Health care - administrative incompetence

[Agatha]

That's crazy - it'd be in my interest NOT to work over there just so I could get a minimum level of care, whereas here my healthcare costs are completely covered whether I work or not. I prefer working and being a productive member of society, but I'll never earn a lot of money and I'd never be able to earn enough to cover my healthcare costs there, so I'd be better off not working and getting Medicaid. How can that be a good thing?

You're condemning people to staying economically inactive if they are ill, it's a poverty trap. AIUI Medicaid covers the basics so I doubt the colostomy I had when things were bad would ever be reversed - I'd still be pooping into a bag.

Your system is broken, people - nobody's saying ours is perfect or that our NHS is the system you should emulate, but there must be a better way.

 

[Uncayimmy]

Meanwhile people like Ducky and bookitty demonstrate how they get let down by the system, and there is little outcry, because it is not news.

EDIT: because, further to Rolfe's post, the system is so utterly broken.

The posters from the rest of the OECD have taken collective responsibility for tehir healthcare, buy ensuring that their governments supply it.

But they weren't let down. They had the same "access" to health care as everyone else, as defined by someone who would rather let his family die than rely on tax dollars taken with the threat of incarceration to pay for treatment. Apparently, though, this same someone is okay with tax dollars being spent to educate folks like Ducky to become doctors and then more tax dollars being spent to do all the research that Ducky could then resell to patients for a huge profit, which in turn he could use to buy catastrophic health insurance while socking away large sums of money.

Oh, and Macs are cheaper here!

 

[Ducky]

But they weren't let down. They had the same "access" to health care as everyone else, as defined by someone who would rather let his family die than rely on tax dollars taken with the threat of incarceration to pay for treatment. Apparently, though, this same someone is okay with tax dollars being spent to educate folks like Ducky to become doctors and then more tax dollars being spent to do all the research that Ducky could then resell to patients for a huge profit, which in turn he could use to buy catastrophic health insurance while socking away large sums of money.

Oh, and Macs are cheaper here!

And yet macs are still overpriced...



(says the UNIX admin that only runs linux on cheap hardware.)

 

[Gandalfs Beard]

To be fair, in the interests of skepticism and intellectual honesty, the study actually said it was 40,000 deaths "associated with" lack of insurance. There are a few confounding factors there, more likely than not.

That said, people definitely do die from lack of insurance in the US. The actual number is unknown.

Well I did qualify my statement with "estimated."

GB

 

[Rolfe]

You know what? While I was dredging Ducky's post up, I found another couple of posts, beaten finalists slammed on the ropes by that eloquence. I feel they could do with quoting as well.

I think a lot of what's difficult for many Americans in this situation is the change in mindset involved. They are used to thinking of healthcare as something everyone should pay for for themselves, like food or fuel - not as an essential service to be funded in the same way as the police or the fire brigade.

Certainly it's arguable that the police are a general public good, delivering a safer society to everyone rather then serving citizens individually. However, other things at present considered to be public services do quite obviously serve individuals. The education service educates individual citizens' children. The fire service puts out individual citizens' fires. Why aren't we insisting that these things become the individuals' responsibility?

I think there's a good reason for this. If citizens decide not to educate their children, we are all bothered by gangs of illiterate teenagers tearing the place up, and business is struggling to find educated staff. If the owner of a building in a crowded part of town lets it catch fire and can't be bothered to pay for any firefighting, half the town might go up in flames. Designating firefighting and education as essential services doesn't just benefit the individuals who are educated or have their fires put out, it benefits society as a whole.

Can the same be said for healthcare? I would argue yes. Taking care of the health of the population as a whole provides more productive workers. It saves resources in the long run if problems are treated in the early stages. But most of all, it relieves us all of an almost impossible burden of charitable giving. Dig deep for the cancer ward. Your contributions are needed for the neonatal intensive care cots. Tom down the road needs brain surgery urgently and he lost his job last month, can you help.

Which appeals to give to? How much? When have we given enough, if the charity workers are still calling? How much is fair? How can it be fair if Daddy Warbucks just sends all the charity collectors away with a flea in their ear?

Is the concept of having a society to live in where members' needs are taken care of without all this arguing and soul-searching too difficult for some people?

Dan asked a question, pages back. He sees the present crisis as having started in the 1980s. I think it was cooking before that, but he has a point. And he was given his answer - the increasing pace of medical advances meaning that previously untreatable things can now be treated, at a price. Or better treatments are available, at a price.

In a thread elsewhere on the forum, we're discussing when modern medicine began. Opinions differ, but it's recent. Mid to late 19th century, perhaps. But even then, there were few effective treatments. Even in the first half of the 20th century, the efficacy of most of what was available was doubtful enough that it might not matter that much if you could pay for it or not. But even more importantly, what was available was relatively cheap.

The doctor could take your tonsils out on the kitchen table. Hospital surgery was unsophisticated. Medication was cheap and of doubtful efficacy. A lot of what the rich were paying for was pampering, and placebo. It wasn't beyond the means of charities to provide reasonably state-of-the-art care to the poor, because frankly the art wasn't that sophisticated.

It wasn't until the 1930s and 1940s that things really started to take off. During the war, it was observed that there wasn't enough penicillin in the world to treat both Churchill and Roosevelt if they'd both needed it at once. But since then it's been a mad rush. Antibiotics, beta blockers, ACE inhibitors, cytotoxic drugs, statins, the list is endless. Bigger and better diagnostic instruments - x-rays, then CAT scans, then MRI scanners and sophisticated ultrasonography and PET scanners.... Basic biochemistry, then immunoassays and chemiluminescence and mass spectroscopy and PCRs.... Chloroform then halothane and thiopentone and propofol. Scalpels and forceps then electrocautery and laser surgery and keyhole surgery.... Peg legs and hooks then bionic arms....

And I'm sorry but it all costs money. And nobody is ever going to be able to be certain of getting all they need for the price of a couple of Big Macs. And you can be as economical as you can, and buy the most cost-effective options and avoid all but the most necessary and effective procedures, and it's still going to cost enormous wodges of cash.

It's no longer reasonable to regard this level of service to be something that individuals can reasonably be expected to pay for off their own resources. Or even that it should be delivered according to a risk-based contribution scale.

The countries that are coping are those that have classified healthcare as an essential service. The only way it can possibly be delivered on a population basis is by contributions being based on ability to pay, and the service delivered centrally with all the economies of scale and reduction in bureaucracy/paperwork.

Looking at the history of the adoption of universal healthcare systems, these imperatives seem to have been accepted fairly readily by country after country during the second half of the 20th century. Either accept that the better off will have to contribute to the care of the less well off, or accept that you're going to see a lot of unnecessary suffering and death. Either accept that contributions will have to be compulsory (through tax), or accept that the system will never be adequately funded, and you're going to be subjected to intolerable moral blackmail every day of your life. Most people seem to be able to see this.

There seems to be something in the American psyche that makes this very hard to accept. The practical imperatives of looking at it in this manner get lost amid cries of "freeloader!" and "coercion". The fact that at the moment American citizens have far less freedom in this area than people in other countries is ignored amid intense focus on the fact that freedom can never be absolute.

Well, get over it.

Rolfe.

Of course, left-wingers say ... why should those who make more get better health care? And why should they drive better cars? And why should they get to live in better houses? And why should their kids get to go to better schools? And they are depending on Obama to correct all those injustices. It's called communism folks, whether the Obama supporters admit it or not. So you better ask yourself if you want to live in a communist country.

That's a pretty slippery slope you have there. Bobsleigh run quality.

Why should those who make more get to live in better houses? Because they can pay for them. That doesn't mean that the poor should be forced to live on the streets. Every civilised country has a basic level of social housing provision to prevent homelessness. None that I know of forces affluent citizens to live in council houses though.

Why should those who make more get to drive a better car? Because they can pay for it. Actually, having a car at all is not regarded as a necessity of life anywhere. Taking the bus may be inconvenient, but it won't kill you. So, no subsidised Reliant Robins for the poor. However, note that there are public transport subsidies for the poor.

Why should those who make more get better healthcare? Well, if they want something which isn't provided by a universal healthcare system, they can pay for it. Why not? The real question is, what should that be?

Note that in none of the above examples is there no publicly-funded help for the less well-off. And indeed, in the USA at present there is publicly-funded healthcare for the less well-off. All we're arguing about is what level of provision there should be, and who gets to access it.

The universal healthcare proponents are arguing that minimal healthcare is no healthcare at all. This is where the parallel with housing and transportation breaks down. Nobody needs a million-pound mansion to stay alive. Nobody needs a Rolls Royce Silver Spirit to stay alive. The basic functions can be perfectly well performed by a small apartment on the wrong side of the tracks, or a bus ticket. The rest is luxury.

In contrast, it is entirely commonplace that someone needs a liver transplant, or a quadruple bypass, or expensive chemotherapy to stay alive. This is not luxury. Therefore, it should be available to everyone, regardless of ability to pay. This puts healthcare into an entirely different category from the other examples.

So much for level of coverage. Level of coverage has to be high and comprehensive simply because for some people expensive procedures are a necessity of life and not a luxury.

This puts your "better healthcare" remark into perspective. You are arguing for less than comprehensive coverage for the less well-off, even though that means some people will die because they need something very expensive, purely in order to have some sort of "extra care" option available to those who want to pay more. News flash. Being able to afford a quadruple bypass when your neighbour can't is not in the same league as being able to afford a Rolls Royce when your neighbour can't. The idea of restricting healthcare to the poor just so that the rich can feel superior due to their ability to afford lifesaving procedures is diabolical.

So there you have it.

Now, who gets to access the publicly-funded system as opposed to having to pay for it themselves? Who might find themselves in desperate need of a procedure they are unable to pay for? Well, just about anybody. Sure, many reasonably well-off people who are in good health could probably afford to pay for the level of treatment they need, but come on, why should they? These people are after all the ones who are providing the bulk of the funding for the public provision, it would be unconscionable to tell them that they were barred from any benefit. Indeed, why should you force people with a good income and savings to pay for something that is available for free to those who have not saved or been prudent with their money?

In addition, setting the standard of access at "everybody" is extraordinarily cost-effective. Whether or not you decide to exclude illegal immigrants is a different matter, and indeed most countries with universal healthcare systems have some restrictions on non-citizens accessing publicly-funded care. But as far as legal citizens are concerned, then if everybody is eligible for coverage then you just lost a huge layer of bureaucracy dedicated to deciding who is covered and who isn't, and for what procedures.

So, you have a level of care which is comprehensive so that all necessary medical procedures are available to anyone who needs them. Because restricting the level of coverage below that just so that rich people can have something to be exclusive about is uncivilised. And every citizen is entitled to access this care. Because dammit, they're paying for it! And because it saves an awful lot of administration.

But no, you want "better" healthcare for the rich. Why? Just so that they can thumb their noses at the poor who have the misfortune to be dying because they needed an expensive "luxury" procedure?

You louse.

If the rich want to thumb their noses at the poor in the healthcare stakes, by all means let them pay for a swanky private clinic with luxurious rooms and gourmet menus and Old Masters on the walls. Well, even let them pay to have their procedure done at a time more convenient to them than the public system is able to offer.

But we will not let them pay for a lifesaving procedure which we deny to someone of modest means. Not because we refuse to let them pay, but because we refuse to deny the less well-off person the lifesaving procedure. If that's too egalitarian for you, then I'm sorry.

Rolfe.

You can see why I called it Groundhog Day.

Rolfe.

 

[Rolfe]

And this one is also worth a read.

In 2003 I worked for a bank. I had insurance through a major provider here in the midwest in the US. I began having back pain. I went to see doctors I picked from that insurer's list of approved/in-plan list and they never once took imaging. I went back and went back until the pain was so severe one day I went to the emergency room twice in a 48 hour period. They gave me pain meds and said I needed physical therapy. I did the physical therapy and wound up back in the emergency room with severe back pain and numbness beginning in my legs. They took a CT of my lumbar spine (the problem was in the thoracic) determined I was having either some sort of muscular pain or was trying to scam for drugs and sent me on my way.

Then I lost my job and found myself doing temp work and the insurance ran out. I had to go to a sliding scale pay clinic here in the twin cities that made a deal to get an MRI for me at very low cost. This was now a year after initial back pain symptoms started. They found that t-9 had been completely obliterated (you can see pictures of this in the Swift article I wrote for Randi.) I was then instructed to go to MinnCare, a government sponsored program to get health care to the poor. I was told that I could not make more than 500 dollars a month to qualify for the coverage to have my operation, thereby effectively forcing me to not file for unemployment when I told my temp agency I had cancer and they let me go.

I had my surgery. It was done by some of the best doctors in the US, and cost an absolute fortune (most of which was covered my minncare.) After the surgery I had to have radiation and regular checks with bone marrow biopsies and imaging and blood work. Each visit costs literally thousands of dollars. On Jan 1, 2005 MinnCare handed my coverage off to a private insurer, the same one I had when working for the bank. Since the doctors I had now were not the doctors I had on file with the private insurance company 2 years prior they refused to pay for any of my radiation treatments or follow up exams. I could not afford to have a physical therapist help me learn to walk again, I did that on my own. All this time I had gone deeply into debt and was living off kindness of others and what little credit I still had.

The reason they stopped coverage? The original doctor had not referred me to any of those that actually did their job.

I am still fighting debt collectors over medical costs they refused to cover. I am still in a monstrous amount of debt despite earning a decent living now as an IT professional. I make a decent living and can't afford to fix or replace my ailing and trashed 10 year old jeep.

By the time I learned these things might be actionable by attorney, it was too late per Minnesota law to do anything about it (or so I was told by the attorneys I saw.)

Anyone who thinks Private insurance doesn't pull shenanigans is simply wrong. I have been all but bankrupted by this BS, all to live through cancer and a major operation on my spine.

To top it off, I have to sneak in through work group insurance policies because I have a pre-existing condition. So much for choice. The events of the last 5 years have cost me enough to consider bankruptcy.

So it's piss off and die or go bankrupt for the non-rich in this country. And the insurance company does not have the insured's best interests at heart. I am now also limited in amounts of meds per 90 days I can have for pain, etc. This is to keep me from being addicted to not having pain, apparently. If I shop around to other doctors, I break the law. If I tell people I have back pain they look at me as though I am trying to score drugs like some common street addict.

It's broken. The whole system is broken and costs way too much. I don't know what the answer is but it sure as hell is not the status quo.

Rolfe.

 

[kellyb]

That's crazy - it'd be in my interest NOT to work over there just so I could get a minimum level of care, whereas here my healthcare costs are completely covered whether I work or not. I prefer working and being a productive member of society, but I'll never earn a lot of money and I'd never be able to earn enough to cover my healthcare costs there, so I'd be better off not working and getting Medicaid. How can that be a good thing?

You're condemning people to staying economically inactive if they are ill, it's a poverty trap. AIUI Medicaid covers the basics so I doubt the colostomy I had when things were bad would ever be reversed - I'd still be pooping into a bag.

Your system is broken, people - nobody's saying ours is perfect or that our NHS is the system you should emulate, but there must be a better way.

It absolutely is a poverty trap. I have a friend who has a son with multiple medical issues who would quickly die without insurance, so they have to make sure not to make more than a few hundred dollars a month, so they can have the child covered by Medicare. (They are really livin' the good welfare "medicare and food stamps" life, let me tell ya'.)

 

[Rolfe]

Honestly, if xjx388 comes back here and says that all this could be fixed if there was just a real free market, when everything would come down to the price of a couple of Big Macs and doctors would still make movie-star incomes, I'll probably hit him.

Rolfe.

 

[Fiona]

That's crazy - it'd be in my interest NOT to work over there just so I could get a minimum level of care, whereas here my healthcare costs are completely covered whether I work or not. I prefer working and being a productive member of society, but I'll never earn a lot of money and I'd never be able to earn enough to cover my healthcare costs there, so I'd be better off not working and getting Medicaid. How can that be a good thing?

You're condemning people to staying economically inactive if they are ill, it's a poverty trap. AIUI Medicaid covers the basics so I doubt the colostomy I had when things were bad would ever be reversed - I'd still be pooping into a bag.

Your system is broken, people - nobody's saying ours is perfect or that our NHS is the system you should emulate, but there must be a better way.

No I think you will find that a system which encourages/allows you not to work is anti american: in fact I think the word used was "preposterous".

 

[kellyb]

Honestly, if xjx388 comes back here and says that all this could be fixed if there was just a real free market, when everything would come down to the price of a couple of Big Macs and doctors would still make movie-star incomes, I'll probably hit him.

Rolfe.

Naw, he won't say that. He knows some types of medical care will stay expensive.


He and his MD wife (with her tax funded education, and their top 3-5% income) simply see the obvious moral good in allowing themselves to die should they face an illness they can't personally afford to treat. Good enough for the rich, good enough for the rest of us plebs.

In our brave new Orwellion world, the fact that a LOT of us are basically living as health care serfs is "liberty". Being debt-enslaved by our millionaire CEO health care overlords is "freedom"...we have the freedom to f*** off and die, you see! It don't get much more free than that!

 

[Uncayimmy]

You can see why I called it Groundhog Day.

But what if there's no tomorrow? There wasn't one today.

These debates would be a whole lot shorter if those against nationalized health care would simply stick to their guns. Seriously. Just say you don't think as a nation that we should do it. Other nations believe otherwise. That's the real debate. Most of this thread has been correcting misinformation that has been put forth as a weak rationalization for an ideology.

Me? I would be more than happy to pay into a system where medical care is provided to everyone. Of course, I want a system that works reasonably well, and it seems there are systems that do. If somebody doesn't want it on general principles, then it doesn't matter how efficient other systems are.

Of course, if you don't want it, stand up for your beliefs and explain them. In this case we have someone who is happy accepting tax dollars for education so his wife can become a doctor. He's happy with tax dollars being spent on medical research, which his wife simply resells (in some cases to people who read the same research but are forced by law to pay her to make the same conclusion). He's happy that those without money go without treatment, but at the same time he's happy with carving out special exemptions to protect doctors from paying for their mistakes.

That's the inconsistency I don't get.

 

[Fiona]

But what if there's no tomorrow? There wasn't one today.

These debates would be a whole lot shorter if those against nationalized health care would simply stick to their guns. Seriously. Just say you don't think as a nation that we should do it. Other nations believe otherwise. That's the real debate. Most of this thread has been correcting misinformation that has been put forth as a weak rationalization for an ideology.

Me? I would be more than happy to pay into a system where medical care is provided to everyone. Of course, I want a system that works reasonably well, and it seems there are systems that do. If somebody doesn't want it on general principles, then it doesn't matter how efficient other systems are.

Of course, if you don't want it, stand up for your beliefs and explain them. In this case we have someone who is happy accepting tax dollars for education so his wife can become a doctor. He's happy with tax dollars being spent on medical research, which his wife simply resells (in some cases to people who read the same research but are forced by law to pay her to make the same conclusion). He's happy that those without money go without treatment, but at the same time he's happy with carving out special exemptions to protect doctors from paying for their mistakes.

That's the inconsistency I don't get.

Are you sure you don't get it? Seems quite simple to me: think of the "two chickens" argument

 

[bookitty]

It absolutely is a poverty trap. I have a friend who has a son with multiple medical issues who would quickly die without insurance, so they have to make sure not to make more than a few hundred dollars a month, so they can have the child covered by Medicare. (They are really livin' the good welfare "medicare and food stamps" life, let me tell ya'.)

Yep. MIL went through the same thing. Had she kept her job (they were willing to let telecommute) she might have had enough cash to cover some of the stuff she needed (wheelchair, taxis to hospital, etc) but she would have lost all medical benefits. So she quit her job before she knew for sure that she didn't have coverage, because if she had coverage she could still get COBRA and then get medicare.

Of course, this is the excessively simplified version. It happened over months of making phone calls & faxing in paperwork every day. I can no longer remember all the details because there were so many dead ends.

The entire experience is the main reason why the husband and I aren't legally bound. If one of us gets expensively ill, the other won't be ruined.

 

[Cleon]

What I find extremely strange is that while xjx388 agrees that the US system is irretrievably broken and needs to be completely re-thought, he can't see beyond his own ideology for a solution.

Nobody living with a universal healthcare system is saying their system is broken - in contrast, everyone is pretty well content even though some tweaking round the edges might be advocated. But basically, you will prise our NHS or equivalent from our cold dead hands.

xjx388's system, though, is broke.

Now, he agrees it needs to be re-thought. He has all these many and varied systems around the world to look at and observe the advantages, and any disadvantages. But does he so this? No, instead he spends all his energies rubbishing an entirely imaginary strawman version of the NHS. Jealous, much?

The thing is, the one feature all these varied systems of working effective universal healthcare have in common is a high degree of government involvement, either by taxing to fund healthcare directly or by mandating insurance coverage and subsidising as necessary. There is no example of any country where the "free market", without government intervention, has succeeded in delivering affordable healthcare to an entire population. For the very simple reason that any rational assessment of the suggestion demonstrates that it is quite self-evidently impossible.

But does xjx388 want to look at what actually works? No, because that would be socialism, and that's evil. Even if it works immeasurably better than what's going on in the USA.

He just wants to fantasise about this alternate universe where the laws of supply and demand work quite differently from Earth, defend the indefensible (even while agreeing it doesn't work), and rubbish the systems that actually deliver healthcare security to real people.

Rolfe.

And it frustrates the **** out of us who do live here and have to deal with this craziness. Xjx isn't some bizarre phenomenon - hers is the mainstream view here. An NHS-style system, or at least nationalized insurance, is by all rational analysis the right way to go - but no, it's ideology verboten. Instead, we get the privilege of having our health care entrusted to organizations who profit from not delivering it.

In Europe, capitalism is how business is conducted. Here, it's a goddamn religion.

 

[Ampulla of Vater]

One by one, let me share my experience with these:



Absolutely accurate for me. While I have not yet been told I hit a lifetime cap/maximum, when this happens (and I assume it will until something drastically changes) I'll be even deeper in than I am now.



Yes. When I was starting my business I had a day job for the insurance. When I was diagnosed I had begun full time to work on my business and was between coverage. Due to this, I faced a host of problems being covered and getting care I could afford.



Absolutely true. Were I to get my own policy now it would be completely unaffordable. I should point out I make well above the poverty line, and it is still unaffordable.



100% accurate. I don't have a lot to add, that's pretty specific and self-explanatory.



One better: I turned to MinnCare, a public service for those without insurance who need it. I was told to qualify for coverage to get the surgery to fix my spine I had to make less than 500 dollars a month. That doesn't even cover rent, but I shut down my business and under advice from the social worker did not file for unemployment in order to qualify. When I did that, and was forced to rely on credit for the qualifying period and I found myself in massive debt from it. 6 months later when that coverage was changed (based on need of cost, emergency operation v. continued care) MinnCare has a program worked out with private insurance companies. When I was handed over to a major Private insurer in Minnesota, that insurer promptly dropped any payments on any services because several years prior I had been covered with them under another primary care physician. Because of this, 100% of my radiation treatments and PT recovery regimen was not covered. My debt has spiraled well into six figures since then, even after getting on insurance through my work's group policy.

But hey, I should have gone without because I couldn't afford it, right xjx388? Obviously I'm one of those welfare cheats you describe.

ETA: Side note: at the time this happened I was called a welfare cheat by someone whose views mirrored xjx388. Apparently I am somehow a welfare cheat for needed gov't assistance for health care and yet NOT filing for unemployment.

Hey Ducky,

Completely OT but if you ever need any help getting your insurance company to pay, please PM me. I do it for a living and I would be more than happy to wage a battle for you.
-P

 

[Ampulla of Vater]

You know, that's a point. I don't have an insurance policy on my cat, because I'm a vet and I know I'm unlikely to need another one unless something goes "cat"astrophically wrong. I know I have enough savings to cover paying my friend Noel for whatever bionic implant might be needed.

I wouldn't use myself as an example when it comes to funding veterinary care, that's for sure.

Rolfe.

How does it work in your line of work? Cash or no healthcare for the pet, right? That is the way it used to be in the U.S. No insurance companies, no government healthcare. You traded a jar of jelly (or a chicken or whatever) for whatever treatment you needed. That is what it needs to return to (even though that would put me out of business )

 

[Agatha]

How does it work in your line of work? Cash or no healthcare for the pet, right? That is the way it used to be in the U.S. No insurance companies, no government healthcare. You traded a jar of jelly (or a chicken or whatever) for whatever treatment you needed. That is what it needs to return to (even though that would put me out of business )

Wouldn't that mean poor people, or those unable to work through illness, would just have to die?

 

[kellyb]

Wouldn't that mean poor people, or those unable to work through illness, would just have to die?

Actually, Ducky (and you?) would have been euthanized.

Pentobarbital is your friend in libertopia.

 

[bookitty]

How does it work in your line of work? Cash or no healthcare for the pet, right? That is the way it used to be in the U.S. No insurance companies, no government healthcare. You traded a jar of jelly (or a chicken or whatever) for whatever treatment you needed. That is what it needs to return to (even though that would put me out of business )

That's the only free market proposal that might work. In some ways it makes sense. Get rid of the massive army of middlemen and you may get rid of enough of the non-medical costs to make medical care affordable.

Problem is the middlemen represent a billion dollar industry that isn't particularly interested in going away.

 

[Agatha]

Bring it on!