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Subject: How should we ration healthcare in the US? rss

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Steve
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In another thread I suggested that we should be having a conversation on just how the US should "ration" healthcare if it had a single payer system.

Until we have this conversation those Libertarians who know that without rationing healthcare will bankrupt the nation will be able to keep pointing to this. Where "bankrupt" might mean "suck up so much of the GDP that the rest of the population suffers great hardship". Surely this would happen at less than 50% of the GDP.

OK, I challenge us to go out on a limb and make suggestions of how to do it. Specific suggestions.

Who decides?
On what basis should their decision be based?

I'll go 1st because that is only fair. I propose that the US create a time machine that is cheap to build and operate. Then, use it to send messages to the doctors in the past [say 6 mo. ago] to tell them that patient X is going to die anyway, so go ahead and pull the plug. This is the only fair way that we can ration healthcare. Any other system will at least many times be killing people before it is necessary to kill them. Maybe I should say "let people die" rather than "kill them", but I want to be blunt. Any other system will in many other times waste money trying to save someone who is going to die no matter what we do. Remember this is one of the lessons of the movie "Groundhog Day".

Yes, I know; my proposal is impossible. I just want to set the stage for the conversation. This is the crux of the problem in 5 sentences.

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Derry Salewski
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are you being drunk or sarcastic?
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Peter Lloyd
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All health care is rationed one way or another. That is the first thing people need to understand. In the U.S. the rationing mechanisms are wealth and profit. The ACA created a, though far from ideal, method of gentrifying those regulations. Even if fully implemented, the ACA would not have brought its promised results, but at least it would have been an improvement.

The house GOP has now made a decisive gesture. I call it a gesture because it has no hope of passing the senate. Equally any senate reform to the ACA, who is having a more thoughtful discussion on the subject, is quite unlikely to fashion anything acceptable to the house.

The fatal flaw, and the U.S. is unlikely to resolve this anytime soon, is that U.S. healthcare is based primarily on insurance, and people equate insurance with health care.

What is actually need is a base healthcare plan. Whether it is implemented via the government or by insurance corporations is largely unimportant. The big corporate mandate would be, if you sell heath insurance, you sell at least this plan to ever comes. If the plan is government provided, insurance companies would move into the subsidy market.
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Frank F
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Implement a resource based economy, the aim of which is to promote public health and provide the basic necessities of life to all people without artificial restriction.
 
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Mac Mcleod
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plloyd1010 wrote:
All health care is rationed one way or another. That is the first thing people need to understand. In the U.S. the rationing mechanisms are wealth and profit. The ACA created a, though far from ideal, method of gentrifying those regulations. Even if fully implemented, the ACA would not have brought its promised results, but at least it would have been an improvement.

The house GOP has now made a decisive gesture. I call it a gesture because it has no hope of passing the senate. Equally any senate reform to the ACA, who is having a more thoughtful discussion on the subject, is quite unlikely to fashion anything acceptable to the house.

The fatal flaw, and the U.S. is unlikely to resolve this anytime soon, is that U.S. healthcare is based primarily on insurance, and people equate insurance with health care.

What is actually need is a base healthcare plan. Whether it is implemented via the government or by insurance corporations is largely unimportant. The big corporate mandate would be, if you sell heath insurance, you sell at least this plan to ever comes. If the plan is government provided, insurance companies would move into the subsidy market.


We ration on other methods as well.

Likely quality and duration of life which also includes things like not giving the liver to an alchoholic, how much longer the patient is likely to live if they recieve treatment, and how many patients can be treated.

Our rationing based on money is less formal and often hidden from us to prevent resentment.
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Steve
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Just as I expected, nobody wants to climb out on that limb for fear someone will saw it off behind them. Or call them horrible names for suggesting such a thing.

So far 1 sarcastic comment and a few descriptions of how we do it now.

So, you can see why I didn't really want to start. Whatever I suggest is going to get me pilloried in the court of RSP opinion.

I suggest every hospital have 1 or more "Panels to decide when health care for this patient is useless because he will die soon no matter what we do" or maybe "Death Panels".

These Panels would be selected for a 1 month term from the pool of local people who have graduated from college. Like jury duty you get "drafted", unlike jury duty you get paid some percentage of your normal income. There might be a process to eliminate people with strong opinions either way. They are also like a jury in that they all must agree. The hospital might be allowed to ask the next Panel, a month later, to review the case. The patient or their family might be allowed to appeal in some way, like stay the decision until another panel can look at it.

There would need to be a set of guidelines that all Panel members must read and know well.

In some cases we might as a society decide that certain birth defects or similar very early childhood conditions are just too expensive for the society to provide care to all for free. I can imagine that there might be a defect that will cost $100M over the 1st 30 years of their life. At this point can we agree that the family should pay on their own? Or that we just let the baby die?

Good thing I will never be on such a panel because I'll die before there is single payer in the us.
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Trey Chambers
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We should ration it out to those that need it.

/thread
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Vapix
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Shampoo4you wrote:
We should ration it out to those that need it.
/thread

In this case the costs become infinite. Not could become impossible to deliver - will become impossible.

Imagining efficient rationing will happen of its own accord is dangerous, because:

1. It will happen anyway
2. Whatever actually happens will definitely (100% certainly) be sub-optimal
3. It won't just be wrong individual by individual: investment and tactical resource allocation within healthcare will also be sub-optimal

Of course Steve1501 is right not to make the first suggestions. He would get viciously attacked by "forum crazies" for doing that.

But logially, because of point (1) above, it's up to the "socalism in healthcare" brigade to start this discussion. The hated "let the market decide" group already have a complete answer to that question, so they have no obligation to even participate.
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Trey Chambers
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Vapix wrote:
Shampoo4you wrote:
We should ration it out to those that need it.
/thread

In this case the costs become infinite.


Lol you can get out of here with this nonsense. 20+ countries make this work, why can't we?
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Shampoo4you wrote:
Vapix wrote:
Shampoo4you wrote:
We should ration it out to those that need it.
/thread

In this case the costs become infinite.


Lol you can get out of here with this nonsense. 20+ countries make this work, why can't we?

They ration it of course. But they really ration it. They don't use simplistic principles that are impossible for a medical technician to apply.

BTW - a lot of countries with more efficient healthcare than the US still don't handle rationing all that well. But this is to be expected, because it's a really hard problem. Not least because there are always a lot of people putting a lot of effort into trying to get more than their share.
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Lynette
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Shampoo4you wrote:
Vapix wrote:
Shampoo4you wrote:
We should ration it out to those that need it.
/thread

In this case the costs become infinite.


Lol you can get out of here with this nonsense. 20+ countries make this work, why can't we?


They have a rationing system in place that DOESN'T cover all those who need it.

There are trade offs between system X and system Y. That is why some people from Canada come to the USA for some treatments and some people from the USA go to Canada for other treatments.

It is reasonable to have a discussion about brainstorming where the balance point should be.
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Lynette
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I personally think we need to come up with a hybridized system of care that is between government and private.

A single payer system funded by the government that covers basic health care for all people for basic health care if they are not covered by employers, and which subsidizes some kind of catastrophic insurance coverage for this same pool of people.

I think letting employers and employees continue to work out private insurance benefits that go above basic care is a good idea.

I think regulations need to be in place that forbid insurance companies from excluding people with preexisting conditions from getting health insurance they would normally be entitled too. Aka, if you start a new job with company X, and company X offers an insurance package to its employees than the insurance company cannot refuse to cover that person and their family no matter what health issues that person/family has.
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Christopher Dearlove
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The US healthcare system spends more per head than any other in the world. And massively underperforms. If you ran a system more like any other modern industrialized country and got even close to their efficiency, you'd have a healthcare system that the world would envy. As it is you have a tip of the system that is really great (though other countries have their tips too) and a greatly underperforming rest (although social conditions matter too). But could you get to a sensible system? It seems not. The original concept of Obamacare tried, but the ACA was a compromised version of that. And now even its modest gains are being rolled back. But as long as half your voting population seem to think that's great, you're stuck where you are.
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Meerkat wrote:


I personally think we need to come up with a hybridized system of care that is between government and private.

A single payer system funded by the government that covers basic health care for all people for basic health care if they are not covered by employers, and which subsidizes some kind of catastrophic insurance coverage for this same pool of people.

I think letting employers and employees continue to work out private insurance benefits that go above basic care is a good idea.

I think regulations need to be in place that forbid insurance companies from excluding people with preexisting conditions from getting health insurance they would normally be entitled too. Aka, if you start a new job with company X, and company X offers an insurance package to its employees than the insurance company cannot refuse to cover that person and their family no matter what health issues that person/family has.


Oddly, this description is probably closest to the UK's health system. Which is one of the most government run healthcare systems, rather than a hybrid.
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Scott O'Brien
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we need to go back to the old system where healthcare was tied to employment.


1) it encourages people to be employed, which we should be striving for 100% employment.
2) it encourages businesses to provide higher levels of preventative and reactive healthcare, because they want their employees to be at work, not off on sick leave.
 
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sao123 wrote:
we need to go back to the old system where healthcare was tied to employment.


1) it encourages people to be employed, which we should be striving for 100% employment.
2) it encourages businesses to provide higher levels of preventative and reactive healthcare, because they want their employees to be at work, not off on sick leave.


Well, this is filled with fail, partic on #2.

Why?

Not all employees are created equally. Apple will apply this principle for Tim Cook, because there is only one Tim Cook.

Chipotle will not apply this principle to line cook #3, because there are hundreds deep of line cooks that can be called up from the bench to replace line cook #3.

Furthermore, the likelihood of the above scenario happening would fall on the probability spectrum depending on how deep that local economy's bench was. Therefore, in Bumfuck, Idaho, where they may be lucky to have any reserves, the employer's incentive is there. In any large city (where the majority of Americans live), the bench is deep and wide.


Please tell me how your system would address this issue?

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81% of Americans live in urban areas - by 2010 Census data.
 
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sao123 wrote:
we need to go back to the old system where healthcare was tied to employment.


1) it encourages people to be employed, which we should be striving for 100% employment.


So those people most in need of healthcare can't get it.
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Wendell
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sao123 wrote:
we need to go back to the old system where healthcare was tied to employment.

1) it encourages people to be employed, which we should be striving for 100% employment.
2) it encourages businesses to provide higher levels of preventative and reactive healthcare, because they want their employees to be at work, not off on sick leave.


3) it encourages people not to retire.
4) it encourages people not to attend university.
5) it encourages people not to be freelance writers, or artists, or musicians
6) it encourages people not to quit their job in order to take a chance on launching a new business.

Health care was never entirely tied to employment anyway. Tying it to employment is a historical accident (WW2; US companies not allowed to offer raises - so instead competed for labor by offering insurance). It is a stupid system.
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Everyone in the USA gets all of the healthcare they need until age 30.

Then Carousel!
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Frank F
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darthhugo wrote:
sao123 wrote:
we need to go back to the old system where healthcare was tied to employment.


1) it encourages people to be employed, which we should be striving for 100% employment.
2) it encourages businesses to provide higher levels of preventative and reactive healthcare, because they want their employees to be at work, not off on sick leave.


Well, this is filled with fail, partic on #2.

Why?

Not all employees are created equally. Apple will apply this principle for Tim Cook, because there is only one Tim Cook.

Chipotle will not apply this principle to line cook #3, because there are hundreds deep of line cooks that can be called up from the bench to replace line cook #3.

Furthermore, the likelihood of the above scenario happening would fall on the probability spectrum depending on how deep that local economy's bench was. Therefore, in Bumfuck, Idaho, where they may be lucky to have any reserves, the employer's incentive is there. In any large city (where the majority of Americans live), the bench is deep and wide.


Please tell me how your system would address this issue?



Employers don't need to provide health insurance for robots. Your job will be automated. Please investigate a resource based economy.
 
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scifiantihero wrote:
are you being drunk or sarcastic?

What, he can't do both?
 
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LightRider wrote:
darthhugo wrote:
sao123 wrote:
we need to go back to the old system where healthcare was tied to employment.


1) it encourages people to be employed, which we should be striving for 100% employment.
2) it encourages businesses to provide higher levels of preventative and reactive healthcare, because they want their employees to be at work, not off on sick leave.


Well, this is filled with fail, partic on #2.

Why?

Not all employees are created equally. Apple will apply this principle for Tim Cook, because there is only one Tim Cook.

Chipotle will not apply this principle to line cook #3, because there are hundreds deep of line cooks that can be called up from the bench to replace line cook #3.

Furthermore, the likelihood of the above scenario happening would fall on the probability spectrum depending on how deep that local economy's bench was. Therefore, in Bumfuck, Idaho, where they may be lucky to have any reserves, the employer's incentive is there. In any large city (where the majority of Americans live), the bench is deep and wide.


Please tell me how your system would address this issue?



Employers don't need to provide health insurance for robots. Your job will be automated. Please investigate a resource based economy.

Who allocates the medical supplies in a resource based economy?
 
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Derry Salewski
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lelandpike wrote:
scifiantihero wrote:
are you being drunk or sarcastic?

What, he can't do both?


Oh i was fully expecting a simple "yes."
 
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For those that want an example of poisoning the well, see this thread.
 
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