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Post by dreamboatcruise on Apr 10, 2018 15:21:18 GMT -5
There may be arguments to the contrary but not good, honest arguments. Opposing views on almost any subject can be found on the web, especially when it comes to politics. The U.S. medical market place today is definitely not free market. If it was you could buy health insurance across state lines. More importantly results would be coming from consumers versus insurance companies and bureaucrats. I'll now refrain from the politics on this subject but hat's off to Jeff Dachis for his willingness to speak up! If you think states shouldn't be allowed to regulate insurance, do you think they shouldn't license doctors? Truly free market, anyone could practice medicine and prescriptions wouldn't be required to purchase drugs. I have a chronic disease (thyroid) for which I am perfectly qualified to order lab tests, adjust my treatment plan and buy drugs myself without any need for doctors or insurance. However, I don't actually think a truly free market in medicine would be beneficial overall. I'm not a big fan of having insurance where my only recourse to complaints would be to a state regulator in a state where I am not a constituent. Why would the insurance commissioner in AL care about my concerns as a CA resident? Just seems odd to allow regulation to be done state by state but then force all states to open up their markets to insurance regulated in other states. If the regulation were done at the Federal level that would make more sense than cross state purchasing, since then the regulatory body would at least theoretically be controlled by citizens everywhere... but in this case I don't see why states shouldn't be allowed to experiment with regulations tailored to their own specific needs... i.e. states rights. |
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Post by dreamboatcruise on Apr 10, 2018 15:29:34 GMT -5
The Veterans Health Administration is an example of socialized medicine. There are pros and cons to the VA, but it is overall ineffective and unintentional burdens are put on veterans because of its dynamics. A perfect example is Person #1 is a combat disabled veteran with a felony that has a heroin addiction and wishes to enroll in an opioid abuse program for help. The veteran must spend hours on the phone and must fill out copious amounts of paperwork, and wait for weeks until hearing back from the VA to inform him that the nearest program is in the neighboring state 2 hours away. Now the veteran must obtain approval to leave the state by parole officer. Then, the veteran is made aware that he will have to make a 4 hour round trip to receive a once daily liquid dose of medication. The veteran realizes this is unrealistic and so remains addicted to heroin and received no realistic help despite begging for it. Person #2 has all the same issues as Person #1 except he lives in the state with the program and thus can realistically receive treatment for his addiction. That is socialized medicine. That is underfunded socialized medicine. It would be expected that Vets would have very expensive healthcare needs based on their service. The VA is not funded to that reality. Hence not having drug addiction services sufficiently prevalent geographically. Would a fully funded voucher system work better than fully funded VA? That I cannot say, but I'm pretty confident the level of funding the VA currently has would not provide adequate care to all vets if redirected to a voucher system for privatized services. Either way, more money would need to be spent to give the type of care our vets deserve. |
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Post by mango on Apr 15, 2018 12:23:54 GMT -5
The Veterans Health Administration is an example of socialized medicine. There are pros and cons to the VA, but it is overall ineffective and unintentional burdens are put on veterans because of its dynamics. A perfect example is Person #1 is a combat disabled veteran with a felony that has a heroin addiction and wishes to enroll in an opioid abuse program for help. The veteran must spend hours on the phone and must fill out copious amounts of paperwork, and wait for weeks until hearing back from the VA to inform him that the nearest program is in the neighboring state 2 hours away. Now the veteran must obtain approval to leave the state by parole officer. Then, the veteran is made aware that he will have to make a 4 hour round trip to receive a once daily liquid dose of medication. The veteran realizes this is unrealistic and so remains addicted to heroin and received no realistic help despite begging for it. Person #2 has all the same issues as Person #1 except he lives in the state with the program and thus can realistically receive treatment for his addiction. That is socialized medicine. That is underfunded socialized medicine. It would be expected that Vets would have very expensive healthcare needs based on their service. The VA is not funded to that reality. Hence not having drug addiction services sufficiently prevalent geographically. Would a fully funded voucher system work better than fully funded VA? That I cannot say, but I'm pretty confident the level of funding the VA currently has would not provide adequate care to all vets if redirected to a voucher system for privatized services. Either way, more money would need to be spent to give the type of care our vets deserve. They are not underfunded. Another vet I know received a $50K grant from the same local VA last month to help with an equine-assisted therapy program he is starting. |
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Post by dreamboatcruise on Apr 16, 2018 12:09:39 GMT -5
That is underfunded socialized medicine. It would be expected that Vets would have very expensive healthcare needs based on their service. The VA is not funded to that reality. Hence not having drug addiction services sufficiently prevalent geographically. Would a fully funded voucher system work better than fully funded VA? That I cannot say, but I'm pretty confident the level of funding the VA currently has would not provide adequate care to all vets if redirected to a voucher system for privatized services. Either way, more money would need to be spent to give the type of care our vets deserve. They are not underfunded. Another vet I know received a $50K grant from the same local VA last month to help with an equine-assisted therapy program he is starting. I'd be willing to bet dollars to donuts that is a congressional appropriation specifically for that and doesn't come out of general VHA budget. I bet with a little googling you'd find it was some in congress wanting to look good on veterans issues by sponsoring this, but that the amount of money actually spent on it is drop in the bucket of the VA budget. Congress does yearly appropriations for VHA. There are more vets that want to enroll in VHA than they have money for. VHA has to choose to spend less on those already enrolled or turn more away at the door. Objectively speaking VHA pays less for many things vs private healthcare... doctors services, hospital services, pharmaceuticals. The studies I've seen indicate that if VHA were to switch to a voucher system for private insurance it would require more money, not less. If you know of any study to the contrary I'd be interested in seeing it. If more money need be dedicated, it is worth considering whether it is better spent on existing VHA system... and it may well be the best solution is some combination of vouchers for private services combined with VHA for specialized care more unique to combat vets. |
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Post by hopingandwilling on Apr 16, 2018 13:48:17 GMT -5
In France should you need medical care you merely go to your doctor, hand one clerk/receptionist your medical ID card---looks like any Visa Card /Amex Card. Automatically your complete medical history is pulled for the Doctor's reviewing your personal medical information--conditions you are being currently treated, plus all other conditions you have been treated, plus list of medications you are using, etc. It tells the doctor if you have a history of allergic reactions you might have for particular drugs. For example--many people are allergic to sulfur based drugs. After his review the doctor starts his examination for this visit--assuming its a new condition and he prescribes a new drug, he enters the information into your data base profile--aka-Medical ID card. Upon completing this patient's visit--the patient merely leaves the doctor's office and walks down the block to the local pharmacy and hands his Medical ID card to a clerk. The clerk inserts the Medical Id card into their terminal--notes what the Rx calls for, then goes over to the drug storage area and pulls the prescription. Patient leaves the drug store and heads back to work or home!
This is the procedure in the US:
1) Patient gets sick and immediately wonders if he goes to the doctor will his insurance cover the cost.
2) Patient might be out of town so he now needs to worry about going to a doctor or hospital that might not be in his network of coverage.
3) Patient in this case goes to his regular doctor after making an appointment. He is able to get an appointment for two weeks later, but first, one the many file clerks he has on staff will confirm if you have insurance (often when a person doesn't have insurance, the offer to see you in two weeks, turning into a case of the doctor now not taking new patients.
4) Patient arrives and waits and waits in the reception area.......why? A file clerk is searching to a room filled with rows and rows of medical history that has been compiled in handwritten notes involving massive number of pages for the doctor to review before he sees the patient.
5) But once again--before you see your doctor you must prove you have insurance that is valid and the doctor is in their approved network.
6) How many have ever wondered why you bother getting an assigned appointment time--because you always have to wait.
7) Doctor finally sees you but only has a few minutes of his time to listen to you telling him about your condition.
8) You are lucky the doctors decides a drug will solve your problem--so the doctor leaves the examination room.
9) He comes back and hands you a handwritten Rx.---and walks out because he must spend time wading through pages of handwritten medical history for the next patient cooling their heels in the waiting room.
10) You the patient leave the examination room and note that 99% of doctor's office require you going through a special exit door--a door that leads to a massive number of insurance clerks or clerks to process your co-payment requirement.
11) Patient goes to drug store to get your prescription filled--first have to provide proof of insurance coverage and wait for hours or come back the next day to pick-up your prescription.
Get the picture--get the big picture. Notice anything different in the experience in France vs here in the US.
1) In France the issue of insurance is never brought up between the doctor and the patient.
2) In France the issue of whether your condition is covered---only is rare and unusual cases.
3) Notice that the only human interaction between the patient before seeing the doctor is only ONE person --a person who inserts your Medical ID card into the doctor's terminal.
4) Doctor doesn't have to wait for your personal records being found in his cavernous file room filed with pages of random medical history notes.
5) French doctors have time seeing the patient, not rushing through so he can get to the next patient. Notice that the French patient never is involved with making payment arrangements between Dr. or Pharmacist. Based on Medical ID sourcing the information at the end of the month--doctor's charges is credited to his account. Pharmacist charge for the drug--automatically credited to his account.
Let me give you my personal history with European health care. Last year my wife and I were in Norway on vacation. Upon arrival in Oslo and checking into our hotel, I noted that I had forgotten one of my daily generic medications. A drug that cost me $15.00 co-pay for a 30 days supply. I went down to the concierge person in the hotel and asked if there was Pharmacia located near by. Luckily, there was one in the next block. I walked in and there was a lady ahead of me--she handed the pharmacy clerk her Medical ID card, the clerk went over and pulled open a cabinet where drugs were stored. She pull out a box of medicine walked over and handed them to the lady. Lady turns and walks out of the store--no money being exchanged. My turn--I walked up and asked to see the Pharmacist. He came over (he was a middle-eastern gentlemen--very polite) and asked me in perfect English what I needed. I was prepared to give him an elaborate story of why I ( a non-Norwegian citizen) needed a drug. I started by telling him I was from the US and need an emergency fill for my US prescription. He asked what it was--I told him! With that he turned and started walking away. I was stunned--the man was ignoring me--I thought! But he walked over to the cabinets where the drugs were stored. He reached in and pulled out a box. He came back over and asked me to provide him my passport. I gave it too him and he went over and started to type out a standard dosing label with my name on it. Within a minute he came back over and handed me the box---I immediately noted the box contained a 90 days supply of the medication. I started to tell him that I only needed a two week supply --he smiled and said that they only had packages for a 90 day supply. Sorry! I was glad to get the drug, so I didn't hassle over the fact that with me being a US citizen that I was going to be stuck with paying a massive amount of money for a prescription needed for a two week supply. I handed him my Visa card--afraid to ask him how much the prescription was going to cost me. When he returned I looked at the amount--and I ask him if the amount was in dollars or Krona's--he laughed and said the amount you see, it will be less when converted to the dollar. The amount charged--in US dollars was $7.00. This whole sequence of events from the time I left the hotel to when I walked out of the drug store was about 20 minutes--and I got a 90 day supply where just with my co-pay would have cost me $15.00---and we have people in the US that find it necessary to castigate the Europeans for their healthcare system. But this story gets more interesting--on the cruise I had the pleasure of having to interact with a gentlemen who had been the CEO of an international bank. At each meal and social hour I had to listen to him complain about European socialism. But it just so happened when we returned to Oslo after our cruise we were checking into our hotel as we flying out the next morning. The gentlemen made a misstep and fell at the entrance to the hotel--busted his forehead, broke his glasses and he was bleeding badly. The hotel called for a taxi, luckily my cousin who is a medical doctor examined him and thought he wouldn't need an ambulance but he went with him to the hospital. They were gone for less two hours--can back to the hotel, after having been given a MRI to see if there was any internal damage, twenty stitches, etc. and being examined by two medical doctors---his payment to the hospital came to approximately $25.00.
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Post by mytakeonit on Apr 16, 2018 15:32:52 GMT -5
So, if you're paying out of pocket $900 for a 30 day supply of Afrezza ... you could actually book a round trip flight from California to Oslo for $311 on cheap fares. WOW! Let's see ... $900 x 3 = $2700. Less the $311 and $25 for 90 day supply of Afrezza ... leaves me with ahhhh ... wait ... I'm an accountant ... so, you'll have a ton of $$$ left !!!
As they say in Hawaii ... Book 'em Danno !
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Post by boca1girl on Apr 16, 2018 17:02:08 GMT -5
So, if you're paying out of pocket $900 for a 30 day supply of Afrezza ... you could actually book a round trip flight from California to Oslo for $311 on cheap fares. WOW! Let's see ... $900 x 3 = $2700. Less the $311 and $25 for 90 day supply of Afrezza ... leaves me with ahhhh ... wait ... I'm an accountant ... so, you'll have a ton of $$$ left !!! As they say in Hawaii ... Book 'em Danno ! Medical tourism is a booming business. Once Canada starts selling Afrezza, if mail order doesn’t work, travel will be pretty convenient. |
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Post by digger on Apr 16, 2018 22:27:02 GMT -5
So, if you're paying out of pocket $900 for a 30 day supply of Afrezza ... you could actually book a round trip flight from California to Oslo for $311 on cheap fares. WOW! Let's see ... $900 x 3 = $2700. Less the $311 and $25 for 90 day supply of Afrezza ... leaves me with ahhhh ... wait ... I'm an accountant ... so, you'll have a ton of $$$ left !!! As they say in Hawaii ... Book 'em Danno ! Medical tourism is a booming business. Once Canada starts selling Afrezza, if mail order doesn’t work, travel will be pretty convenient. I wonder if that's a reason Mannkind hasn't gone for Canadian approval. Canada likely would demand a significant cut in the price and that could dissipate US sales. Even then I'd still be a lot more impressed with Canada than I am with Brazil. |
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Post by mytakeonit on Apr 17, 2018 0:53:30 GMT -5
So what's wrong with a free trip to Oslo? Like any international sale at this time ... we reduce cost per unit by getting it out the door. When money isn't a problem, then we can decide where we want to be.
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Post by dreamboatcruise on Apr 17, 2018 13:15:01 GMT -5
But this story gets more interesting--on the cruise I had the pleasure of having to interact with a gentlemen who had been the CEO of an international bank. At each meal and social hour I had to listen to him complain about European socialism. But it just so happened when we returned to Oslo after our cruise we were checking into our hotel as we flying out the next morning. The gentlemen made a misstep and fell at the entrance to the hotel--busted his forehead, broke his glasses and he was bleeding badly. The hotel called for a taxi, luckily my cousin who is a medical doctor examined him and thought he wouldn't need an ambulance but he went with him to the hospital. They were gone for less two hours--can back to the hotel, after having been given a MRI to see if there was any internal damage, twenty stitches, etc. and being examined by two medical doctors---his payment to the hospital came to approximately $25.00. He probably is worse off paying $25.00 vs the real cost of the treatment because of the higher tax rate he pays on a large amount of income. I guess I'd find that predictable rather than terribly interesting  |
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Post by Chris-C on Apr 17, 2018 14:32:00 GMT -5
Interesting discussion here, but overall a sad commentary on the state of the situation.
When I was in academic medicine, I asked my colleagues one day (over a decade ago, BTW) what they thought would ultimately happen to U.S. health care. What they said generally, with little dissent, was that the system would continue on its trajectory driven by greed until it imploded. Many innocent people would suffer then, and there would be a period of bitterness, chaos and recrimination.
Out of the rubble created by this tragedy, (one of my colleagues imaginatively observed) would come positive change for some communities, namely those lucky enough and with sufficient social capital to mobilize their citizenry toward productive solutions. She opined that in all likelihood, these lucky communities would establish their own transparent NON PROFIT "cooperative" systems scaled to their needs and attentive to all the features that emphasize access, prevention, quality of life, evidence-driven practices, incentives for innovation and "humanistic care". While thinking this outcome unlikely, others agreed that such a reformed "cooperative" would require that people (and families) accept reasonable responsibility for behavioral changes related to their own health, including prevention and self-care.
I've never forgotten that conversation. And the trajectory since that time has changed little, save for the well-intentioned but one-sided and only partially effective effort put forward with passage of the ACA.
As premiums and copays continue to climb beyond mortgage payment levels, and Congress continues to come up empty in inspired attempts at reform, I'm more convinced than ever at the likelihood of implosion. Maybe the point is that unless people (we all) are willing to think creatively, accept the need for change, and check our entrenched expectations and attitudes at the door, the current greed contest will take all of us over a cliff with devastating consequences. It's just a matter of time.
And, if we're lucky, that implosion will force us all to think more creatively and collectively. As I observe the impressive wisdom and resolve of my adult kids and their friends, it's easier for me to imagine that perhaps (suffering aside), implosion might lead to the dramatic new approaches that give us more probability of success in the future.
Regards to all longs
Chris C
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