Health care - administrative incompetence

[kellyb]

Expertise and advice <> health care. We aren't sending doctors over there to care for patients for free. That's what charities are for.

We're sending MONEY over there to do stuff like this:

Funding for two other health sectors are rising, but far more modestly than
HIV/AIDS programs. Child Survival and Maternal Health projects aim to reduce
infant mortality by, among other interventions, decreasing the incidence of acute
respiratory infections, diarrheal disease, measles, and other illnesses that occur in the
first 28 days of life and combating malnutrition, and to improve the quality of child
delivery facilities and raise nutritional levels of mothers. Funding for these activities
has grown by 27% in the past four years. Congress has placed special attention on
other infectious disease activities — mainly those addressing malaria and
tuberculosis — increasing spending by 43% since FY2001.

You think it "doesn't count" unless we're sending American DOCTORS over there? WTH?

 

[xjx388]

xjx388: This is the third time I've asked the above.

I'm not ok with it.

 

[xjx388]

We're sending MONEY over there to do stuff like this:



You think it "doesn't count" unless we're sending American DOCTORS over there? WTH?

The claim was that the US sends "Health Care" overseas. We don't do that. We send experts to advise other countries on how to improve their own systems and outcomes. Advice on improvement <> Health Care.

ETA: We also give them some cash to help implement the programs. Still not the same.

 

[Mongrel]

Every time I read these threads a few things always spring into my head... (anecdotes)

Before I met the American culture I knew loads of people who were diabetic, it wasn't till I was exposed to US TV shows and interactions on forums that diabetes could mean amputation. All I knew was that diabetics meant you had to be careful of your feet.

Frequenting another board aimed at customer facing jobs, I always took it for granted that "I get ill, **** happens". On there I see people going through college, taking on two crappy retail jobs and panicking because they're ill because they've got no medical insurance. Leaving aside the atrocious "at-will" and no sick pay (which is another discussion entirely, so no derails) I don't think anyone should have to make the decision "Should I eat or should I get my asthma\diabetes meds" in any country that purports to be civilised.

I also have a friend that suffers from a rare\unusual degenerative eye condition, his parents are adequately well off -nice house but nothing to write home about. His 'guy' for this is the top Optometrists in the country for that (admittedly rare) disease. If my friend had been in the US when he was growing up then his parents would have been bankrupt by the time he was 12 and then he'd have been told "You're blind, live with it"
(see Stephen Hawking;

'People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.'

)


Un-anecdotally, most of the NHS is transparent - if I knew where to look I could feel gypped that my Omeprazole is £1.81 for a months supply and I got charged £7.20 but then my friends Methotrexate cost the same but costs the NHS £53.67 it's not so bad, and he's probably on it for the rest of his life.

So, here in the UK we spend far less per person for healthcare (and we can pay more if we wish to go private) and we noticeably outperform you on most measurable factors. Tell me again why is your way better?

 

[kellyb]

The claim was that the US sends "Health Care" overseas. We don't do that. We send experts to advise other countries on how to improve their own systems and outcomes. Advice on improvement <> Health Care.

ETA: We also give them some cash to help implement the programs. Still not the same.

You think we're spending billions of dollars on advice? Really?

What do you think cash to implement the programs" means?

Again, sending cash to pay for drugs and medical care "doesn't count" because...why?

 

[Ducky]

To respond directly to that post, I need him to clarify some numbers. He says $1.2 million. 1. Is this what the bills amounted to? 2. How much of that did the insurance pay? 3. How much was written off? And 4. How much do you personally owe? There is a lot of padding in medical bills because of the system we currently have. 1.2mil may actually be $500000 of which he would be responsible for $100000 or so. Big difference. It's hard to debate with ink the 1.2mil number.

No, you don't get to hand wave this. I gave you the scenario, I gave you a set of numbers which is roughly my scenario. What you chose to do is ignore it because you realize at some point you would have to say directly to someone having medical related debt problems they aren't worth their treatments. So, if you want to actually address what I asked, I will repost again for you:

So again: How should I have been budgeting for my situation? What personal irresponsibility is to blame for my getting multiple myeloma, having a chunk of spine replaced, learning to walk again and overall medical costs for 7 years of treatment and recovery at 1.2 million (ETA: Of which I personally owe quite a bit, but not all)? What, exactly, do we do about people currently embroiled in out of control medical debt?

Exactly what fiscal or personal irresponsibility is it I can look to in my past and say "yes, were it not for that choice I would not be facing more in medical debt than most people face in their mortgage."?

How is it we are to encourage startup businesses if those starting one cannot possibly hope to have their business survive an illness?

Every time I have asked these questions, you have ignored all or part of the post to respond completely inadequately for a discussion on the matter. I don't think you even read them, because I gave you rough numbers to work with. Here's hint though, detailed number or not, the point is not the budget you jump through hoops to come up with, it's the point that there is no budget I could ever have possibly have had to save for this. That makes your whole argument for a catastrophe fund complete bunk. If you care to do re-address this I will consider further discussion but at this point your behavior doesn't demonstrate to me you're interested in anything but furthering an "us v. them" internet fight where you get to score points for your side.

Which is what I see in pretty much every thread related to either health care or politics on this forum. You're par for the course, there, so shine on you crazy diamond.

 

[kellyb]

So, here in the UK we spend far less per person for healthcare (and we can pay more if we wish to go private) and we noticeably outperform you on most measurable factors. Tell me again why is your way better?

Because taxes are taken at gunpoint, which is theft...armed robbery. People who advocate armed robbery are evil.

That's the meat of the issue. That's the mentality that prohibits UHC in the US.

 

[kellyb]

No, you don't get to hand wave this. I gave you the scenario, I gave you a set of numbers which is roughly my scenario. What you chose to do is ignore it because you realize at some point you would have to say directly to someone having medical related debt problems they aren't worth their treatments. So, if you want to actually address what I asked, I will repost again for you:



Every time I have asked these questions, you have ignored all or part of the post to respond completely inadequately for a discussion on the matter. I don't think you even read them, because I gave you rough numbers to work with. Here's hint though, detailed number or not, the point is not the budget you jump through hoops to come up with, it's the point that there is no budget I could ever have possibly have had to save for this. That makes your whole argument for a catastrophe fund complete bunk. If you care to do re-address this I will consider further discussion but at this point your behavior doesn't demonstrate to me you're interested in anything but furthering an "us v. them" internet fight where you get to score points for your side.

Which is what I see in pretty much every thread related to either health care or politics on this forum. You're par for the course, there, so shine on you crazy diamond.

He just lacks the courage to state what he believes:

"You should be dead, Ducky. That you could get out of this debt by filing for bankruptcy is unjust to people like me. You should have been able to pay for your treatment or die. Now, kindly **** off."

God Bless the USA.

 

[xjx388]

You think we're spending billions of dollars on advice? Really?

What do you think cash to implement the programs" means?

Again, sending cash to pay for drugs and medical care "doesn't count" because...why?

Yes. We are spending $63 billion over 6 years to send experts all over the world to tell them how to run things. Do you deny this? We are also giving them cash for them to implement health initiatives based on this advice. This is not the same thing as "providing healthcare."

Anyway, why do you think this is relevant to the effectiveness of our health system?

 

[Uncayimmy]

Yes. We are spending $63 billion over 6 years to send experts all over the world to tell them how to run things. Do you deny this? We are also giving them cash for them to implement health initiatives based on this advice. This is not the same thing as "providing healthcare."

You have a nasty habit of not reading your own sources. Here are just a couple of bullet points showing how wrong you are. The USA is not spending $63B on just giving advice.

http://www.pepfar.gov/documents/organization/136504.pdf
Provide direct support for more than 4 million people on anti-retroviral treatment;

Provide direct support for care for more than 12 million people, including 5 million orphans and vulnerable children;

Tuberculosis (TB): Save approximately 1.3 million lives by reducing TB prevalence by 50 percent. This will involve treating 2.6 million new TB cases and 57,200 multi-drug resistant (MDR) cases of TB.

 

[kellyb]

Yes. We are spending $63 billion over 6 years to send experts all over the world to tell them how to run things. Do you deny this? We are also giving them cash for them to implement health initiatives based on this advice. This is not the same thing as "providing healthcare."

Anyway, why do you think this is relevant to the effectiveness of our health system?

How is "giving them cash for them to implement health initiatives" not "providing healthcare"?

And this is relevant to the question of "health care as a right", not the trainwreck monster that is the US health care "system".

 

[xjx388]

Every time I have asked these questions, you have ignored all or part of the post to respond completely inadequately for a discussion on the matter. I don't think you even read them, because I gave you rough numbers to work with. Here's hint though, detailed number or not, the point is not the budget you jump through hoops to come up with, it's the point that there is no budget I could ever have possibly have had to save for this. That makes your whole argument for a catastrophe fund complete bunk.

Savings + Catasrophic insurance + Free Market = Lower costs so you don't have to save up ridiculous sums. For your current debt, let's give the doctors/hospitals you owe a tax break to write-off all or part of your debt. As for irresponsibility in your past, I can't make judgements on that because I don't know you. You didn't necessarily have to be irresponsible; you're probably just a victim of our current system.

If you care to do re-address this I will consider further discussion but at this point your behavior doesn't demonstrate to me you're interested in anything but furthering an "us v. them" internet fight where you get to score points for your side.

Which is what I see in pretty much every thread related to either health care or politics on this forum. You're par for the course, there, so shine on you crazy diamond.

I'm interested in debating the best way to improve healthcare in America. I'm interested in discussing healthcare/medicine in general. I'm not interested in flame wars, "us vs. them," or just fighting with people for the sport of it.

 

[xjx388]

You have a nasty habit of not reading your own sources. Here are just a couple of bullet points showing how wrong you are. The USA is not spending $63B on just giving advice.

Those are "targets" for improvement. The way they accomplish this is by 1)Advising each country's health officials and 2)Providing funds for said officials to carry out said advice. It doesn't mean the US is actually going to treat anyone. The countries we provide aid to are actually providing the health care. It's a subtle but important distinction. But this is a huge derail. Tell me how foreign aid has anything to do with the healthcare of Americans or administrative inefficiencies in it's provision.

 

[kellyb]

Savings + Catasrophic insurance + Free Market = Lower costs so you don't have to save up ridiculous sums

Can you tell me how a hypothetical "free market" in healthcare can operate alongside a third party payer (insurance)?

How are they compatible? With insurance in health care, you have other people deciding how to spend your money on other people's health care. How is that a free market?

 

[FattyCatty]

Where do you think his pharmacy gets the bulk of it's income from?

I don't know. I was waiting for your evidence (different from an assumption) that it was the government.

It's not OK for corporate CEOs to make a ton of money? How do you figure that, but at the same time have no problem with Tom Brady making $8mil?

I didn't know who Tom Brady was and had to Google him. He's not making his money at the expense of those needing health care.

Expertise and advice <> health care. We aren't sending doctors over there to care for patients for free. That's what charities are for.

The USAID funding includes amounts for treatment and care.

General welfare of the United States. Pursuit of happiness not happiness.

Promote the general welfare (from the Preamble to the Constitution) would seem to include food, shelter, health care. Not "pursuit of happiness," but, from the Declaration of Independence, "...such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness." And from Article One, Section 8, of the Constitution, "...provide for the common defense and general welfare of the United States...." The United States includes its citizens; as I said before, I believe "general welfare" includes food, shelter, and health care.

So basic healthcare = liver transplants but not breast cancer drugs that extend life?

Well, in Arizona, apparently basic health care doesn't include liver or other transplants. On purely economic grounds, of course. Just as apparently, in the UK it does. As for breast cancer drugs that "extend life," that is a question that in the US the "health care provider" (aka, insurance company) would have to decide. Since they are mostly for-profit entities, it's anyone's guess whether or not they would approve the drug. Even if approved, there would probably be at least a 20% copay, which many people (including your straw-woman from the UK) wouldn't be able to afford. Or if the person had no insurance, the full cost not only of the medicine, but of the preceding doctor's visits (including oncologist), chemotherapy, and radiation treatment. So what happens if they have no insurance and cannot afford these bills? Under your stated philosophy, it's tough luck, you should have saved, drop dead. I'd rather have the philosophy of the UK and other civilized countries.

Oh, sorry. It's successfully feeding and housing 99.8% of all American citizens. Pretty damn good.

With a U.S. 2010 population of 308,745,538, I get 15.9% in danger of hunger; 5.6% actually experiencing hunger; 0.2% homeless (based on single-night numbers); and 0.5% homeless (numbers over a year). Pretty damn bad when 49.1 million people are in danger of suffering from hunger and 17.5 million actually do suffer from hunger. Pretty damn bad when 1.56 million people over the course of a year are homeless and 643,067 people are homeless on a single night.

 

[kellyb]

Those are "targets" for improvement. The way they accomplish this is by 1)Advising each country's health officials and 2)Providing funds for said officials to carry out said advice. It doesn't mean the US is actually going to treat anyone. The countries we provide aid to are actually providing the health care. It's a subtle but important distinction. But this is a huge derail. Tell me how foreign aid has anything to do with the healthcare of Americans or administrative inefficiencies in it's provision.

How in the world is providing funds to pay for health care not "providing health care"?

WTF?

But this is a huge derail. Tell me how foreign aid has anything to do with the healthcare of Americans or administrative inefficiencies in it's provision.

At this point, I think this is mostly just useful for pointing out to you how intellectually dishonest you can be.
Instead of putting a coherent argument forward about "health care as a right" and USG policy, you're trying to say that funding health care isn't actually "providing" health care. And you probably don't see how warped that appears from the outside.

 

[xjx388]

How is "giving them cash for them to implement health initiatives" not "providing healthcare"?

And this is relevant to the question of "health care as a right", not the trainwreck monster that is the US health care "system".

OK, let's go that way. The health care we are providing overseas is what I would consider basic: Immunizations, safe water, more sanitary conditions, improving infant mortality, teaching them how to treat diseases, etc. We don't pay for their liver transplants, do their cancer surgeries etc.

 

[xjx388]

How in the world is providing funds to pay for health care not "providing health care"?

WTF?



At this point, I think this is mostly just useful for pointing out to you how intellectually dishonest you can be.
Instead of putting a coherent argument forward about "health care as a right" and USG policy, you're trying to say that funding health care isn't actually "providing" health care. And you probably don't see how warped that appears from the outside.

OK, fine. We provide healthcare overseas. Happy now? This still proves nothing about how health care is a right, unless you are talking about the right to clean water, sanitation, etc. Are we paying for liver transplants overseas?

 

[kellyb]

OK, let's go that way. The health care we are providing overseas is what I would consider basic: Immunizations, safe water, more sanitary conditions, improving infant mortality, teaching them how to treat diseases, etc. We don't pay for their liver transplants, do their cancer surgeries etc.

We pay for HIV drugs, too.
By "OK, let's go that way." do you mean "I was in error"?

 

[Ducky]

Savings + Catasrophic insurance + Free Market = Lower costs so you don't have to save up ridiculous sums. For your current debt, let's give the doctors/hospitals you owe a tax break to write-off all or part of your debt. As for irresponsibility in your past, I can't make judgements on that because I don't know you. You didn't necessarily have to be irresponsible; you're probably just a victim of our current system.


I'm interested in debating the best way to improve healthcare in America. I'm interested in discussing healthcare/medicine in general. I'm not interested in flame wars, "us vs. them," or just fighting with people for the sport of it.

That's quite a bit of back pedaling on your earlier statement:

If healthcare is so much of a universal need, then why don't individuals prioritize it in their budgets? I hear a lot about how uninsured people struggle to pay their health bills. Well, let me ask you this: How many of those uninsured (or even insured) people are saving anything towards their future health care needs? If it's such an important universal need, why do they spend so much money on cigarettes, HD TV, sporting events, alcohol -all the luxuries? Until we tell people that "Your own healthcare is your own financial responsibility," things will never get better. Individual budgets should prioritize Food, Shelter and Healthcare, everything else is disposable.

Oddly, you did acknowledge the flaw:

There is no way you could have budgeted for your condition in our current system. I acknowledge this.

And yet:

What about a system in which people are mostly responsible for their healthcare but must purchase a catastrophic insurance plan that kicks in once their expenses reach a certain level, which the person can choose.

How would I have chosen anywhere near correctly not knowing what it is I will become ill with?

And you still haven't answered my questions. The answer to people who can't afford health care costs is to get more insurance? Really? Then they should budget more? Because current insurance companies drop coverage, have caps, do everything they can not to pay out, why wouldn't someone's catastrophic insurance have the same issues? And catastrophic coverage doesn't change the fact that ongoing illnesses will still put them in huge financial hardship. Once you hit your catastrophic cap, if you're still sick you will still have medical costs.

Then of course you advocate people just go without:

I don't. I save large amounts of money per month and have a catastrophic health insurance plan, not a traditional plan. I think it's the best of both worlds. I still pool my money with others, but at very little cost to me. Yet, I'm covered if something goes horribly wrong.

I also have a very different philosophy than most posters here. I don't want to overly burden anyone with my health care. If I get cancer and I can't pay for it myself, I'm OK with the fact that I will die. I'm going to die anyway, right? As for my kids and wife, that's a little harder to admit to, but the concept remains. I'm loathe to stick my hand in your pocket to take care of my problems. If you volunteer your help out of the kindness of your heart, that's one thing and I'm appreciative. I'll pay you back any way I can. But I don't think the government should threaten you with incarceration to pay my medical bills.

Let me make this absolutely clear: Your original point was that people should be fiscally responsible enough to budget for future health care costs above their own insurance. You then said if it is not affordable you think the best choice is to go without, demonstrated by the importance you would place on this idea...applying it to yourself.

I owe more in 7 years of medical debt than 90-95% of America pays for their house over 30 years. There is no ability to assign irresponsibility for my medical condition unless you can tell me how my actions 1) lead to me getting multiple myeloma (hint: you can't) or 2) how I could possibly have saved that amount and yet frittered it away on tobacco and big screen tv's (as you pointed out in the following quote.)

It's not a fantasy. The average person spends about $2100 on entertainment, alcohol and tobacco and about $2010 on healthcare.

Future coverage is questionable at best unless I sneak in on a group plan and my condition gets expensive. I'll probably never be able to own a house and I sure won't get approved for any credit so that leaves me without another avenue of budgeting. Are you saying that once remission is shown to be over if I cannot afford to pay for my treatments I should go without?

You also never addressed my points regarding small businesses and the encouragement of market growth and competition via small businesses. How would we best serve markets if people won't take the chance of going out of business just because of illness or medical costs?

If you were actually interested in debating I probably would have seen you at least acknowledge the numerous posts either pointing out your sourced cites were not saying what you thought, or the posts giving you new and specific evidence in refutation of your fast held belief that health care could possibly be a free market commodity.

All I really see are right-wing talk-radio bullet-points and hand waving. My prediction is that even if you are cornered, you won't admit your error you'll simply say "ok fine...." and wave hands more.