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ocrenter
Participant[quote=livinincali]
Free markets could solve a lot but not all of the cost side. For example allowing somehow to open an MRI imaging facility assuming they hired the necessary licensed personal would lower the cost of MRIs but Certificate of Need licensing prevents that from happening. Forcing medical providers to post prices would allow customers to shop around.
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MRI would be a bad example. You got to realize the amount of incidental findings from a single MRI can generate so much more follow up MRIs or potential unnecessary procedures and surgeries. So to suggest that we reduce the threshold for MRI imaging and lower the barrier to an MRI will increase cost, not lower it.
Assuming that $1000 cost (it can be much more, $4000 sometimes), and assuming you allow the cost to go down to $500. Now you are making MRI a standard practice for ALL knee pains. the cost to the system would explode.
[quote=livinincali]
Forcing medical providers to eat the costs of their own mistakes would help. I.e. if I elect to have knee surgery for an aching knee if I get an infection while under the care of said hospital they would eat the cost of treating the infection and extra days in the hospital but instead they currently get to charge people for that.
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I know someone who went in for spine surgery for chronic back pain, came out of the surgery as a paraplegic. The medical group that did this is absorbing all future cost related to his new paraplegic status. This is already being done. This is not the reason why cost is high.
[quote=livinincali]
Allowing a business that is licensed to purchase drugs in India or somewhere else where the drug company sets them much lower and re-import them here would drastically lower the price of drugs here. These are all free market forces that would lower the cost of health care here.
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Big Pharma is blocking this for the obvious reason. And Big Pharma is in bed with congress.
[quote=livinincali]
Forcing health care providers to post prices and always charge that price would effectively lower health care costs. If you want Medicare patients you bill everybody the Medicare price or you choose not to have any medicare patients. If you can’t make if with the medicare patients or without them because you have a lot of debt or outlays you go out of business and somebody buys your assets for pennies on the dollar and can make a profit at the medicare rates.
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Not if you are not paying for it. Who cares about the price printed and listed if you don’t actually have to pay for it in person.
This would only work if you move away from insurance and change to a full fee for service system.
[quote=livinincali]
All of those free market forces would work to lower health care costs. Single payer is just an alternative to that and one that’s likely less efficient. It would probably work and it might involve slightly less disruption.
In the end though Health Care revenue is a component of GDP. If you lower the cost of health care you’ve lower health care revenue and GDP. By definition lower GDP means we’re in recession. Health care primarily is a service provided by people. If you materially reduce health care costs you are most certainly are either laying people off or reducing their salaries by a material amount. This is math not theory.[/quote]
You do realize you have a huge black hole known as the ER. Where people not covered and not able to afford fee for service will simply allow whatever that ills them to worsen until it becomes bad enough to be life-threatening and thereby the ER can not turn them away.
China runs a very good free market health care system. But they allow people that can’t pay for the ER to die outside the doors.
That is a key ingredient in a successful free market health care system.
Participant[quote=harvey]If efficiencies and cost savings led to recessions then most of economic history would have been a recession.[/quote]
Health care doesn’t lend itself to unbridled free market forces. It is beyond easy to scare the client into doing a whole bunch of expensive and worthless treatments and procedures. In fact, client expectation is the expensive stuff. Efficiency can only come about from single payer forcing discipline in cost control.
Participant[quote=livinincali][quote=SK in CV][quote=livinincali]
That’s exactly the point and why I don’t see the government ever fixing the health care issue in this country. We’re never going to get to single payer because it would create a massive recession in the short term. [/quote]I don’t buy the recession thing. Wouldn’t happen. Health care jobs won’t disappear. Health care admin jobs won’t disappear. Both will increase. Dramatically.[/quote]
Well then you didn’t fix the cost side of the equation. Why is health care so expensive in this country. Most of the money spent is going into somebody’s pocket somewhere. If we’re spending 3 trillion per year on health care and change that number to 2 trillion via single payer or whatever mechanism you can come up with, that’s 1 trillion less dollars going into some person’s pocket. Yeah the economy will reallocate the jobs and spending over time but it won’t happen immediately. Health care spending is included in GDP. If I reduce health care spending dramatically via some solution or change then I’ve reduced GDP as well.
If what you say comes to pass and we increase the number of jobs in the medical sector how exactly will health care costs come down.[/quote]
Huge % of cost is in pharmaceutical and specialty cost.
Let’s say right now 5/10 patients with knee pain goes to the orthopedic surgeon directly. And orthopedic surgeon is charging $100 per visit instead of the $50 per visit at the generalist. If you force the 10 patients to all see the generalist, and only the one needing surgery is referred to the specialist, that would be a difference of $600 vs $750.
Now let’s say instead of 5/10 of these patients all getting an MRI, which is say $1000 (you got to pay the radiologist), only 2 of the 10 got the MRI, now the difference is $2600 vs $5750.
Next, let’s say 5 of the patients got a steroid injection at $30 each, vs the Synvisc injection at $300 each, the difference is now $2750 vs $7250.
FYI, Synvisc injections are not proven to help any more than steroid injections. Further more, most MRIs are done as therapeutic treatment of patient’s anxiety about their particular joint pain.
I can go on and on about the potential savings. Does changes like the above reduce income for the local orthopedic surgeon and radiologist, you bet, but they are not going to be in the poorhouse, that I can guarantee. But true impact on jobs would be minimal, except the drug company pusher that provides the free lunch and luxury box seat to the local sporting event, he or she will certainly get the axe.
Participant[quote=matt]Thanks for the kind wishes all and sorry for the delayed response.
We are not at retirement age yet but it could be an option to live in Mexico off the rent of our la Costa oaks home. Ideally a small apartment in Barcelona on the side as well :). Right now I am working in the UAE and saving every penny I can for the future and our kids college… so I do need to start generating some cash from this place.
The main thinking on the investment was the realization of how little 1m can buy you in so-cal + the financial burden of property taxes. And the desire to create an option in a lower cost of living country. We are currently getting a maid all day for about 25 dollars and if u choose to live within your means even Los cabos can be affordable..
The HOA over here is fine with short term rentals. The only peculiarity being they do not allow you to rent the casita but I’ll see if I can get away with it![/quote]
Great job with the house. I agree, do you park a million in a tract home from the 60’s in an iffy neighborhood in SoCal or do you just go for the best Cabo has to offer?
You mentioned solar and hurricanes. I suppose if the panels are flush against the roof that should be ok. But that’ll raise the cost of investment significantly. But then again, with Mexico’s infrastructure, it pays to be energy independent. Tough decision.
Participant[quote=matt]Thought I’d share where we ended up on this project. Total investment of 800k purchase price plus 200k to renovate. Enjoying it right now and the area is booming.
Matt[/quote]
Looks great! How’s property tax and HOA compared to State-side?
Participant[quote=SK in CV][quote=ocrenter]Interesting how with a couple of tweets no one is talking about the failed hugely unpopular senate health care bill any more.
The guy’s timing is impeccable.[/quote]
Except Trump. He tweeted about it this morning. McConnell had already sent the Senate home for recess Thursday morning.[/quote]
True. Except he just called for complete repel first, another reversal of prior position, a reversal that would leave 32 million uninsured.
How many Americans heard that story today in the middle of his little cyber bullying stunt?
ParticipantInteresting how with a couple of tweets no one is talking about the failed hugely unpopular senate health care bill any more.
The guy’s timing is impeccable.
Participant[quote=harvey]Just when it seemed we’ve reached the limits of irony:
Trump golf clubs displaying fake Time magazine cover
But 38% of America doesn’t see the irony. They see this as just another attack on their president.
And these 38% are “more American” then you and I because their votes are weighted more.
Participant[quote=moneymaker]I find it very ironical that the US has the most expensive health care that is revered all around the world and yet when I read peoples experiences on medicine.net or other health care sites, doctors are constantly misdiagnosing people. I think most of you out there know what I’m talking about. So wouldn’t it be better to build a better health care system that can get it right the first time and thus be more efficient. I think this approach really applies to everything out there and not just health care, car repair, cable companies, plumbers. 10 minutes with a patient just is not going to be enough time for a doctor to get it right most of the time, a more holistic approach would be better.[/quote]
Not to make excuses for those doctors, but patients frequently come in with a list of 5-10 problems expecting them to be addressed within a 15-20 minute visit, essentially expecting a 2 minute per problem efficiency and 100% accuracy. And don’t forget the “oh-by-the-way” bomb on the way out that they expect fully addressed by the doorway.
The problem is the way things are structured. Someone is paying thousands of dollars for the insurance. Then another $50 for the copay. Of course they feel they are entitled to hit the doctor with as much questions as they can squeeze in. Which then lead to medical mistakes and excessive labs and studies, driving up cost even more.
This is a vicious cycle.
Bring the cost down with a single payer system, and people are not going to feel the need to milk that 20 minute visit for everything they got, and they might actually get good advice and more accurate diagnosis.
Participant[quote=CarlsbadCub]Full buyout was quoted at $88k. Prepay was quoted at $51k. I’m told that the home generates about 18k kWh annually or 1,500 kWh per month. I didn’t get the consumption numbers from them. They did tell me that they don’t usually pay SDG&E anything. The manufacturer of the panels isn’t in their agreement with the solar provider, but they are insured and maintained by the solar company.
The owner put a lot of panels up generating a lot of power that the next family (i.e. Mine) might not consume, and therefore the risk exists of overpaying for the next 19 years as you’re required to buy what is produced, not what is consumed.[/quote]
My 5000 watt system generated 8600 kWh last year. So you are likely looking at a 11,000 watt system up on the roof.
Average pre tax credit cost per watt is $3.5. Which means before tax rebate the system should have cost $40k or less.
Buyout is more than twice the cost PRIOR to tax incentives.
WOW!!!
Participant[quote=scaredyclassic]i have no ac in my house
id be happier without a car.
fridge is useful.
septic tank.
univ. education brings debt and misery.
i dont know. im not persuaded things are getting better[/quote]
Xi is not very happy with you right now.
ParticipantA lot of alcoholics must hit rock bottom before they finally wise up and seek the help they really need. One guy had to fall down the stairs a few times and it wasn’t until he ended up in the ICU did he finally quit.
Looks like that’s what it takes for us as a nation when it comes to health care too.
Participant[quote=FlyerInHi][quote=scaredyclassic]the people of tibet are not the same post conquering. would those original buddhist folk want a consumer society imposed on them.
all is change, though, and suffering.
and desire[/quote]
For sure.
There is no answer to that however. It’s the eternal pursuit happiness. Buddhist philosophy is very helpful. Control desires and fnd happiness within.
Right now, the objective measures of wellbeing are money/GDP, and material possessions, objective measures we developed in the west.
Own a car? Check
Have air conditioning? Check
Went to university? Check
Have savings? Check
Modern sewer system? Check
Electricity to all households? Check
Refrigerator for all? Check[/quote]Cars, AC, electricity, and refrigerator are fleeing, would you like to exchange your language and culture and identity for a washer and dryer?
Participant[quote=FlyerInHi]
Isn’t that the same argument Whites use against Blacks in USA. We give them affirmative action, all kinds of benefits… and instead of being grateful, they choose to be criminals causing chaos in society. Ok, not all Whites, but you get the general idea.
Minorities are oppressed in many ways in all societies.
BTW, a lot of Han Chinese feel that the government is showering benefits and development money in Tibet while ignoring other areas in need. Financially, Tibet is getting way more than it contributes in output.[/quote]
So based on that parallel, expat US students would be protesting a commencement speech by MLK if he is alive and barred by the US government?
Minorities are oppressed, especially in a colonial relationship with the ruling government. Uighurs and Tibetans are colonized people whose language and customs are systematically erased through slow and gradual assimilation.
Glad you have Uighur friends that benefited from Chinese rule. Such is the strategy of the colonizers throughout history. I do have to give it to you, you really do fight a valiant fight for colonialism and oppression of minorities.
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