immediately effect them.


As far as primary care goes, someone needs to tell people that healthcare isn't free and you need to care for your own health. When you get an unexpected car repair and it costs 1,200 bucks, you aren't thrilled with that either but it's called life. If you don't want to get checkups or deal with warning signs then that is where personal responsibility comes in. People need to care for their own health. Yeah it sounds callous but there is no way the system would've gotten this far out of whack if these simple principles were in place.

As far as drug costs...
Something like Humira for arthritis or Gleevex for leukemia, why can't the cost trajectory for something like that go down? Once the patent expires can't the generic be less expensive? How is it 100k a month for this stuff?

When you have no incentive to bring down costs, they usually don't come down. MRI's are a good example of this, I realize the technology is very expensive but a lot of technology in other industries are very expensive as well and have come down over time because of competition. The healthcare industry just doesn't have enough competition when 80% of the costs are being paid by a 3rd party.

 

[PatsFan1283]

I'm not smart enough to go much further with the debate so I'll let whoever wants to add anything digest this

http://www.aei.org/wp-content/uploads/2015/12/Improving-Health-and-Health-Care-online.pdf

It is a good read even if you can only get through a fraction of it.

 

[halekulani]

Yeah, I understand what you are saying. Clearly we're good at keeping people alive even if they are sick and require tons of care. This drives up costs.

I would say medicare was flawed from the start and HSA's should've been covering peoples healthcare costs a long time ago and insurance covers high cost stuff, but obviously nobody really had a problem with being told the government would pick up the tab for them. Ponzi schemes are nice if you can get in on the ground floor. Sure a lot of people can't spend $3 on coffee or 60k a on a car anymore or live like slobs, but it is more sustainable long-term. I just don't know what other solution there would be. The healthy/working weren't going to be able to support the old and sick forever. It was a demographic time bomb waiting to happen but nobody cared since it didn't immediately effect them.


As far as primary care goes, someone needs to tell people that healthcare isn't free and you need to care for your own health. When you get an unexpected car repair and it costs 1,200 bucks, you aren't thrilled with that either but it's called life. If you don't want to get checkups or deal with warning signs then that is where personal responsibility comes in. People need to care for their own health. Yeah it sounds callous but there is no way the system would've gotten this far out of whack if these simple principles were in place.

As far as drug costs...
Something like Humira for arthritis or Gleevex for leukemia, why can't the cost trajectory for something like that go down? Once the patent expires can't the generic be less expensive? How is it 100k a month for this stuff?

When you have no incentive to bring down costs, they usually don't come down. MRI's are a good example of this, I realize the technology is very expensive but a lot of technology in other industries are very expensive as well and have come down over time because of competition. The healthcare industry just doesn't have enough competition when 80% of the costs are being paid by a 3rd party.

tbh, on one hand i completely agree with accountability for one's own health. on the other hand, it is a total setup for failure and is the reason why we are in this 5%/50% mess in the first place. you simply cannot depend on people to be reliable, especially when they have socioeconomic disadvantages that predispose them to poor health. the reason we have a small population spending so much is because of the lack of prevention leading to incredibly costly chronic diseases. the alternative is the emergency dept getting flooded for non urgent issues mixed with them doing primary care (which they are not trained to do) and admitting people to the hospital who never should have been admitted.

drug costs are high b/c investment is high (billions + years of research) and lots of money is spent to protect that intellectual property. MRIs are the least of medical cost problems imo. we have developed algorithms for working up diseases and diagnosing shit without an MRI. i think the public perception of what money is being spent on is completely off point. the drunk that has been sent to the emergency dept for the 10000th time and probably the 3rd time in the same day probably spent 1mil in ambulance rides alone. we have people who have heart failure that come in at least 4 times a year and 2 of those times within the same month. we have nursing homes filled with people who cannot take care of themselves. all of these people are the ones that cost billions. while i mentioned cancer care costs, it doesn't even touch a fraction of the every day common diseases that burden society.

when social security runs out or when the medicaid bill gets too high, people are going to be fucked. you have to invest into a infrastructure that supports the aging population and to make sure that they do not have advanced chronic diseases to minimize hospitalizations and utilization of health care resources. primary care is one of them. housing and home health are probably two of the main industries that really needs to advance to accommodate this population.

 

[Ricboff]

fascinating discussion......it's like start at point A, how long does someone last before blowing off in a vibrant tangent? .the question was, why is USA healthcare costs in outlier territory as compared to other westernized countries? amzing to read the various difference of opinions/solutions. ...... how can a system go so terribly wrong , inflating at a disturbing rate? It CANT be that hard to curtail costs, gimme a break. I'd imagine it would mean stepping on influential shoes-... brass balls for that ..............random thoughts.......dagone.........





one thing we all can agree on is this-- That the people involved in making legislature should be VOID of conflicts of interest. Lobbyists go fuck yourself . They are lobbying for THEIR financial interests, not for benefit of the country at large (lol). NO sector has enjoyed such prosperity than healthcare , check the 10-yr chart on xlv



healthcare is tricky-- tedious life/death/compassion/empathy stuff gets in the way. I think everyone would agree some sort of govt safety net is needed - in western countries we dont turn our back on the sick and old. The grossly negligent obese smoking drinker with no insurance ? ...don't help him? .... 'Okay grandma, i know your A1c level is off the charts, ya know i love ya but i got no monies, i'm month to month.. just go the hospital---they wont turn you away.'...dont help grandma?.......

obviously this has been brewing for awhile, nobody has been giving a shit cause the massive profits have been enjoyed in healthcare and the average folk hasnt been hit hard in the pocket--... shit finally hitting the fan?




that gentlemen who's letter i posted had some interesting thoughts. We reward folks with impeccable driving records with lower premiums. He was saying, do the same with healthcare? hmm, dunno, sounds odd.........it seems set-up to 'punish' the responsibly healthy, fiscally. This is socialized medicine, just a different shade,......family of 4 with no chronic disease , paying $2000/month with a $7,000 deductible ? with largely stagnant wages? in usa? SOMETHING HAS GONE MOTHER FUCKING WRONG--


price controls?.....The Maryland Solution.


ttp://www.beckershospitalreview.com/finance/has-maryland-found-a-solution-to-the-u-s-healthcare-cost-crisis.htmlh




big pharma has been amazing ...gotta free roll...fuckin' Gilead chaps......... Do we call them brilliant?


http://time.com/money/4406167/prescription-drug-prices-increase-why/

Prescription Drug Prices in America Are Rising Like No Other Industry


The high cost of prescription drugshas been causing pain and hardships for millions of Americans for years. And the situation appears to only be getting worse: Drug prices have risen an average of nearly 10% over the 12-month period ending in May 2016—a time when the overall inflation rate was just 1% in the U.S.
According to data cited by the Wall Street Journal, while food and alcohol prices have risen 2.8%, and clothing and accessories are up 5.7%, pharmaceutical prices have increased 9.8% in the past year.
Drug prices are ballooning to new highs even though Big Pharma is increasingly under more scrutiny from insurance companies, consumer groups, and American lawmakers—who are all, apparently, powerless to stop the price hikes. Prescription drug price increases of nearly 10% or more have hit American consumers for three years in a row.

It’s hard to imagine consumers would stand for such price hikes if it came to nearly any other kind of product. “You can’t take the price of the iPhone…up 10% a year,” Geoffrey Porges, a Leerink Partners LLC biotech analyst, told the WSJ.


But because medications are literally essential—patients could die without them—people have little choice but to pay up no matter what the price. The fact that more Americans have high-deductible health insurance plansmakes the situation more painful, as they’re generally on the hook for the full cost of prescriptions.
Meanwhile, a new report from Americans for Tax Fairness says that Gilead Sciences, the world’s sixth most valuable pharmaceutical company, has been gouging consumers, raking in billions in profits, and dodging U.S. taxes—all based on medications that were developed by taxpayer dollars


In an op-ed on Huffington Post, U.S. Sen. Bernie Sanders called attention to the study, and the fact that “a lifesaving product does no one any good if a patient cannot buy the medicine they need, and that is now happening far too often in the richest nation in the world.”
Gilead’s profits rose from $4.2 billion in 2013 to $21.7 billion in 2015; during the same time period its effective tax rate decreased from 27.3% to 16.4%. The company pulled off this magic trick by purchasing a company called Pharmasett, which makes the hepatitis C treatment drug Sovaldi, and whose owner, a nearly full-time federal employee, received at least $2.7 million in taxpayer money for research. After Gilead snatched up the company, it raised the price of Sovaldi through the roof, and “Gilead made its investment back in less than a year,” Sanders explained:

Gilead’s greed is particularly reprehensible because the American public paid for these drugs twice: first taxpayers bankrolled the research behind the hepatitis C drugs and then they paid a second time when Gilead decided to charge Americans the highest price in the world for the treatment.


Gilead also “appears to have engaged in a massive shift of profits offshore to dodge U.S. taxes,” at one point doing the seemingly impossible by reporting “more offshore profits than offshore revenues,” the Americans for Tax Fairness report states.
So “now Americans are getting cheated a third time as Gilead stashes its profits abroad to avoid taxes,” Sanders wrote.
And how do Gilead and other pharmaceutical companies get away with all of this? Well, it’s worth noting that Big Pharma spends more money lobbying American politicians than any other industry, by far.

......

 

[Ricboff]

tbh, on one hand i completely agree with accountability for one's own health. on the other hand, it is a total setup for failure and is the reason why we are in this 5%/50% mess in the first place. you simply cannot depend on people to be reliable, especially when they have socioeconomic disadvantages that predispose them to poor health. the reason we have a small population spending so much is because of the lack of prevention leading to incredibly costly chronic diseases. the alternative is the emergency dept getting flooded for non urgent issues mixed with them doing primary care (which they are not trained to do) and admitting people to the hospital who never should have been admitted.

drug costs are high b/c investment is high (billions + years of research) and lots of money is spent to protect that intellectual property. MRIs are the least of medical cost problems imo. we have developed algorithms for working up diseases and diagnosing shit without an MRI. i think the public perception of what money is being spent on is completely off point. the drunk that has been sent to the emergency dept for the 10000th time and probably the 3rd time in the same day probably spent 1mil in ambulance rides alone. we have people who have heart failure that come in at least 4 times a year and 2 of those times within the same month. we have nursing homes filled with people who cannot take care of themselves. all of these people are the ones that cost billions. while i mentioned cancer care costs, it doesn't even touch a fraction of the every day common diseases that burden society.

when social security runs out or when the medicaid bill gets too high, people are going to be fucked. you have to invest into a infrastructure that supports the aging population and to make sure that they do not have advanced chronic diseases to minimize hospitalizations and utilization of health care resources. primary care is one of them. housing and home health are probably two of the main industries that really needs to advance to accommodate this population.

medicine , in N America has never really been heavy on prevention. Sadly. Unlike dental. Perhaps that will change /is changing? Less smokers...less pop drinkers...............of course, US govt inadvertently helped fuel the obesity crisis with its nonsense foot pyramid, low-fat crap...absurd sugar levels in our foods. If they really gave a fuck they'd make changes in our groceries stores........