Yes it is. The center cannot hold.
Healthcare
- Thread starter RDCR07
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In the latest episode of the United Hour Podcast, Nik (@Rood) is joined by CEO Duncan Drasdo and Financial Director Andy Green from the Manchester United Supporters Trust for a special episode on all things behind the scenes at Old Trafford including a brief history of MUST and their aims today, views on INEOS and Sir Jim Ratcliffe so far, and the Old Trafford regeneration.
It will have to be a gradual transition. Extending Medicaid to the uninsured and allowing anyone to opt in is the best way forward. If its a cheaper alternative for companies and individuals it would eventually kill the insurance companies.
We've been trying gradual for decades and it hasn't worked.
Partly because there is a lot of misinformation. Perception is Medicaid is inefficient and wasteful yet its admin costs are less than half of the insurance industry average. Doctors are scared they will earn less with a single payer. Their revenues might be lower but with one payer the costs associated with billing and account payable will be very low.
Sorry I missed this post.
We currently have a wide variety of performance indicators that are used across the health service to determine which hospitals are failing, which are treading water and which are flourishing. Naturally these are focused around health outcomes in comparison to both national targets as well as what the specific hospital was previously achieving, also how similar hospitals in similar area's are performing. From a budget point of view it's obviously straight forward, those turning deficits into surpluses whilst maintaining health outcomes would obviously be seen to be performing well.
It's no difference to Ofsted in terms of assessing Schools. They don't just look at total pupils vs budget or the narrow sphere of exam results. They do a proper audit that looks at a wide variety of variables to assess how a School is performing both in relation to national targets and in relation to prior performance.
It isn't a false presumption that the private sector is more efficient, it's an obviously accurate assumption. Inefficient private sector companies fail and collapse. Inefficient public sector enterprises get continually propped up by central government. Just like evolution the most adaptable and robust companies survive and the least adaptable fail.
If a private sector company is cutting corners then it is the responsibility of governmental regulation to slap them back into line. A private enterprise of course will not follow unenforced or non-regulated "rules", just as the majority of people break the speed limit in zones where they know there is little chance of being caught. If those regulations and rules were ardently enforced and punishable by strict and costly sanctions and sentences, then those corners would not be cut; just as average speed check zones force motorists to driver at the speed limit. Don't blame a player for diving if referee's are constantly rewarding that behavior with penalties.
In terms of your last paragraph the excess would be low enough to avoid encouraging that kind of behavior, but high enough for someone with the sniffles to think twice. Just like the introduction of the "auto enroll" pension scheme resulting in a huge increase of people saving for their retirement, we need to "nudge" people into acting the correct way. An excess is the simplest means of doing this in my view.
As a country we need to reduce the amount of people using the NHS frivolously. The only way to do this is either to financially reward them for good behavior; financially punish them for bad behavior; or financially punish everyone for the transgressions of a large minority. Out of these three options politically and bureaucratically I can only see the first option as a solution in the current climate.
I won't call it misinformation, it's just lies...plain and simple. There are corporations and politicians whose sole purpose during a debate about healthcare is to spread lies, knowing fully well what the actual truth is.
It really isn't that simple. There is a common perception in the US that anything government is poorly run and wastes money. That mindset has developed over many years. What is needed is a concerted effort to actually inform the public on healthcare administration and operational costs across the board.
Doing it in one effort over a couple to a few years is just not viable. The healthcare system has too many moving parts. The best way to change is use an established vehicle like Medicaid and expand it over time. If it became a viable alternative to private insurance and it allowed companies to join it would expand rapidly. Even if the system only elimited the extra insurance company administration (7%) insurance company profit (3-4%), and reduced the billing and accounts billable burden on healthcare providers by half (12%), it would save a significant amount of money for most people. With tough billing schedules for procedures and drugs an additional 10% could easily be saved. Add all that up and healthcare costs could go down by 33%, which is $3,500 per capita.
I would invite Warren Buffet, Jamie Diamond and Jeff Bezos to take a look at Medicaid and see if they could improve the infrastructure and delivery. Any solution will rely heavily on technology so Bezos is the perfect guy, especially considering his political views.
How about a combination of the carrot and the stick. Give everyone a ID card that is charged with $100 (pounds) for miscellaneous expenses. Each time someone uses a doctor/ER reduce the balance by $20. At the end of the year allow people to use the money left over anywhere. If someone uses healthcare services more than ten times they have to pay $20 out of pocket.
Although I'm sure there is increasing support for single payer there will always be an image problem as the GOP and their cronies paint it as socialist which is a dirty word for Americans.
There are people who would genuinely rather pay more than have some scummy poor person helped by the overall population.
@Eboue is definitely right that incrementalism isn't working, and a fundamental rethink from the ground up is the only thing that will fix anything, but selling that truth to the electorate in the face of lies and propaganda from the right (foreign and domestic), and the stubborn selfishness of a sizeable portion of the people is a challenge I don't see the Dems winning any time soon unfortunately.
There are people who would genuinely rather pay more than have some scummy poor person helped by the overall population.
@Eboue is definitely right that incrementalism isn't working, and a fundamental rethink from the ground up is the only thing that will fix anything, but selling that truth to the electorate in the face of lies and propaganda from the right (foreign and domestic), and the stubborn selfishness of a sizeable portion of the people is a challenge I don't see the Dems winning any time soon unfortunately.
That's a ridiculous idea because many people have to make repeat visits to the Doctors and that isn't their fault. You would be punishing the people who actually need the services the most.
It would need exceptions for certain cases. Maybe people over certain earnings don't even get a charge card they have to pay everything out of pocket.
Lets get this straight the NHS is a two tiered system now. Not only do you have 11-12% (and rising) of the population signed up for private health insurance, you also have incremental services that the NHS actually charges for. I was sick back in the mid 90s and had to be admitted to a NHS hospital. I paid extra to go in a private room, plus extra for a few additional services. In the late 90s my Mum had breast cancer and it was quicker and easier to use a private hospital (she had BUPA).
Exactly, @Eboue posted a poll where 64% of US citizens favour a form of single payer and CNN and the New York Times both used one last week that said it was actually closer to 70% However the same as with gun control laws, the will of the people is behind these issues and they want real change but the political will doesn't seem to be there only with a handful of politicians like Bernie and Liz Warren etc. More need to grow some balls and stand up if they believe in these issues.
When you then factor in the obstruction and misinformation and propaganda that would be spread by the likes of Fox, Trump and co and the money the lobbyists and insurance companies would use to fight the change, Well, It's a hard battle to win. But these are insanely important issues and if the Dems don't stand and fight for them and don't prioritise them then who will? And what is the point?
It's time the Dems stood up and actually fought for these rights and issues. Like the stance on DACA. Damn right and good on them. Stop letting themselves be bullied and if they get the house back, use it to their advantage. Learn their lessons and don't try to be bipartisan and play politics with the Republicans because they don't return the gesture nor do they care. They see it as weakness and take advantage. The Dems have to do the same and fight for and push through what the people want and feck listening to those who shout the loudest in objection.
Have you any idea how big and entwined the US health system is? Its just such a huge undertaking to rebuild things from the ground it that it will never happen. You have 50 different States with 50 different statue books on many healthcare related things. You have thousands of private hospitals, and tens of thousands of private doctors offices. The only thing that stands the slightest chance of getting traction and reforming the system is using an existing vehicle like Medicaid.
Means very little. It is like asking "Do you like free ice cream", of course the majority say yes. I actually use Conjoint Analysis in my role at work and surveying and finding out what is really important to people is a lot harder than a single question survey. On the healthcare issue you have to factor in cost, loss of freedom when it comes to delivery of services etc. Like Raoul said the debate needs to happen but I haven't seen a single politician put forward a viable plan at this stage.
Agree with all that, the Dems absolutely need to stand up and fight for it stop being so bloody weak willed.
This is one of the biggest problems, and a stance @Raoul often takes on US political issues; just saying "that won't happen" or "it's too big a job" leads to the status quo staying untouched. Its giving up before you've even started.
Reform by very definition requires change. Real change, not bit by bit nothingness that doesn't actually help or achieve anything. Saying it's too tough a task is akin to shrugging your shoulders and saying "what can you do".
Incrementalism has been shown over and over not to work, saying it's the only way for things to work is just kidding yourself into thinking you're trying something.
Lets get this straight? Jeez 
We have long had the option of paying to go private if someone wants to. That's not new.
I'm not quite sure what that has to do with anything though and what it has to do with you suggesting people pay for services if they use them too much?
I was just disagreeing with that suggestion because it would punish those most in need of the services they were using.
We have long had the option of paying to go private if someone wants to. That's not new.
I'm not quite sure what that has to do with anything though and what it has to do with you suggesting people pay for services if they use them too much?
I was just disagreeing with that suggestion because it would punish those most in need of the services they were using.
Your post absolutely nailed it. I work in the medical profession and have come across many situations where medical bills have destroyed peoples lives. Universal healthcare can easily be funded in the U.S without much of an issue. They could have started without that new tax plan in which only the rich and corporates profit. Middle class population would not even notice the benefits that they are getting. The reason why universal healthcare is not coming any time soon is because big pharmaceuticals and insurance companies pumping big time money into politicians pockets with their lobbying.
I have a lot of patients who purchase their medication from Canada because they cannot afford to buy the medication in the U.S, even if they have insurance because their insurance company will not cover it. These are medications that are manufactured in the U.S and sold at half price or less in Canada.
The politicians have done a great job of scaring the American public into thinking that universal healthcare is the most evil thing in the world. We can fund everything else including wars, but not universal healthcare as it would not profit the politicians.
So accepting that the NHS has an issue with people going to the doctors and ER unnecessarily how do you address that?
Well they have already addressed it here where I am through various tactics. Firstly you can't just turn up at the Doctors anymore you have to phone and now when you phone you are assessed by a nurse who either books you in for an appointment the same day or if It's not urgent she schedules you one later in the week. If serious she will recommend you visit the ER and even phone an ambulance if needs be.
All test results are given out by phone now or can be found online with secure passwords. The local surgeries and hospitals have also had newspaper adverts and information flyers distributed with details explaining how best to use the Doctors and hospital services and aside from the odd few that slip through it seems to be working well.
The ER at the hospital also now has a full time seperate doctors area so if you turn up and It's not something you should be visiting the ER for then they direct you to the Doctors room instead. Education seems to be working well here and to be honest I think the NHS has far bigger problems to worry about really.
There are a lot of variables that go into the debate on moving to UHC. For starters the current system is actually working for the majority of Americans.
Much better to try and fix the problems first, which in this case is addressing the uninsured. The ACH was a poor attempt to fix that issue. We already have a healthcare payment system in place that has around a trillion dollars flowing thru it. Using that to fix the biggest issue in US healthcare is the logical choice IMO.
The problem with that is that there are members of Congress who peddles that perception when they themselves were elected to fix these things. But I agree with you.
I'd love to know the basis for that assertion.
edit: and even IF that were true, it doesn't justify the disgusting attitude towards the people for whom it isn't working, and that isnt just the uninsured, but the underinsured also.
Well I am an American, I work with Americans, I live with Americans, and my wife works in healthcare. For the most part the current system is serving a lot of people well. Most people would like lower premiums, copays, deductibles and less paper work though.
I really think the majority of Americans want to fix that issue.
I generally agree with what you're saying here, but the problem is that the policy hasn't been adequately sold to the public. The polls cited earlier are always going to be positive based on how the question is framed, but what is not talked about enough is that this would be a fundamental restructuring of a large part of the US economy (the health care sector) from the private to government control, which will have knock on effects to many other areas of the economy. So all of this has to be properly thought out and a vast majority of the country (including Republicans) need to support it so that politicians are elected to represent that level of consensus. If the US tries another Obamacare type approach where one 85% of one side is for it and 100% of one side is against it, then it will simply unravel the next time the Dems lose power and result in a worse version of what has happened to Obamacare in recent years. That sort of chaos should be avoided at all costs by having a healthy national debate about it now and electing politicians who are willing to move on the results of the debate.
The biggest challenge would be to sell this sort of thing to a large swath of the public who are quite content with their current, employer based health care that they are getting, and don't particularly want to change.
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That's your basis for saying that the current system works for the majority of Americans? Seriously?
That's like me saying there's no homelessness problem in the UK because all my friends have somewhere to live.
I think Raoul reiterated what I said.
Let me give you an example of why it is working. I have used a local orthopedic surgeon. The practice have 4-5 doctors plus a couple of PAs. They take pretty much all insurances, medicaid and medicare. IF I have a sore knee I call up book an appointment, which is usually in the next few days. On arrival I would see a nurse, get an x-ray and be mevd to a room for the doctor to see. If a scan is needed they have two machines onsite, and if it can't be done same day it would be next day at latest. If the doctor sees something that needs surgery like a torn MCL you can generally get it done within two weeks.
I have been through the process above three times in the US. One time it was under two weeks from making the call to having surgery. Downside is I had to pay $35 for first doctors visit and $250 copay for the surgery, which they deducted the $35 off. Most Americans have insurance to the experience would be similar, although some may pay more in copays.
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Obviously this is an issue but I'm not quite sure how major it is. Yes, people clogging up A&Es and GPs with minor issues is a waste of resources; and money, DRs etc could be directed elsewhere. But is the issue not beyond the front line. Serious A&E cases who need an admission are being backed up and all the major delays are for people awaiting required tests, treatments etc.
Beyond that first point of contact DRs aren't going to needlessly put people through into secondary care. There is a revolving door of wasters on the frontline and these are the people who end up waiting longer than 4 hours to be seen in an A&E. But those who are waiting 12/18/24 months for a scan etc are people DRs have assessed to need further investigation. The same with treatment options.
I'd disagree its working for the majority of Americans. It's just that they don't the flip side of the coin so they "think" it's working for them.
In reality big pharmaceutical companies are absolutely ripping the country off.
Ironically the military who are usually republican, the government who are against all have free healthcare.
It's a giant con that people have bought into.
I used to pay $16 a paycheck for my daughter and I to have health and dental. Now for my family I pay $500.
A month or bi-weekly?
Has to be bi-weekly.
Bi-Weekly
That is on the highside. Is it PPO or high deductible?
I agree the polls don't tell the real story and I agree the concept needs selling better by the politicians, absolutely.
More anecdotal 'evidence' that doesn't come anywhere close to supporting your original claim. You can't even reasonably use this to claim that it works for the majority of people in Florida, or even your district, let alone the whole of the US.
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Cigna Open Access plus whatever that is.
$1,000 a month for the whole family is actually on the cheaper side believe it or not.
Fact: most Americans get better healthcare than the NHS provides, and most Americans are happy with healthcare delivery. That is assuming 50% is most.
Fact: Most Americans to not like the current payment system.
According to eHealthInsurance, for unsubsidized customers in 2016, "premiums for individual coverage averaged $321 per month while premiums for family plans averaged $833 per month
How are you quantifying and supporting these statements?