Healthcare Question: If we don't force people to get coverage....Who pays if they get sick or injured??

LOL!!! Maybe I am misunderstanding what you're saying but are you simultaneously arguing against fee for service AND saying that the solution is the sacred "free market reform"? Isn't charging a fee for goods and services the cornerstone of a free market?

Why would you extend a thread by showing your unbelievable ignorance? Wow. You are indeed misunderstanding. "Big league."

You clearly don't understand what fee-for-service represents in this context. It incentivizes quantity of care, not quality. Doctors and hospitals make more profit by keeping people coming back through the door. If everyone in the US suddenly becomes incredibly healthy and rarely goes to the doctor, do you think doctors would be happy?

It's similar to the law profession, defense contractors, etc. Anything that can simply charge customers by the hour and make bank regardless of outcome is not incentivized to provide high quality outcomes. Thus having zero cost containment incentivization.

Do you really not understand this?

No I understand that. My questions for you are 1) are you one of those folks in this thread that believes the only solution to our healthcare problems are the oft repeated, vague calls for "free market reform"? 2) if the answer to #1 is yes, how do you propose money is exchanged between those providing the service / goods and those receiving them?

You've made your opposition to insurance clear. So, how do we contain cost?

Did you read my post on the previous page? Maybe I was too subtle. Fully socialized medicine is what they have in most European countries. We, in USA have been brainwashed by billionaires and health insurance corporations that free market health care is best.Those who have employer sponsored health care are wrong to believe the propaganda stated by billionaires and insurance corporations. If one gets very sick with great employer sponsored health care, one most likely will get fired. Once fired and with a terminal disease, free market means insurance corps. do not want terminally ill individuals. European style socialized medicine is the ONLY solution.

former student of economics wrote:

Did you read my post on the previous page? Maybe I was too subtle. Fully socialized medicine is what they have in most European countries. We, in USA have been brainwashed by billionaires and health insurance corporations that free market health care is best.Those who have employer sponsored health care are wrong to believe the propaganda stated by billionaires and insurance corporations. If one gets very sick with great employer sponsored health care, one most likely will get fired. Once fired and with a terminal disease, free market means insurance corps. do not want terminally ill individuals. European style socialized medicine is the ONLY solution.

Wait are you "educated guy" using a new handle? I'll admit to not reading every post in this thread but "educated guy" implied in one of his posts that he thought moving to a free market system was the way to go....but then railed against fee for service which begs the question of how money changes hands in such a free market system. Several like minded posters agreed with those pretty obviously contradictory posts. So, if you are "educated guy" are you now Advocating for socialized medicine? If so, I think you're pretty confused and no so "educated" on this topic.

On the other hand if you're arguing for a system in which the government steps in and mandates a certain level of evidence based care for everyone (basically single payer) but also allows those with $$$ to go out and get all the crapy, unproven expensive care / tests / treatments / drugs / surgeries/ etc. that are currently available through the "free market" those are changes that could be an improvement for US healthcare depending on the details.

These changes would also be in line with many developed countries that have "socialized" / universal healthcare but also allow rich people who don't understand biology and medicine to be swindled out of large sums of $$$ by medical snake-oil sales people.

You use a lot of smoke & mirrors. I do not this other individual you stated. I stated rational people have demonstrated socialized medicine is best for society as a whole. Are you stating free market health care is best? Most people in US will have lengthy deaths: 1) cancer, 2) dementia/Alzheimer, 3) cardiovascular illness. Most will need health care not sponsored by an employer. Do not personally attack me. Make you case that free market health care is best for society as a whole.

former student of economics wrote:

You use a lot of smoke & mirrors. I do not this other individual you stated. I stated rational people have demonstrated socialized medicine is best for society as a whole. Are you stating free market health care is best? Most people in US will have lengthy deaths: 1) cancer, 2) dementia/Alzheimer, 3) cardiovascular illness. Most will need health care not sponsored by an employer. Do not personally attack me. Make you case that free market health care is best for society as a whole.

Um, well I don't think I was saying free market healthcare is the best. If that's what you took away from my post it is likely my failure in clearly explaining my position. I apologize for that.

For the record, I think the "free market" should have very little role in healthcare. In fact, for 99% of people in the US the "free market" should have NO (zero) role or impact on their ability to get care. The government should provide a basic level of care based on high-level medical evidence to EVERY citizen of this country.

The only role the free market should play in US healthcare is that every individual should be allowed to choose to get non-evidenced based, crappy care (I.e. Laboratory tests, imaging studies, drugs, surgeries, etc.) they want based on tv/YouTube commercials, Google searches, what their relatives say works, etc. as long as they pay out of pocket for that type of crappy care.

former student of economics wrote:

Did you read my post on the previous page? Maybe I was too subtle. Fully socialized medicine is what they have in most European countries. We, in USA have been brainwashed by billionaires and health insurance corporations that free market health care is best.Those who have employer sponsored health care are wrong to believe the propaganda stated by billionaires and insurance corporations. If one gets very sick with great employer sponsored health care, one most likely will get fired. Once fired and with a terminal disease, free market means insurance corps. do not want terminally ill individuals. European style socialized medicine is the ONLY solution.

I'll go for that European style healthcare 👍. I don't have any chronic health conditions that requires medical intervention, nor am I on any prescription meds. So, it would nice to have free coverage in case of an emergency and circumstances beyond my control.

And to pay for some of it, why not charge the snot out of these people with their chronic conditions, who are the ones using up most of the resources. A lot of these people who have PREVENTABLE medical conditions are fat, sedentary, eat poorly and could give a sh%@ about changing their dietary & lifestyle habits (anyone been to the South lately?...my goodness! 😨).

Call it high-risk healthcare insurance or something for these people. They're the regular customers with many taking multiple prescription drugs, and who brag about it like it's somekind of badge of honor 😄. And for the aging population, no excuse for them either. Many have become lazy, fat, eat poorly and aren’t interested in exercising. I'm middle-aged & low-income, and find the discipline to run & workout (and it's painful at times!)...so what's their story? And many of the boomers are now retired/semi-retired with time to excercise...so again what's their problem? You physically fit young Bucks should be disgusted with some of these boomers! America has become nothing but a land of the fat & unhealthy! 😔. And you don’t hear Trump talking about this issue as part of his make America great again montra.

So, why won't the rich & famous Congressional members of our Government, who have sweet healthcare plans for themselves, adapt an European type healthcare system? And why won't they consider some type of high-risk coverage for many of people who have PREVENTABLE chronic medical issues. Surely, our Congress is astute enough to see the current state of health of this country and the drug-addict patients who take zero responsibility for anything in their life, whether it's their weight, diet, exercise, etc.

Typical left wing thinking. You are wrong and your argument is absurd. The maker of the MRI machine needs to sell more to survive. Someone will buy MRI machines and offer that service. The maker of the MRI machine will lobby the government not to allow monopolies because it is in his best interest.

The problem is that if the government steps in and decide who can own the MRI machine, then all hell breaks loose. The government is creating a mess my trying to fix things.

You white boys are so out of touch with reality in this country. Where are all you fools from? Obama came out with the FORCED BY LAW healthcare for only one reason. You fools create some insane ideas and reasons for forced healthcare. You white fools are you own worst enemies. I got more respect for Trump and the Republicans than you ignorant, cowardly white boy Liberals.

I'm from another country. For decades we have this forced national healthcare.

What you get is, working in the medical field becomes a dumbed down field. The salary soon becomes worthless. You are told what scary batshit place you must go to for care. Usually months out. No one wants to work in the field anymore. You make more fixing or working on the roads as a laborer. They actually force people to work in healthcare. You Americans are so lucky in the USA. I'm a laborer here now. Last year my 3yr old needed a serious operation.

My work health insurance, we didn't like the Doctor. The best in our state Doctor was not on my insurance. I decided I'd pay cash payments and we had the top Doctor take care of my child. It cost me 8,000 dollars. It was a great feeling for us, my wife and I felt like we were blessed to have such a choice. We could never have done this in my country, we would be arrested or worst.

Educated guy wrote:

Why would you extend a thread by showing your unbelievable ignorance? Wow. You are indeed misunderstanding. "Big league."

You clearly don't understand what fee-for-service represents in this context. It incentivizes quantity of care, not quality. Doctors and hospitals make more profit by keeping people coming back through the door. If everyone in the US suddenly becomes incredibly healthy and rarely goes to the doctor, do you think doctors would be happy?

It's similar to the law profession, defense contractors, etc. Anything that can simply charge customers by the hour and make bank regardless of outcome is not incentivized to provide high quality outcomes. Thus having zero cost containment incentivization.

Do you really not understand this?

So, you honestly believe that a large portion of US doctors practice medicine with the intent of "keeping people coming back through the door" as opposed to helping people achieve optimal health?

Seriously?

Wow, what an extraordinarily, horrifyingly paranoid world you live in inside your own head! I feel truly sorry for you brother. Hope you get better soon.

Hope this is not dumb question wrote:

What if these people don't have money to pay for their services? Is this cost factored into the Republican plan? Are there any estimates on this cost?

Often the Hospital eats the cost.

Since the ACA, they started signing up the patients, and then billing the ACA.

The ACA paid up, but the 'freeloaders' rarely paid any premiums.

And the government called that coverage. In th old system the hospital would eat the uncovered cost. Now we do. But we have a fiction of coverage increases

dutchoven wrote:

Hope this is not dumb question wrote:

What if these people don't have money to pay for their services? Is this cost factored into the Republican plan? Are there any estimates on this cost?

Often the Hospital eats the cost.

Since the ACA, they started signing up the patients, and then billing the ACA.

The ACA paid up, but the 'freeloaders' rarely paid any premiums.

And the government called that coverage. In th old system the hospital would eat the uncovered cost. Now we do. But we have a fiction of coverage increases

And this is what helped suppress increases in average premiums for those on private insurance plans.

Will you stop. Look, and I'm being serious, if you haven't taken at least one course on the Economics of Health Care, read a single Peer Review Journal Article on the economics of health care, or written Research Papers on the topic, please don't try to make a point.

People get into practicing medicine because it pays extremely well. It pays extremely well because there are intentionally high barriers to entry (starting with the education itself), there's zero pricing transparency (no one knows what anything actually costs), it's a fee-for-service system (outcome doesn't matter for payment), and there's heavy third party payment involvement (skimmers everywhere). You cannot even mention economic equilibrium- which is required to even be in the ballpark of being considered "efficient"- with these characteristics in place.

I'm not saying doctors developed the business model. It is what it is at this point. Whether they are in it to make money, or to make sure everyone is achieving maximum health across the country... do you think they care about whether or not it's inefficient when they're getting paid what they do? No. And you can't blame them.

If it paid a teacher's salary though, you better believe there'd be a lot less folks interested in being doctors.

Educated guy wrote:

How anyone can defend a system that is EITHER fee-for-service OR employs a third party payment system (just one of the two) is beyond me.

But how anyone can defend a system that is BOTH fee-for-service AND employs a third party payment system... wow... I mean, that blows my mind. And it doesn't matter how many people pay into the system; the basic foundation of how the system operates needs to be efficient. You can't have a bunch of people skimming off the top, with unlimited funds (because "everyone's paying in") and expect to keep costs in check.

The solution isn't based on any Left/Right politics either; it's rooted in basic economics and incentive structure. Anyone including politics/political references in their responses are not to be taken seriously when discussing health care reform.

How can anyone defend this system? Hospitals, doctors, pharmaceuticals, medical equipment companies, insurance companies... did I miss anyone important? The money people spend on their health care is not vanishing into thin air. Someone else is making money out of it. Of course, there are many people who defend this, because it is profitable to them. You don't need to be "educated" to understand that.

Runningart2004 wrote:

One of the biggest problems with ACA was that the penalties were not high enough. If you don't want health insurance and the penalty is less than the cost of coverage then it's a no brainer. One solution is tying the penalty to the cost of coverage. 1.5-2x cost of least expensive plan.

Remove state lines. Even if it's been proven to not actually lower costs. It "looks good".

If you're going to go with expanded government run healthcare it's going to cost a lot. You're going to have to increase taxes. I know it's been all the rave since Reagan to just not pay our bills but it's illogical.

Alan

Poor people are not going to be able to afford either -- even if the penalty was 100x the cheapest plan.

Yes, you could raise taxes to pay for a real universal health care plan OR... you could reduce the budget of the largest military force in the world by far.

Les wrote:

Yes, you could raise taxes to pay for a real universal health care plan OR... you could reduce the budget of the largest military force in the world by far.

https://www.nationalpriorities.org/campaigns/us-military-spending-vs-world/

OR, you could avoid raising taxes, and not reduce the military budget (though I would be all for that), and still give people universal healthcare, by attacking the real culprit - out of control costs.

We don't need more money to give people coverage. As of 2015, we are #4 in the world in PUBLIC (#1 when you add in private) spending per capita, and for all that spending we don't even cover everybody, and the quality of care and coverage is far inferior to countries who cover everyone AND spend less per person. You would think the party of "fiscal responsibility" would have a problem with that, but they are the major impediment to it being fixed. I wonder why?

Stop voting for politicians who accept money from pharmaceutical and hospital interests.

Source for spending btw:

dutchoven wrote:

Hope this is not dumb question wrote:

What if these people don't have money to pay for their services? Is this cost factored into the Republican plan? Are there any estimates on this cost?

Often the Hospital eats the cost.

Since the ACA, they started signing up the patients, and then billing the ACA.

The ACA paid up, but the 'freeloaders' rarely paid any premiums.

And the government called that coverage. In th old system the hospital would eat the uncovered cost. Now we do. But we have a fiction of coverage increases

There is a lot wrong with this post, mostly just that it is not grounded in actual facts.

hospitals provide ucompensated care, but the federal and state governments have long covered almost all of those costs through grants and programs. Hospitals and private entities actually cover an extremely small percentage of care.

Here is a good article with actual facts: