Has U.S. Democracy Been Trumped?

[helene_t]

Part of the problem is the profit motive behind hospitals

While at was at the Netherlands Cancer Institute, we frequently analysed US data sets and compared them to Dutch ones. Sometimes this led to bizarre findings. For example, I encountered a US brain metastatis patient that had some 20+ brain tumours that apparently had been treated individually at 20+ separate admissions. In the Netherlands, we would normally treat two and sometime three or four tumours individually, but normally bundled in single admissions. Patients with 5+ tumours would always get a single full-skull treatment.

 

I first thought it was a very unusual case or, more likely, a data management error, but my boss told me that it is normal practice since it allows hospitals to write 20+ invoices instead of one for basically the same treatment (except for the added delay and inconvenience to the patient who needs 20+ admissions instead of one).

[barmar]

Part of the problem is the profit motive behind hospitals

Yes, a big part of the problem is the profit motive throughout the medical industry. This in general distorts incentives for manufacturers and providers. It means that drug makers don't want to invest in cures for rare conditions, because there won't be enough sales to recover the costs. It means that hospitals encourage doctors to order more tests, but insurance companies discourage them (because they're footing the bills). I'm sure we've all heard horror stories of patients not getting necessary treatment, because their insurance company refused to pay.

 

Basic health care should not be market-driven, it should be a right of all citizens.

[Cyberyeti]

There is also the assumption that people will be insured and thus not bearing the cost, so the (for profit) hospitals push the costs up, insurance premiums go up and less people can afford them.

[Winstonm]

Yes, a big part of the problem is the profit motive throughout the medical industry. This in general distorts incentives for manufacturers and providers. It means that drug makers don't want to invest in cures for rare conditions, because there won't be enough sales to recover the costs. It means that hospitals encourage doctors to order more tests, but insurance companies discourage them (because they're footing the bills). I'm sure we've all heard horror stories of patients not getting necessary treatment, because their insurance company refused to pay.

 

Basic health care should not be market-driven, it should be a right of all citizens.

 

I agree but there are millions in the U.S. who disagree - at least at the ballot box, even when they don't know that Obamacare and the ACA are the same things.

[olegru]

Goes to show that context is everything.

 

There's probably a number of bridge players with "NO TRUMP" license plates. I wonder how many of them are Republicans who now regret it.

Hi Barry, the next day after we drop out of WZ pair, I played with George.

After disagreement on one hand I made my revenge by buying and wearing "No Trump" cap. :)

[Winstonm]

There is also the assumption that people will be insured and thus not bearing the cost, so the (for profit) hospitals push the costs up, insurance premiums go up and less people can afford them.

 

Having worked in the health industry, I have always found it ironic that Sarah Palin put forth the concept of government "death panels" as something new when there already is an insurance company death panel: the board of directors.

 

So, when it comes to that $1 million treatment for cancer, would you rather have the government decide if it is necessary or do you trust Wall Street to make that decision?

[jogs]

This I hadn't heard of. I assume that would have been done by lowering the age of eligibility?

 

What I did read a lot about was the expansion of Medicaid, which would have covered people of all ages. Similarly, it was refused by many states. How do you go to the electorate and say, "the federal government offered to cover you, at no cost to the state or to you as an individual, but we said no thanks". Oh wait, the people affected are poor, and in many of these states they can't vote.

 

It was expansion of Medicaid. The federal government offered to cover the cost for a limited time. Then the cost goes to the state. Governors said no thanks.

[Winstonm]

The states that refused to expand Medicaid coverage were primarily the same ones that opposed the ACA, i.e., Republican-controlled states. This was not a fiscal decision but an ideologically-drive one, and that decision has not turned out so swell for those states.

 

It is ironic that these states that cared so little about their poor citizens that they ignored those persons' needs in favor of participation in a partisan anti-Obamacare solidarity strike have found their Medicaid costs rising twice that of the states that did expand their Medicaid. Turns out expansion was a positive for the states and the poor of those states and not the financial catastrophe predicted.

 

A Kaiser Family Foundation survey of Medicaid directors in all 50 states and Washington, D.C., showed that those that didn't broaden coverage saw their Medicaid costs rise 6.9 percent in the fiscal year that ended Sept. 30. The 29 states that took President Obama up on his offer to foot the bill for expanding Medicaid saw their costs rise only 3.4 percent.

 

That modest increase in Medicaid spending in the expansion states came even as the rate of Medicaid participation rose 18 percent, three times as much as the states sitting out.

[rmnka447]

You are wrong. The ACA (known as Obamacare) expanded Medicaid, not Medicare. There was a slight benefit added to Medicare - wellness visits - but the expansion was in Medicaid. This is the part that most Republican controlled states refused to do which led to the S.C. ruling that allowed the federal government to start exchanges for those states that refused to comply.

 

Two major problems with funding Medicare and Social Security is the earnings cap of $118,500 on FICA taxes, and that the wealthy do not have to pay taxes on capital gains into these social programs.

My response was in response to and in terms of a post that suggested expanding Medicare to cover everyone as a solution to the healthcare issue. In another comment, I pointed out that Medicaid not Medicare was the program expanded in ACA.

 

You forget to mention that in order to make ACA work, they cut Medicare by $786MM in reduced payments for services so the funds could be diverted to help fund ACA.

 

Indeed, Warren Buffett has suggested that the caps on FICA taxes be eliminated as a means of extending the viability of Medicare and Social Security. But no one seems to be willing to get out front of that suggestion by proposing legislation. With the political polarization, addressing how to make entitlement programs sustainable is impossible. So likely no solution will be faced until we reach a critical point of failure of these programs.

[rmnka447]

I agree but there are millions in the U.S. who disagree - at least at the ballot box, even when they don't know that Obamacare and the ACA are the same things.

A significant number of voters voted as they did because Obamacare/ACA failed them.

 

If you will recall, when Obamacare was proposed, proponents made a great deal of hay about how people in the individual insurance market were forced into "fake insurance" -- insurance policies with high premiums and high deductibles without great coverage. They averred how ACA would fix that.

 

Well, it hasn't. ACA can say it has increased healthcare insurance coverage, but unless that coverage results in actual patient care then it really is a phony claim. Healthcare implies care not just coverage. So the critical issue is "What is the care delivered to the patient?" If you have insurance with all the coverages you could imagine but the deductible precludes you from obtaining that care, then the insurance is really just as "fake insurance" as before ACA. Voters who are in this situation recognized this and voted accordingly.

 

Perhaps the most poignant examples occurred on a town hall debate between Bernie Sanders and Ted Cruz on healthcare.

 

A woman who was a nurse said that her family policy through ACA cost her $800/month and had a $9000 deductible. She said that she had had some screening tests that indicated she might have a specific cancer. However, follow up testing to confirm and define the cancer costs several thousand dollars. Because of the deductible and her financial situation, she can't afford to pay for the tests, so must go on not knowing if she does have a cancer growing inside of her that will eventually kill her and leave her children motherless.

 

To be fair, OTOH, another woman with MS said that private insurance that she could get wouldn't cover an MS drug she needed that would help her have some semblance of a normal life. She was able to qualify for Medicaid under ACA. Medicaid did allow her to obtain this drug, so she's back to a pretty normal life.

 

These two women probably define the ends of the spectrum of healthcare issues. How do we make sure both obtain/keep the right medical care?

[rmnka447]

Having worked in the health industry, I have always found it ironic that Sarah Palin put forth the concept of government "death panels" as something new when there already is an insurance company death panel: the board of directors.

 

So, when it comes to that $1 million treatment for cancer, would you rather have the government decide if it is necessary or do you trust Wall Street to make that decision?

If you believe in healthcare as a right, then neither insurance company board of directors nor Wall Street nor the government should make that decision. It should be a decision between the doctor and the patient. Bureaucrats are just as likely to make arbitrary and poor decisions as businessmen. If you don't believe that, then maybe you should take a look at the VA.

[Winstonm]

If you believe in healthcare as a right, then neither insurance company board of directors nor Wall Street nor the government should make that decision. It should be a decision between the doctor and the patient. Bureaucrats are just as likely to make arbitrary and poor decisions as businessmen. If you don't believe that, then maybe you should take a look at the VA.

 

Maybe you should talk to doctors (as I have) who work in Canada where medical decisions are made by doctors and patients.

[PassedOut]

You forget to mention that in order to make ACA work, they cut Medicare by $786MM in reduced payments for services so the funds could be diverted to help fund ACA.

That's not correct.

 

The ACA cut subsidies to the Medicare Advantage plans set up by private insurers to compete with Medicare. Those subsidies originally had been intended to be temporary to allow the companies to ramp up against the existing government Medicare program. Once established, though, the private insurers then insisted that eliminating those subsidies would put them out of business against the more efficient government program.

 

In fact, the subsidies have not been cut by the amounts originally projected. Instead, congress eliminated subsidies to insurers in the health insurance exchanges, subsidies that had been earmarked by the ACA to protect insurers against losses, thereby undermining the ACA (as congress intended to do). That's why some insurers are dropping out of the exchanges.

 

The private Medicare Advantage plans are still going strong, taking profits from the payments to Medicare.

[rmnka447]

Maybe you should talk to doctors (as I have) who work in Canada where medical decisions are made by doctors and patients.

Which means what?

 

I'm sure we'd all love to hear what you've heard about this from them. I'm under the impression that Canada has been held up by some as an example of how healthcare should work.

[Winstonm]

Which means what?

 

I'm sure we'd all love to hear what you've heard about this from them. I'm under the impression that Canada has been held up by some as an example of how healthcare should work.

 

The doctors I've talked to who worked in Canada loved the system as it removed the pay-for-services model of U.S. medicine and replaced it with a doctor/patient care model. In that system, there was no reward for the doctors to order unnecessary tests nor restrictions on necessary tests.

 

Note, this was only the doctors' viewpoint and did not have anything to do with affordability to the government.

[jogs]

There seem to be funding problems associated with all of the US attempts to provide health care. Since other western nations seem to be able to handle the problem it is obvious that the US is missing something, or there is something in the US system that precludes a straight forward solution. What is it?

Maybe it is because the USA provides the defense of the entire western world.

[ldrews]

Maybe it is because the USA provides the defense of the entire western world.

 

Which I think the USA should stop doing.

[mike777]

Yes, a big part of the problem is the profit motive throughout the medical industry. This in general distorts incentives for manufacturers and providers. It means that drug makers don't want to invest in cures for rare conditions, because there won't be enough sales to recover the costs. It means that hospitals encourage doctors to order more tests, but insurance companies discourage them (because they're footing the bills). I'm sure we've all heard horror stories of patients not getting necessary treatment, because their insurance company refused to pay.

 

Basic health care should not be market-driven, it should be a right of all citizens.

 

 

I think you hit the nail on the head if health care is not market driven......who or what drives it?

 

At this point your post does not answer that.

 

The alternative is a KING/Queen drives it.

 

 

today I just read an opinion piece in my local paper that makes your point...markets should not drive medicare

 

Medicare is and continues to be a godsend for many many people...don't make it market driven, make it a right

[mike777]

The doctors I've talked to who worked in Canada loved the system as it removed the pay-for-services model of U.S. medicine and replaced it with a doctor/patient care model. In that system, there was no reward for the doctors to order unnecessary tests nor restrictions on necessary tests.

 

Note, this was only the doctors' viewpoint and did not have anything to do with affordability to the government.

 

 

As jWinston points out if the docs love that should be enough....I just would like to hear more from these docs

 

 

not sure how to get rid of all of these "unecessary tests"....I married into a family...a large Irish law family that makes money on both sides of the issue, both sides

 

 

perhaps and this is only a guess, not proof.....tech, robots....etc

 

 

see Watson as an early first step

 

http://www.ibm.com/developerworks/library/os-ind-watson/index.html

[mike777]

If you believe in healthcare as a right, then neither insurance company board of directors nor Wall Street nor the government should make that decision. It should be a decision between the doctor and the patient. Bureaucrats are just as likely to make arbitrary and poor decisions as businessmen. If you don't believe that, then maybe you should take a look at the VA.

 

NOt sure why you limit the decision to only two people.....both docs and patients are prone to errors, now you suggest we add the errors

 

 

Taleb discusses this GOD(doctor\patient) issue in more depth in his books.

 

 

When we are sick, really really sick we don't really like to hear just how little docs know as a matter of science about our illness

 

We don't really like to hear bout the mistakes our docs or our local hospitals make on a daily basis.

 

basic mistakes such as spreading illness from room to room....

 

 

Taleb does a good job discussing this issue.

[mike777]

Which I think the USA should stop doing.

 

 

old question but still valid...if not your family and my family ...then whose?

[y66]

From Vox Sentences:

 

When Attorney General Jeff Sessions recused himself from election-related investigations Thursday, he reiterated that he had met with Russian Ambassador Sergey Kislyak only in his capacity as a member of the Senate Armed Services Committee. Except on Thursday night, the Wall Street Journal reported that Sessions used campaign funds to attend the Republican National Committee in Cleveland, where he met with Kislyak. [WSJ / Paul Sonne, Rebecca Ballhaus, and Carol E. Lee]

 

The funds revelation, combined with the coincidence of Sessions's conversations with Kislyak and major shifts in his own and Trump's positions on Russia, certainly calls into question the idea that this was exclusively a matter of Senate business. [Vox / Matt Yglesias]

 

Democrats on the Senate Judiciary Committee have asked that Sessions be told to testify again to explain himself. Judiciary Committee Chair Chuck Grassley (R-IA) isn't playing ball. [The Hill / Jordain Carney]

 

The Trump administration maintains that Trump himself wasn't involved in any of these contacts. Trump's response has been to tweet, from both his and the official @POTUS Twitter accounts, photos of leading congressional Democrats meeting with Kislyak and "demanding" that the Democrats be investigated. [Vox / German Lopez]

 

(The fact that the president does not appear to be serious when he says he demands an investigation into his political opponents is not comforting! But apparently trolling as diplomacy is a thing now; in response to a meme in which Sarah Jessica Parker's character from Sex and the City is pictured musing why everyone is meeting with the Russian ambassador but her, the official Ministry of Foreign Affairs Twitter account posted, "Sarah, if you want it so much, we can help you meet Russian Ambassador.") [Ministry of Foreign Affairs of the Russian Federation via Twitter]

 

But Trump should maybe not be so cavalier about this. On Thursday, former campaign aide J.D. Gordon claimed that Trump had personally asked to change the language in the Republican platform to take a softer stance on Russia's invasion of Ukraine. The Trump campaign had earlier denied Trump's involvement; if the president asked the language to be changed to be friendlier to Russia, and then lied about it, that's not a good thing. [TPM / Allegra Kirkland]

This New Yorker story Trump, Putin and the New Cold War -- What lay behind Russia’s interference in the 2016 election—and what lies ahead? makes the case that Russia's "active measures", which no reasonable analyst considers to have played a dominant role in the ascent of Trump and nationalist politicians in Europe, are an increasingly effective tool for creating "turbulence" in the West. Not news, of course, but still an interesting read.

[Winstonm]

I think you hit the nail on the head if health care is not market driven......who or what drives it?

 

At this point your post does not answer that.

 

The alternative is a KING/Queen drives it.

 

 

today I just read an opinion piece in my local paper that makes your point...markets should not drive medicare

 

Medicare is and continues to be a godsend for many many people...don't make it market driven, make it a right

 

 

What drives healthcare is the same thing that drives all human behavior - interest and need. Advances in research are made by people who have a fascination with their subject and inquisitive minds. Not everyone on the planet is looking to become the next billionaire.

 

Kings and Queens or markets are not necessary to motivate an inquisitive mind.

[Winstonm]

Maybe it is because the USA provides the defense of the entire western world.

 

The troops taking back Mosul from ISIS are from Iraq. NATO still helps to protect Europe. Sweden just re-instituted its draft because of increased Russian aggression.

 

The U.S. leads the West and spends too much IMO on defense, but we are not the sole defense for the western world.

[ldrews]

The troops taking back Mosul from ISIS are from Iraq. NATO still helps to protect Europe. Sweden just re-instituted its draft because of increased Russian aggression.

 

The U.S. leads the West and spends too much IMO on defense, but we are not the sole defense for the western world.

 

I would take that a step further: The US should not be the primary or dominant defender of the western world. The western world is now prosperous enough to look to its own defense. The US should constrain itself to do the same.