Tuesday, August 13, 2013
Today's "Health Industry"
Well Max, first off, how've you been, good health I trust... Health, is health a function of environments, both internal and external? Yes. Is health a function genetics, relative to inherited genetic codes, yes. Is the pool of genetically weak individuals in any given country greater than or less than the ratio of health providers that can create the cures for the attacking cellular invaders that, at one time the scientific communities were optimistic that illness would just be a thing of "the past"... AIDS proved that not to be the case. Slowly the health industry has evolved from eradication of disease to management of disease(s).
Health also seems to have become a massive industry, perhaps surpassing.. Education, construction, manufacturing, food production, heck name any "job" I'd bet health has surpassed every category of employment, a bet you'll correct me on I'm sure. As the population has grown the desire for longevity has grown also, the 300 million here, the billion there, etc, etc. we (they) all want to live longer. Having said all this, is it not the industry you are in the best industry to be a part of? The supply of work will never end, we all wind up in your industries lap sooner or later. Several other industries are tied forever to your industry, are they not, if we all never died, you'd be unemployed, but we all do die. Your industry is designed to do nothing but extend, at a great cost, the end of life. It is logical to me that your industry, Death, is the big ticket here on this planet. Is it not?
Is it the web of industries that have been spawned by death that are the villains, the manufacturers of the dialysis machines, the surgical implants, organ transplants, the list is endless, why we all wind up in "your" hands, do we not? So your a monopoly winner! You and your profession are the big winners here. But what are the ethics behind this profession, surely some are only in it for the money, hell the years of med school, or the expense to learn anything in your chosen "job" normally carries with it a decent living, I would expect those working around you to be earning the highest 1 or 2 percent in the nation.
Rightfully so, yet are they not also the targets of high insurance costs, the targets of the high costs of just about everything, is this not the root cost of the high cost of the end of life?
Insurance, now we're getting somewhere, those assholes that steal from us in order to make sure we live a couple of years longer, even if you smoke, you're overweight or whatever the vice is. Vices, these are the real killers are they not, the human behaviors we addict ourselves too. Driving too fast, eating too much, smoking, the list is long on vices and short on virtues, but its a sure bet that at some point we all wind up getting a last goodbye from your profession.
So... I ramble on and on, yet what am,or where am I going, is it the job of our elected officials to force each and every on of us to take care of ourselves, or do we have the right to subject the entire population to a tax to force us to live right, which we still won't do so it's a given that if the government is going to make us all either pay a tax or or join an exchange or hide in the woods to avoid a tax that big brother, the GOVERNMENT will find you and it will make you pay. Regardless if you eat the good stuff, follow all the guidelines, exercise, etc. etc. is it still up to the government to make sure we do what we are supposed to do. Someday will we face a law for each and every thing we consume that is "bad" for us, too much soda, pay a fine, too much this tho much that? Whom will be our judge, when will the judging begin, age 10, 15, 21 , 27, etc., etc.
It seems Obamacare was designed to hold all of our collective hands from kindergarten forward to march like little robots, god forbid you eat the wrong foods, do this or do that that "they" don't approve of.. Because that is what Obamacare is for, an entire life of hand holding until the inevitable end.... That is going to come anyway.
I for one know in my heart this is the wrong path, you are in the industry that makes sure that whomever you "treat" is only allowed to ingest what someone else commands. God forbid a patient of yours did something NOT prescribed! There would be he'll to pay!
Well, the control freaks have gotten their collective way. The real cost of healthcare is so extreme that only the government can decide who lives and who dies, thanks!
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A genuinely thought provoking post Brandt, and I'm not being a wise ass. There are many things there to grab hold of and discuss, but there are two statements that really caught my attention. The first is "But what are the ethics behind this profession"and the other is "is it the job of our elected officials to force each and every on of us to take care of ourselves, or do we have the right to subject the entire population to a tax to force us to live right"
ReplyDeleteI won't lie that part of my decision to enter health care had to do with exactly what you mentioned, it is a financially stable area. However, without at least a smattering sense of altruism, it is a system that will grind you down no matter how much you make if money is your top concern. As most of you know who have heard me soapbox about the intensive care unit, I left that area because I constantly was bombarded with what I thought were very bad ethics. In particular, my participation in care that was absolutely futile. There are ethics within the system, but the ethics of society and the ethics of workers in health care are not at all what I would call congruent.
Currently Brandt, the ethics of the system are to give the customer what they want. Sometimes people do their research and come in with very good questions about how they can be healthier. Other times, they simply want to keep living as glutenous as possible and be "healthy" without having to work at it at all. Can you honestly tell me that the latter attitude is not a driver of health care cost?
What is health? You described some things that AFFECT health, but not really what health is. I do agree the system has become focused on fixing symptoms, which is to say, it's about interventions, interventions that can be billed for. But, don't you find it a bit ironic that if you are interested in being healthy or learning what it means to be healthy that you probably aren't thinking about your doctor as the first place to go?
A central theme in opposition to Obamacare right now is the premise that people are being "forced" to be healthy. That's not true. People bitch about Bloomberg's silly soda size rule (and even I agree it is silly) but they don't really care about what's driving HIS actions which is that health care costs are staggering. He is not out to dominate in a fascist way, he is trying to escape being stuck with the health care costs of obese people.
This is already long, but I believe that libertarians and antiObamians need to accept a very crucial fact, society has decided that we will not let people bleed to death or die of something else in the hospital parking lot. Because of this reality, we have Obama care. It is not a plot to dominate you. It is not a plot to steal your precious bodily fluids or control your mind with fluoride. It is a response to the shell game of healthcare finance. IF, and this is crucial, IF you can convince the rest of America that we should just let people die if they don't have healthcare, the outrage of being forced to participate in a healthcare plan has much more merit.
I'll be working hard to respond to each paragraph, but my fing 8 year old computer has crashed and using the iPad to discuss things ain't so easy.
DeleteHowever I think that not enough of the electorate are really taking the time to fully become aware of what our federal level government is going to shoving down our collective throats...
Any bill with more than 100 pages needs to something to be afraid of....
Like everything liberal, you can probably just delete three paragraphs of any comment I type and get the same gist. Be that is it may, our healthcare system is not something we can dissect in entirety in just a few paragraphs. For what it's worth, maybe some of these would be grist for separate and more focused discussions.
ReplyDeleteWhat is health? Does our system promote health or dysfunction? What do you want the healthcare system to do for you? If healthcare providers have an obligation to treat the uninsured, do the providers not, at some point, have a right to demand that society take responsibility and pay their bills or at least pay for insurance?
For what it's worth, what drives my support for the ACA is as follows, Despite the high quality of care available in our system, there is enormous waste and because of that waste, millions go without healthcare while millions with healthcare live like entitled assholes. IMO, we go through tortuous mental gymnastics to avoid acknowledging the REAL cost not only of our healthcare, but also of our extremely childish demand that we be allowed to live however we want and then give someone else the bill. This is as prevalent in medicine as it is in our refusal to raise taxes to pay for the debt we have rung debt.
MO, we go through tortuous mental gymnastics to avoid acknowledging the REAL cost not only of our healthcare, but also of our extremely childish demand that we be allowed to live however we want and then give someone else the bill.
DeleteSo very true. Probably the finest example is Bloomberg's law eliminating the super sized sugar laden drinks.
A serious overstep in our right to eat and drink all the fat and sugar we want as no one can tell us we cannot be over weight. Does it go back to personal responsibility and the lack of it?
I treat your two replies as one well thought out response, I will reply further tomorrow.
ReplyDeleteSounds good. I'll look back for it and hopefully others will chime in as well
ReplyDeleteMy issue with the ACA is that I saw no real cost control ... that to me is the heart of the issue.
ReplyDeleteSure , the exchanges offer direct competition with regards to rates for buying in, but I am always reminded of the "teaser" rates that the banks used to offer for mortgages during the pre-bust days.
There is absolutely nothing written into the law that controls cost. Nothing.
I understand what you're saying, Max, in terms of we, the consumers of health care, being responsible for driving the cost of health care, but there's a lot more to it.
A few months ago Time Magazine published an article. I think it was written by Richard Stengel, and it talked about what I'm alluding to.
Let me present a hypothetical,
Let's say I go into the hospital for an emergency appendectomy, 2 scenarios:
1. I pay out of pocket.
On my itemized hospital bill, it costs me $400 dollars for my hospital gown. Wow ...
2. I have insurance.
I look at an itemized bill and my insurance company gets charged $100 for my hospital gown. Great. They get a discount. I love my insurance company.
But later, when I'm home and recovering from my appendectomy, I go on Ebay and find that I can order the same hospital gowns, brand new in a 3 pack, for $14.99 plus $2.99 S&H.
Why? Why is that? Why the discrepency in cost? No one seems to be able or to be willing to answer that question.
To me, that's the heart of the matter.
Sure, personal control over our health and well-being is a big factor, but wtf?
I think that the ACA is a big, sloppy blow-job for the insurance companies. People are forced to buy a product from a private insurance company - 30 or 40 million people - and there is absolutely no limit written into law as to what they can charge.
I see small biz owners and big companies alike protesting against the oppression of the ACA but the big health care insurers remain noticeably mute.
Why is that?
Max, you are better informed about this stuff, what's your theory?
Lou hit most of what I was going to say below. The bottom line is that hospitals get stuck with quite a few costs and they try to recoup them elsewhere. In my last hospital gig in the ICU, I was making $38/hr. The hospital couldn't bill for my services directly, nonetheless, they have to pay for me to be there 12 hours a day whether I am directly doing pt care, or indirectly doing pt care by charting or whatever else. There is a lot that goes into the bill, but most of it does come down to way overcharging on what you can charge for in order to recoup the cost of what you can't charge for. Whether a hospital is full or empty, they always incur expense just to keep the lights on. There is a lot of this stuff that is added on to the bill in indirect ways.
DeleteTo you and Lou both regarding the ACA and cost. Funky, I agree with you entirely about the BJ for insurance companies. Because there wasn't a public option, the ACA just became part two of Bush's drug bill. Congratulations lobbyists. For as messed up as medicare is, there is something very rational in what they do. Comparatively, I think medicare DOES attempt to deal with cost in a rational way. Both, however, have more recently started to play the game of denying claims and that also is why hospital gowns cost $400.
As I said above, I see the current system as a shell game. Obesity and all its related complications drive cost higher, but so do "improvements" in healthcare. Just because we can help people live longer doesn't mean we are actually helping them live healthier. Chronic illness costs a lot to manage and from a nursing standpoint, I'm hard pressed to say that chronically ill people are particularly happy people. This is not a message that we should just euthanize such people, but it is a message that our technical expertise has far outpaced our ability not only to pay for it, but also to use it in ways that are truly healthy. If we want cost control and a system that truly preaches health, we need to be having a much different discussion. At present, we are having philosophical debates between free market versus socialism.
I think I look at the ACA the way a bankster looks at the repeal of Glass/Steagall, now that it's done, we will never be able to go back to how things used to be. The ACA is the wrong step in the right direction and given our political climate, it is the only bill that could have gotten done. Eventually, we will have more rational discussions about how to lower cost and yes, how to ration care in a reasonable way. As it stands, we already ration care. Those who have solid plans through their jobs want services to the uninsured rationed. We need to get over the hysteria of this and have adult conversations. IMO, the larger populous does not know where most of the health care dollars are spent and likely don't know how much is spent in the final years of life helping to keep a body function as a mass of cells long after the consciousness that used to reside in that body is long gone.
My theory is that the current solution and related discussions are cluster fucks.
But later, when I'm home and recovering from my appendectomy, I go on Ebay and find that I can order the same hospital gowns, brand new in a 3 pack, for $14.99 plus $2.99 S&H.
ReplyDeleteWhy? Why is that? Why the discrepancy in cost? No one seems to be able or to be willing to answer that question.
It's not really all that hard.
1. Medicare, medicaid are negotiated costs. Any shortfall is passed down the line.
2. Insurance companies also have negotiated costs. Any shortfall is passed down the line.
3. Citizens and non citizens that have no money or choose not to pay, do not pay. The costs are passed down the line.
4. The short fall hits the last one on the list, the cash payers. Yes, they take the biggest hit.
Healthcare costs what it costs. Government paying 80 cents for a dollar's worth of healthcare doesn't make it cheaper, it just shifts the cost of healthcare (redistributes, I like that) to others.
As to the PPACA, it changes nothing, just shifts the cost of healthcare to others. The costs will continue to rise as people continue to eat themselves to happiness and the waist line of America gets larger. Our lawmakers can demand you buy healthcare or pay a tax but cannot demand you pay a tax for being over weight. Instead of a basic service healthcare plan that provides an umbrella, we get the Cadillac plan, free physicals, pills for maintenance purposes. What people fail to realize, nothing is free, we always pay one way or another.
The PPACA was designed to fail. It is the stepping stone to a single payer system. There are several issues surrounding single payer.
1. How to pay for it? A consumption tax on everything we buy. Oh how regressive. Can't do that as the poor people who will use it would have to pay for it.
2. Imagine the entire insurance industry out of business.
3. As the government is completely out of control and cannot do anything without a yearly conference in Hawaii, imagine how much higher the cost will go. No, the government rarely does anything well.
4. Should we then nationalize all doctors, their practices and all hospitals and services? Nationalize all drug companies? Isn't competition one of the few remaining factors that stimulate innovation?
What a fine mess our government has created, just another intended consequence of government over reach.
Hope you have been well pfunky.
Lou!!! Nice to see you posting my friend!
DeleteThings be well. Likewise, I hope things are good for you and yours.
God responses! However the light bulb is going on in every response, as dingy Harry admitted we're on the road to single payer!!
ReplyDeleteWhat will single payer mean to me, not much, what will single payer mean to the twins, everything. There is no single payer system on this planet that treats folks that are in muscular or skeletal pain in a timely manner. Only life threatening conditions are treated in a timely manner and often not with an outcome that is 100% the "cure"
Only the United States, up till this point in time has dodged the bullet. Alas we elected a socialist president and legislature and the deed was done.
Ok, where are we going from here. Most adults over 50 or so will still linger on with the health insurance they have now, the 40 something's will see an end of what they have now over the next ten years, an my kids and the 20, 30 something's will live under single payer.
Single payer works well for non life threatening issues and for accident driven issues where the patient is patched up right away, what doesn't work, in any country yet, is non life threatening conditions, the wait for these issues is months or even years, and the victims of these conditions suffer the entire time.
There are over 300 million folks in the U.S. and "Obamacare" pretends it will work for them, however not even those that voted for it want any part of it. The law won't be overturned and so it looks like only the rich will be getting anything above emergency room healthcare any time soon.
Obamacare was an assault on the insurance industry, and it is working. An industry type cast as blood suckers doesn't look so bad now does it? Hope and Change doesn't look so good now either. You see folks America is a victim like every other country of the post war baby boom.
Each and every country faces promises that can't be filled, not without extreme taxation or just letting the old die off in the streets...
So, where do we go from here folks? I want my social security check, I want the system I've paid into for 40 years to take care of me, of us. All the promises are underfunded, all the promises are going to be lies, bold faced lies, Obama was only trying to show us that "this is a big fucking deal". The law that had to be read to find out was was in it is now being read.
Do you like what is in it?
Good responses, not God responses .... God doesn't want any part of this rat race he created, he's just watching the rats run the in the wheel and waiting to see if some of the rats can change things somehow....
DeleteSo God came to you and said this? Just kidding.
DeleteI agree with parts of what you are saying here and this in particular "Single payer works well for non life threatening issues and for accident driven issues where the patient is patched up right away, what doesn't work, in any country yet, is non life threatening conditions, the wait for these issues is months or even years, and the victims of these conditions suffer the entire time." is pretty dead on. As you mention, no country and no system has dealt with this very well. I see several failures there from inside the system. If you are rich and can have nutritionists, physical therapists and emotional therapists to help you deal with your chronic illness, you will likely have a better outcome then someone who doesn't have all those resources. But, this is also part of capitalism. If you can't compete and win, you get whatever crumbs your bettors feel compelled to leave you.
This is also a pretty decent statement "Each and every country faces promises that can't be filled, not without extreme taxation or just letting the old die off in the streets." From both left and right, there is plenty of wailing and gnashing of teeth that is heavy on emotion and light on rational discussion. I don't buy the arguments that liberals want to provide cradle to grave ass wiping. Conversely, I also don't buy the story that we can't raise taxes, thrive and provide basic building blocks that help everyone get ahead IF THEY ARE WILLING TO DO THE WORK OF APPLYING THEMSELVES.
At our current levels of outlays versus income via taxation, no, we cannot meet our obligations. For years, Republicans have preached we can simply cut our way to prosperity. IE, if we take away benefits of workers, if we cut government programs, and most importantly, if we cut taxes, we will have so much prosperity our heads will explode. It hasn't happened. I'm being a wise ass and of course, the left has their fantasies as well.
When I hear you talk about the future for the twins, I hear you expressing hopes and dreams that I don't believe are compatible likely outcomes of raw capitalism and a government that is made ineffective by choice. Do the traders who read zerohedge give a damn about your twins?
Many good one liners....
DeleteFrom the bottom up...
Do the traders who read Zerohedge give a damn about your twins, no they only care about making a profit for themselves.
However, the more profits they make in a capitalistic sense the better off the twins MAY be... If there are no profits for traders, the system collapses and folks jump out of windows... (Which I think is coming sooner than later). I have gone out of my way to get out of the "markets"
The twins will benefit from years of conservative living, the investments our collective family have made for them will allow them to NOT have to borrow, or receive a scholarship to have the chance at a decent degree. I am only living for them.
The Republicans cut comment...no party has advocated taking away benefits from workers, it is the political aspect of organized labor that is the issue. For decades I have only been in favor of a tax donation via the 1040 form that donates to a blind pool of funds political advertising, a 50/50 split of the fund, no other "PAC, union, individual, etc. etc. public only funding of political ads.
Where where do I think we can recover our funds, close all overseas bases except key airbases. We do not need to police the world any more, the savings of this policy would balance the budget in 5 years or less and go a long way to getting us out of the crosshairs of the rising tide of militant Muslims.
We need to deal with our collapsing inner cities, so far no magic bullet has been discovered to rid inner cities of the racial issue that divides our entire nation, never has such a small percentage of the population controlled so much territory, simply by living there. An atomic bomb creates a destructive force from an epicenter less than the size of a car, how do we stop the deadly decay, how do we stop the radiation? Would not be a simple equation that if we invested more to the collapse of the inner city that the recovery of those zones yield a wealth squandered?
Would that wealth go a long way towards increasing taxable items to "snowball" the effect from the inside out? If in ten years every inner city is turned around would not the country be more prosperous, wounds would heal, racial bias absolved, healthcare improved, all in all the "turn the other cheek to the inner cities" alone is 50 percent of this nations problems.
For me, the goals are:
Rebuild the inner city, the "ground zero" of the effort to make us all Americans, not having pockets of _______ fill the blank holding us all hostage with fear.
The next step is to put an end to private funding of any election of any kind at any level. How much hard earned cash that could fuel the economy if only the election funding came from a "check the box" on a 1040 form? Do fing tv adds funded by any group or individual generate jobs F no.
Finally, I think the focus on rebuilding the inner cities will go a long way to minimizing our healthcare problems. On the worst of levels who pays for 200 dead Chicago kids... Who is paying for Detroit...???
I will ramble on this topic response more later...
Between the dramatics of all profit is evil to all profit is just is a realistic balance. I believe there are ways to divide profit where it keeps circulating, and there ways to divide profit in a "keep what you kill manner" that simply stockpiles money and keeps it out of the economy. We have currently created a environment wherein the latter attitude dominates. This will do nothing to help your Twins....unless they become traders.
DeleteYou identify similar things that I worry about in this post. I can admit unions have had their excess, but so has business. What makes sense to me is that if money stays in the economy, the economy grows. I think you and I agree on believing we have shitty trade deals and that opening the doors wide to China has killed our production, that's not because of unions, it's because lobbyists got our government to allow our top businesses to enjoy the protection of the United States while basically stabbing it in the back. All businesses want capitalism to thrive until a competitor does something better then they do.
I'm with you on election money reform, but I need to say one thing. I see a distinct difference between a 10 million dollar contribution from a union with 10 million members then I do a contribution of 10 million from Sheldon Adelson. Because of Citizens United, I'm not sure we can ever stop the money and that is frightening. I am pretty much in favor of publicly funded and restricted campaigns.
The decay of cities will likely stop when our standard of living has fallen far enough to meet the rising standard of workers elsewhere. As long as the labor overseas is cheap enough to cover the cost of transportation, that arbitrage will continue to function. That said, the middle class needs to accept reality. Their quest to endlessly consume cheap shit has a lot to do with it as well. If we want to see prosperity return here, we need to accept higher prices and business needs to be a little realistic about how much profit it keeps. for a awhile, I have no doubt we are going to continue supporting the belief that it's good and morally acceptable for our income gap to be so wide. Once we stop accepting that, things will improve. IMO
When we address the free trade agreements which have been beneficial to our trading partners, we will continue to have labor, worker issues.
DeleteUnfortunately, our trading partners don't trade freely as we do. In Japan they tariff rice making California imported rice a non event. All countries are pretty much the same.
We need to restructure all free trade agreements to fair trade agreements. Would goods in the US be more expensive? Yes, however it would level the playing field. A fair trade agreement would allow imports to equal exports. If not a tariff is levied on the imported goods equal to the producing the goods in the US.
I do disagree with you on your contribution statements. Either zero contributions from business and unions or all contributions allowed. Why? It levels the playing field. Elections should not be a 2-3 year event. 1 year prior to election, fixed amount of money to spend. No more campaigning forever or unlimited funds for campaigning.
As to the income gap, it's a government created event. Minimum wage is held artificially low as we have an overabundance of entry level workers. That obviously affects the income brackets above that. Government policy, ZIRP, QE to infinity do not help the middle class. People struggle, the wealthy invest and get wealthier, the gap gets wider. Government interference has certainly created problems.
I'm not saying I necessarily disagree with banning all contributions, I was just saying I see a fundamental difference between a contribution from a union and from an individual. If we went to a system where we allowed candidates to spend whatever they want in primaries but then made the actual election a deal where candidates had to live within a certain limit of public funds, I would be on board with that.
DeleteWe sing the same tune of trade agreements, maybe someday our elected officials will. Given the power of lobbying, however, I doubt that happens. Even Reagan at points was a protectionist, that, to me, is simply being wise enough to defend a greater good. However, even Democrats at the moment have been sucked into signing off trade deals that nothing but labor busting rackets and tax dodges. Clinton STILL believes NAFTA will work someday. Oye.
The income gap is government AND free market created. We likely won't agree on this point, but I believe our current tax structure has also created an incentive for the money class to hoard as much wealth as possible. I can't help but notice that as taxes have fallen as sharply as they have, the income gap has grown substantially. To say government policy doesn't help the middle class is a little misleading when we can trace a clear and direct route from the FED straight to the pockets of the investing class. When a mere pittance is directed to the middle class, or course it doesn't do much. On the other hand, Wall Street has made trillions. Government spending DOES make a difference, but you need to be mindful of where you are pushing it.