Where do you stand on Healthcare?

[hog88]

Quick question, because I might like to debate you a little on this, what about Medicare and Medicare Supplement Plans? Also, as to #4, how would you handle indigent?

As for Medicare/Medicaid period, I would have the gov give the money directly to the person and let them purchase insurance on the open market.

I’m sure that there would be many HC providers that would willing treat the indigent. I’m just saying that there should be no law forcing them to.

 

[hog88]

But is your wife wealthy?

Nope.

 

[0nelilreb]

But is your wife wealthy?

She will be if she ever finds a good place to hide the body .

 

[Rickyvol77]

You are in the very small (and shrinking) minority of earth’s population that believes this.

Forcing someone to provide services for someone else is not a right and NEVER will be

 

[Rickyvol77]

The constitution does not equal personal beliefs, unless you prefer to forfeit your personal beliefs to the words of other men.

Die on the hill of healthcare exclusivity though, future generations will read about that POV with proper distain just like they read about Jim Crow laws or WWII internment camps for the Japanese.

hahahahahaha you say the same thing about the 2nd Amendment too, and you will ALWAYS be wrong

 

[Rickyvol77]

I'm sorry, but healthcare is a right in this country as each and every person is given healthcare when they need it. The government doesn't dole out healthcare, only money.

Saying health care is a right is like saying its a "right" to have someone fix your car or your HVAC unit at your house or itis a "right" to have KUB come hook up water/heat to your house

 

[Rasputin_Vol]

Hmmm, these Latins don't like new taxes and expanded social programs? Interesting.

2021 Colombian protests - Wikipedia

A series of ongoing protests began in Colombia on 28 April 2021 against increased taxes and health care reform proposed by the government of President Iván Duque Márquez. The tax initiative was introduced to expand funding to Ingreso Solidario, a universal basic income social program established in April 2020 to provide relief during the COVID-19 pandemic in Colombia, while the legislative Bill 010 proposed the privatization of health care in Colombia.

Ingreso Solidario, a universal basic income social program introduced by the Duque government during the pandemic, had already provided at the time thirteen monthly payments of around $43 USD to low-income populations since April 2020. Three million of about fifty million Colombians were eligible for Ingreso Solidario payments, with the program being at a smaller scale when compared to other Latin American countries. According to Merike Blofield, director of the German Institute for Global and Area Studies' Latin American division, "Compared to other countries in the region, the coverage that Ingreso Solidario offers is extremely weak, ... For the 3 million people that got it, it certainly made a difference. But there were five times as many households that needed it".

The Duque government, seeking to expand the program to include 1.7 million more people and to establish a permanent basic income program, chose to pursue a tax reform for funding. The tax increase on many Colombians was presented as a way to provide US$4.8 billion for Ingreso Solidario. Duque's tax reforms included the expansion of value-added taxes on more products such as food and utilities, the addition of some middle-class earners into a higher tax bracket and the removal of various income tax exemptions.

 

[Electric Orange]

 

[OHvol40]

There isn’t anything said there that isn’t true, but there is also a lot left unsaid.

 

[NorthDallas40]

Here you go @EasternVol go nuts!

 

[EasternVol]

Here you go @EasternVol go nuts!

Thanks!

 

[NorthDallas40]

Thanks!

Quite welcome. There are several threads specifically on Medicare also but this was the most current discussion and Medicare creeped into this thread also. My Ebenezer Scrooge approach is in this thread I believe

 

[LouderVol]

necroing an old thread for something I heard on NPR this morning regarding prescription drug pricing. I was driving in traffic so I wasn't able to pay too close attention, so I may get some things wrong here, and if someone could correct me or fill in the holes that would be appreciated.

They were talking about how prescription drug prices got so high. NPR gave their pretty typical slanted "both" sides reporting on the matter but I found some things interesting. The way they broke down/I picked up the time line was something like this, the (?) will be places where I missed something or think I might be wrong and am looking for info:

-Pre 2005(?) retailers of prescription drugs were able to make their own selections on what drugs to provide and what costs to sell the at. At the time the tax code allowed for drug companies to sell drugs at a higher price and not face higher taxes the first couple years until they paid off the R&D costs. This lead to the drug Humira costing $1000 a month because it was relatively new in 2002, and they went on to say how many people use that. They also talked about how that lead to increased insurance premiums as they had to cover high cost drugs like that. This lead to a public case of a big retailer(?) essentially taking bribes from a drug manufacturer to only sell their drugs.
-This lead to outrage, and congress got involved. They passed a bill removing the retailers ability to make their own drug selections, because they were gate keeping new drugs. So they passed a measure that created a system to get drugs approved for retailers to sell, but it still had no way to force them to actually sell it. This lead to even more gate keeping, because new drugs had to go through an extra step after getting full FDA approval to get to retailers. This obviously was a problem, and so the bill was adjusted less than two years later. Apparently at this time the price of monthly Humira was about 2000. they did some things to get drugs back on the shelves, including letting distributors make the decisions again on what drugs to sell directly instead of having to wait on government approval.
-A couple years later Congress adjusted how taxes on those distributors are done. Apparently the way a lot of big drug companies work when they sell to a distributor is they sell at market rate, 2000 for a month of Humira, and then offer the distributor a sizeable rebate. Apparently the new tax code did one of two things, this is something I missed and the way NPR talked afterwards confused me. It either let the distributor count the full cost of the drug as a loss and only had to report the profit from selling the drug at whatever the rebated cost to them was, and didn't have to report the actual rebate. Or they had to report the rebate, but that was all they had to report to the IRS, and not the sale of the full price drug, because they paid their taxes on the rebate as the "sole" profit from the drug.
-Then under Obamacare these rules got re-written again to allow for access to cheaper drugs, and to lower the cost of existing, they were saying Humira was hovering over 4000 a month by that point. This apparently formalized and strengthened the distributor model, -not from the NPR broadcast but this seems similar to some of the backwardsness I have heard about alcohol distribution-, giving additional tax breaks, all the while the government was talking about individual greed. Apparently one of the Obamacare fixes was to make the distributor pay the right taxes on the drugs they were middle man for including the rebate on new drugs, however they lifted the cap on rebates and basically what they could receive rebates for. This meant that new drugs coming to market for a distributor were taxed at a much higher rate than older existing drugs. and those older established drugs could give as large of rebate as they wanted up 100%, and it didn't matter if it was taxed that way because the distributors still got to sell it and make a larger profit on that, especially considering the rising costs of drugs like Humira. One of the tax breaks given to older drugs was that the IRS lifted the limit on higher costs for drugs could receive tax breaks for longer than recouping R&D costs. The effect NPR was saying, and again blaming corporate greed, was that charging more for an old drug, paid less taxes than charging less for a new drug.
-This plus Humira's patents have made new drugs difficult to get out to market. NPR was going on about how Obamacare saved us and really changed things, and how the government was doing everything it could to fix the problem but the darn corporations were using all their new rules to make even more money. And apparently some Trump era (they just said 2018) law was resigned by Biden which reduced costs of drugs, and is supposed to help drop insurance premiums. It sounds like it extended the reduced cost of the drug, via rebates, to the insurance companies, I am really not sure about that part. They were in full double speak mode at this point. and now the cost of Humira has fallen to 7000 a month, but they didn't say from what high or when that actually was, but the way they talked about the resigned law extended the tax breaks that Trump gave to the insurance companies. Note that is 7000 dollars now vs the 1000 the government "saved us from".

all in all it was a pretty typical NPR piece of providing some real information about something I didn't know about, but they buried it in a bunch of bs and twisting, while making themselves seem unbiased. They really hammered the corporate greed, but downplayed the corporate greed was only possible because of new government laws, and of course they didn't break down which supporters of these laws were sponsored by which pharmas.

If anyone has more/better information I would appreciate because as I started with I still have some questions I am not sure about, or things I just straight up didn't understand thru their double speak.

 

[LouderVol]

TLR version, the government should not be involved at all with health insurance.

I ran into something myself this last week that I wasn't expecting regarding prescription drugs.

So I knew that insurers don't help cover the cost for every drug. However, what I didn't know was that even if a drug is covered, the insurer still gets to decide how much they cover. I am on a prescription to take a pill twice a day, my insurance only covers once a day. meaning I can't get my insurance to pay for a refill when I run out in "half" the time the insurance company is expecting. Apparently I should be able to get them to adjust, but I have to wait until one of their adjustments. Apparently this was an Obamacare "protection" of the consumer to allow the insurers to determine how much of a prescription drug the consumer should take. not their doctor, pharmacist, or anyone who has ever medically examined the consumer, the government requires it to be the insurer's pencil pusher getting to determine what I get.

so when paying for my non-insured refill the pharmacist told me I am saving money not using insurance because they use a discount program. I knew those existed, but always thought they were the cheaper option only if you don't have insurance. turns out its just generally cheaper, and the pharmacist knows this. but once they pull up that I have insurance they aren't allowed to tell me about the cheaper option unless I tell them I am not using my insurance, again this is another Obamacare "protection" for the consumer to hide cheaper drug options from the consumer. in reality its protection for the insurer. who would have thought, the government helping the insurance company screw over the consumer. As long as I continue to tell them I am paying out of pocket I will save the equivalent cost of 2 months of prescriptions over a 1 year period. and I won't deal with running out in half the time.

so I am paying my insurance premiums for higher end cost to me. and going back to my post above, that higher cost gets returned to the insurance company as additional profit. they are using the government to get me coming and going.

 

[Vol8188]

Without a doubt government involvement is a major problem here. The entire reason behind the employer health insurance model in this country was FDR making it illegal to provide employees with a raise. So companies started adding “benefits”.

Outside of insurance I can’t name a single other service the government forces you to buy. If you don’t like McDonald’s I’d tell you not to eat it. If you don’t like insurance, well Obama and Bernie don’t care, you’re forced to buy it anyway (granted thanks to the courts and Trump, there’s only 5 states that still require health insurance).

Which is why it’s hilarious now to hear Bernie cry about the profits of the insurance agencies. Profits he created.

 

[volkyries]

The whole health care system is broken, not just insurance. The real question is does everyone deserve access to health care and life saving drugs/care? If you say yes, then someone (government unfortunately) has to be involved to see that everyone gets some sort of chance to afford it. If you say no, then accept that a lot of people are going to die, reduce their quality of life, etc, by not being able or willing to pay for it. The problem today is that everyone says everyone should have access, but then everyone hates paying for the access or the costs involved. If we want the market to take over, we have to accept the market will let people die/suffer. Everyone says they are willing to let people die until it is their grandparent, parent, sibling, spouse, child, best friend, etc that is dying or suffering and then it is "how could we let this happen"/"something has to be done".

Insurance has screwed it up, pharm companies have screwed it up, med schools have screwed it up (by keeping supply of doctors low/controlled), med tech companies have screwed it up. Name an organization in the health care industry and they have probably had a hand in screwing it up.

 

[volkyries]

TLR version, the government should not be involved at all with health insurance.

I ran into something myself this last week that I wasn't expecting regarding prescription drugs.

So I knew that insurers don't help cover the cost for every drug. However, what I didn't know was that even if a drug is covered, the insurer still gets to decide how much they cover. I am on a prescription to take a pill twice a day, my insurance only covers once a day. meaning I can't get my insurance to pay for a refill when I run out in "half" the time the insurance company is expecting. Apparently I should be able to get them to adjust, but I have to wait until one of their adjustments. Apparently this was an Obamacare "protection" of the consumer to allow the insurers to determine how much of a prescription drug the consumer should take. not their doctor, pharmacist, or anyone who has ever medically examined the consumer, the government requires it to be the insurer's pencil pusher getting to determine what I get.

so when paying for my non-insured refill the pharmacist told me I am saving money not using insurance because they use a discount program. I knew those existed, but always thought they were the cheaper option only if you don't have insurance. turns out its just generally cheaper, and the pharmacist knows this. but once they pull up that I have insurance they aren't allowed to tell me about the cheaper option unless I tell them I am not using my insurance, again this is another Obamacare "protection" for the consumer to hide cheaper drug options from the consumer. in reality its protection for the insurer. who would have thought, the government helping the insurance company screw over the consumer. As long as I continue to tell them I am paying out of pocket I will save the equivalent cost of 2 months of prescriptions over a 1 year period. and I won't deal with running out in half the time.

so I am paying my insurance premiums for higher end cost to me. and going back to my post above, that higher cost gets returned to the insurance company as additional profit. they are using the government to get me coming and going.

Every system needs a check and balance aka insurance review of your prescription. Without the pencil pusher reviewing (what I would guess is a non-standard dose), the insurance is relying solely on the doctor's call. I am not saying your doctor, or doctors in general, aren't trustworthy, but there does need to be some sort of check or insurance could be sacked for a lot of billable items just because a doctor ordered them. Just take a look at the opioid crisis to see how easily some doctors started handing them out because they were getting kickbacks from the drug makers. Drug reps wouldn't make so much money and be able to treat offices to free food all the time, take doctors on trips, etc. if those things weren't having some sort of affect of the demand for their drugs. Same for expensive exams. A practice could buy a new MRI and then sudden everyone who comes in with a headache needs an (expensive, but covered) MRI to make sure it is not something more serious. I had an early colonoscopy due to family history and other issues at the time. It was questioned by the insurance folks, but with a bit more information was approved.

 

[Vol8188]

The whole health care system is broken, not just insurance. The real question is does everyone deserve access to health care and life saving drugs/care? If you say yes, then someone (government unfortunately) has to be involved to see that everyone gets some sort of chance to afford it. If you say no, then accept that a lot of people are going to die, reduce their quality of life, etc, by not being able or willing to pay for it. The problem today is that everyone says everyone should have access, but then everyone hates paying for the access or the costs involved. If we want the market to take over, we have to accept the market will let people die/suffer. Everyone says they are willing to let people die until it is their grandparent, parent, sibling, spouse, child, best friend, etc that is dying or suffering and then it is "how could we let this happen"/"something has to be done".

Insurance has screwed it up, pharm companies have screwed it up, med schools have screwed it up (by keeping supply of doctors low/controlled), med tech companies have screwed it up. Name an organization in the health care industry and they have probably had a hand in screwing it up.

Where your entire premise falls apart is when you said “if you say no, then accept that a lot of people are going to die, reduce their quality of life, etc by not being able or willing to pay for it”. I fully disagree with that sentiment.

Adding government isn’t a magic pill that magically provides everyone with higher quality of life nor the ability to pay for additional care. If anything it will likely reduce the quality of care many receive

 

[LouderVol]

Every system needs a check and balance aka insurance review of your prescription. Without the pencil pusher reviewing (what I would guess is a non-standard dose), the insurance is relying solely on the doctor's call. I am not saying your doctor, or doctors in general, aren't trustworthy, but there does need to be some sort of check or insurance could be sacked for a lot of billable items just because a doctor ordered them. Just take a look at the opioid crisis to see how easily some doctors started handing them out because they were getting kickbacks from the drug makers. Drug reps wouldn't make so much money and be able to treat offices to free food all the time, take doctors on trips, etc. if those things weren't having some sort of affect of the demand for their drugs. Same for expensive exams. A practice could buy a new MRI and then sudden everyone who comes in with a headache needs an (expensive, but covered) MRI to make sure it is not something more serious. I had an early colonoscopy due to family history and other issues at the time. It was questioned by the insurance folks, but with a bit more information was approved.

in my case its not one of the "fun" prescriptions to have, I doubt there is much of a market for my legal drug. We had started out at the "typical" amount, and after 4 months of no results the doctor increased the amount. so its not like he started me off at a higher rate. he sent in the change of prescription, but the insurance company still think they know best.

for me the issue with most of the health care issues is that they are government mandated/supported. and it was only through talking with various parties, doctor, pharmacist, HR, and insurance, that I found out what I did, and that there are government laws/regulations behind all the things that were messing with me. It would be one thing if my particular insurer was being extra cautious, if it was a problem that couldn't be corrected, I could just change insurance. but with the government regulations, it doesn't matter what insurance I have, this will be a problem. at least to stay in somewhat the same price range.

its just frustrating to hear that I am required to pay extra for worse service than I would get without. and that the free market has a better option, without any extra hoops, but we aren't allowed to be informed about those options simply because the government says so.

 

[LouderVol]

Where your entire premise falls apart is when you said “if you say no, then accept that a lot of people are going to die, reduce their quality of life, etc by not being able or willing to pay for it”. I fully disagree with that sentiment.

Adding government isn’t a magic pill that magically provides everyone with higher quality of life nor the ability to pay for additional care. If anything it will likely reduce the quality of care many receive

JMO but I think a lot of the health issues in this country have arisen because of access to health care. how many people just rely on the system to take care of them, instead of doing it themselves? They can do that because the system is required to care for them.

people don't want to accept the possibility that a little pain and suffering now, could lead to a better outcome than the path we are on, even knowing there is a worse future.

 

[volkyries]

Where your entire premise falls apart is when you said “if you say no, then accept that a lot of people are going to die, reduce their quality of life, etc by not being able or willing to pay for it”. I fully disagree with that sentiment.

Adding government isn’t a magic pill that magically provides everyone with higher quality of life nor the ability to pay for additional care. If anything it will likely reduce the quality of care many receive

So hospitals choose to take everyone that shows up at the ER either without insurance/under insured or are they forced to do so due to government regulations? I think you are only looking at it from the insurance point of view, if you look at the whole system, there is regulation both for and against the consumer that drives up cost everywhere.
I didn't say government was the magic pill. I said it was the voice of the people who want their families to get insured/taken care of, but don't like the costs.

Along your line of reasoning, though, I highly doubt the un-insured/under-insured before ACA are now receiving worst care than before when they didn't have good or any access to healthcare. I highly doubt the care you receive has gotten worse since ACA took effect.

 

[Vol8188]

So hospitals choose to take everyone that shows up at the ER either without insurance/under insured or are they forced to do so due to government regulations? I think you are only looking at it from the insurance point of view, if you look at the whole system, there is regulation both for and against the consumer that drives up cost everywhere.
I didn't say government was the magic pill. I said it was the voice of the people who want their families to get insured/taken care of, but don't like the costs.

Along your line of reasoning, though, I highly doubt the un-insured/under-insured before ACA are now receiving worst care than before when they didn't have good or any access to healthcare. I highly doubt the care you receive has gotten worse since ACA took effect.

All systems have regulation to some level. You’re proclaiming total regulation will fix the system, I’m disagreeing.

As far as quality, that’s an element of price. What has happened since the ACA? Prices have skyrocketed.

So if your point is simply “we can pay a lot more and get better care for more people”, I agree. But I disagree with your idea that the best way of getting there is by having the government pay for it.

 

[InVOLuntary]

Where your entire premise falls apart is when you said “if you say no, then accept that a lot of people are going to die, reduce their quality of life, etc by not being able or willing to pay for it”. I fully disagree with that sentiment.

Adding government isn’t a magic pill that magically provides everyone with higher quality of life nor the ability to pay for additional care. If anything it will likely reduce the quality of care many receive

And increase the cost.

 

[volkyries]

its just frustrating to hear that I am required to pay extra for worse service than I would get without. and that the free market has a better option, without any extra hoops, but we aren't allowed to be informed about those options simply because the government says so.

There is no "free market" in healthcare aside from maybe a concierge practice that takes cash only. Most of those practices probably still benchmark the insurance healthcare rates when setting their own prices, so not even sure if they are either. The discount program available on your drug is only there because the system is so screwed up to being with, not because it is a "free market".

 

[Vol8188]

There is no "free market" in healthcare aside from maybe a concierge practice that takes cash only. Most of those practices probably still benchmark the insurance healthcare rates when setting their own prices, so not even sure if they are either. The discount program available on your drug is only there because the system is so screwed up to being with, not because it is a "free market".

So you’re complaining about insurance setting prices while also praising the ACA that forced everyone to get insurance?

Yes, there’s less of a free market because of policies you openly support.

Also worth noting there are numerous companies that do not accept insurance and do set there own prices