[ocrenter]

Bottomline, we need to figure something out before the Baby Boomer generation hits 80+. The first of that generation are already in their late 60’s. So we got about ten years before the bomb explodes.

[ocrenter]

[img_assist|nid=17715|title=__|desc=|link=node|align=left|width=694|height=600]

Here’s the cost of care per age group

[ocrenter]

[quote=all][quote=ocrenter][quote=Jazzman]Do you work in healthcare OCR?[/quote]

yes, I do play one on TV. :-)[/quote]

Dr. Jake Ramoray, is that you?[/quote]

I had to google that.

btw, brain transplant IS NOT a covered benefit with or without Obamacare. The actuaries were quite clear about that.

[ocrenter]

[quote=Jazzman]Do you work in healthcare OCR?[/quote]

yes, I do play one on TV. 🙂

[ocrenter]

[quote=Jazzman]
That is correct, but the term “superuser” has negative connotations. You can be the same risk profile as someone else but through misfortune be a so-called “superuser.” I’m not a scientist, but I believe genome mapping hasn’t quite developed to the stage where the risk of all diseases can be predetermined. And then there’s accidents.

Doctors should be rewarded for preventive practices and results thereof. It has proven effective in other systems.

I think it fair to say that remains to be seen. Presumably, actuarial calculations took that into account.

Bankruptcy insurance seems a fitting description of some insurance policies. Each generation will be dependent on the next generation so everything evens out. Isn’t social security funded similarly?

I don’t agree with the ideological frameworks being used but agree in principle with the costs and incentives argument.

I’m guessing the second option is a rhetorical suggestion.

Drug companies, training, medical equipment companies, bureaucracy, duplication, litigation, and research must also contribute significantly to the cost of insurance. This is not just about insurance. The core of the problem is costs, so why not apply reductionist principles and surgically remove the tumor as opposed to applying palliatives. In other words, treat the disease, not the symptoms.
[/quote]

You’re right, superuser does have a negative connotation. I used it because I purposely wanted to dehumanize everything and spin this into a pure cost-wise analysis. And to point out what would truly be the best option if our purpose is to save dollars as well as to include as many of our citizenry as possible.

Doctors have been rewarded with preventive care awards. Most plans have a P4P system (pay for performance) system in place. But old habits die hard. And remember, a primary can make far more seeing 40 patients then 20 patients. And when you see 40 patients, it is FAR EASIER to send the twisted knee for the MRI and the ortho consult. Also keep in mind that a lot of PPO plans allow for self referrals. Which means a guy with heart burn may self refer to a cardiologist first, gets the EKG and the treadmill plus a CT coronary. After the “million dollar” workup, then referred to GI who then does a scope and put him on Nexium (the most expensive option but the rep was in with a free lunch earlier in the day.) Bottomline, without a gatekeeper doc who’s given sufficient time and compensation who’s also monitored on his/her prescription patterns and referrals and imagings, the system’s default is to spend as much as possible.

Funny you termed it bankruptcy insurance. I like that. except in a lot of cases as someone becomes a “superuser”, they also end up getting laid off or fired because of the reduced productivity, which means their insurance then disappears. This is why it is SO AWFUL to link health insurance to work. Again, by linking insurance to work, you are selecting for patients that are healthy enough to work. and when someone is no longer healthy enough to do so, there goes the insurance as well.

The completely capitalistic model was somewhat rhetorical, except to point out that we do not have a RIGHT to be treated, even if you are having crushing chest pain in front of the ER doors. We have a guaranteed right to bear arms, but the Founding Fathers did not grant a RIGHT for a pregnant woman to be delivered in a clean hospital bed with trained professionals. So if the population of this country decides they are willing to stomach seeing people turned away at the ER and die on the streets, we CAN do that.

[ocrenter]

[quote=harvey]Anyone who claims that they actually understand what they are getting from their health insurance policy is suffering a severe case of hubris.

I doubt that most attorneys who specialize in health insurance even understand their own policies completely.

Healthcare is the ultimate example of economic information asymmetry.

Before ACA, lots of people were paying health insurance premiums.

Far fewer actually had insurance.[/quote]

+1

That’s why even with “insurance”, if you are unlucky enough to become a superuser, the insurance companies would do their very best to get rid of you. Because their actuaries told them so.

[ocrenter]

[quote=EconProf]My son is a single, healthy 30-year old. He has always bought inexpensive health insurance on his own with a high deductible. He pays the first $2000 per year of any medical expenses and 20% of anything over that amount. Very cheap because at his age the insurance company has little risk and competition with other insurance companies forces them to price it low. Also, he shops around when he needs medical service, offers to pay up front, and gets huge discounts when the provider realizes they don’t have to deal with insurance paperwork. In other words, he is dealing in the private sector he has found the right solution for his situation, and puts no burden on others to subsidize his medical needs.
Now, under Obamacare, he will see his costs double or triple because he will have to pay for older, less healthy people. The government is imposing a one-size-fits-all plan upon us rather than letting us pick and chose what best fits our situation. The result is hidden subsidies to some and hidden costs to others. For all you Piggs under 40, and especially those under 30, the coming rate shock will be a wakeup call. Interestingly, the under 30 year olds were those who most likely voted for Obama.[/quote]

But isn’t this the main idea behind all insurance scheme? Essentially the majority of non-users or minimal users are subsidizing the “superusers”. Aka shared risk. Is shared risk really capitalistic? No. Actually, once you are within an insurance system, it is very communistic. The choices a user makes once they have insurance are no longer driven by market forces because everything is well subsidized. And because it is fully subsidized by your fellow insured, you can pick from whatever care you like. But here’s the rub: doctors are incentivized to recommend the MOST. Therefore, a twisted knee turns into a MRI and a visit to the orthopedic specialist. Because you now have insurance, you are buffered against market forces and therefore, you go along with the recommendations. Which ultimately drive up the cost.

This system will therefore drive up cost even without having superusers in the game, because the doctors are making capitalistic recommendations but the patients are shielded from market forces by having the insurance pay for all of the recommendations.

This system will therefore collapse on it’s own weight IF superusers are included. This is why all medical insurance companies work so hard to remove superusers from their system.

So let’s look at the system in place before Obamacare. They excluded the superusers, but year after year the insurance rate continued to go up at rediculous levels. The ones that need healthcare were denied care, and the rest of us got more care then we really needed. The end result is IF you are unfortunate enough to become a superuser, plan on filing for BK even if you have insurance.

Obamacare at least tries to rectify this by forcing acceptance of the superusers back into the system, but he needed the nonusers like your son to buy into the program as well, otherwise, like I said before, the systems was already barely afloat and would collapse if they take in those that need the most care.

Why Obamacare won’t work? Because it doesn’t address the fundamental problem of doctors incentivized to recommend the most possible care and the patients agreeing to them because they are shielded from paying the true market price of those recommendations.

The only way out is get out of this hydrid system of capitalistic providers and communistic consumers. Which as you can see, only serve to drive up cost to no end without serving people that need it the most.

We have two options, full blown socialist model of single payer. You get the doctors out of the game of incentives for doing more for more profit. They are the main cost drivers under the current system. Remember, the same doctor without the kickback from his radiologist and orthopedic buddies will likely just recommend some icing and course of high dose ibuprofen for that twisted knee instead of the MRI and a visit to orthopedics. The single payer has the power of monopoly to set how much they are willing to pay for supplies and drugs, cost can then come down..with the cost controlled, we can take care of our superusers.

Our other option is a fully capitalistic model. The government completely get out of the game of health care. Superusers should just move out of the country and if you can’t pay, you are refused service, period. This model does work, see China and Mexico and Thailand. The healthcare cost for these countries are very minimal.

But that’s really the two choices we got, anything in between really is just a big FAIL.

[ocrenter]

[quote=CA renter][quote=spdrun]Hope it does collapse and we end up with socialized medicine (or at least a public option) instead. There now, I said it.[/quote]

X2[/quote]

X3

[ocrenter]

[quote=Essbee][quote=ocrenter]
just took at look at the PUSD map. Of course these guys would think they live in Scripps Ranch. the condos on north side of Scripps Poway all go to Scripps Ranch schools. And since they empty onto Scripps Poway, shopping would be done in Scripps as well.

These folks would probably be really p*ssed if Sabre Springs decide to come over and place “community markers” proclaiming Sabre Springs on Scripps Poway Rd.[/quote]

If you drive on eastbound on Poway Rd, there are big Sabre Springs corner “neighborhood signs” (the type placed by a developer) at the streets turning into the communities on both the north and south side of Poway Rd. So in a sense, they are already “marked”, at least from that direction.[/quote]

yes, pass those on a regular basis. but that’s Sabre Springs proper.

I meant they would probably cause an uproar if they place these markers on Scripps Poway.

[ocrenter]

[quote=enron_by_the_sea][quote=Essbee]

Actually, it is both north AND south of Poway Rd. http://www.zipmap.net/California/San_Diego_County/Z_Sabre_Springs.htm

:)[/quote]

Very interesting. If this map is true, boundry between sabre springs & Miramar Ranch N. is Scripps poway pkway. That means that a few streets south of the canyon & north of Scripps-poway pkwy (e.g. ivy hill Dr., Village Ridge Rd. etc.) belong to Sabre springs.

I bet most residents on those streets think that they live in “Scripps Ranch”! (And a huge majority living in Miramar Ranch N. probably does not know what Miramar Ranch N. is!)[/quote]

just took at look at the PUSD map. Of course these guys would think they live in Scripps Ranch. the condos on north side of Scripps Poway all go to Scripps Ranch schools. And since they empty onto Scripps Poway, shopping would be done in Scripps as well.

These folks would probably be really p*ssed if Sabre Springs decide to come over and place “community markers” proclaiming Sabre Springs on Scripps Poway Rd.

[ocrenter]

[quote=no_such_reality]You get very little water savings from artificial turf, you use almost as much cleaning and cooling it.
[/quote]

uh… would really really really really have to disagree with this.

The $100 per month difference between my neighbor with traditional lawn and myself with the artificial turf is not “very little water savings.” And I have a pool and he doesn’t.

The $100 per month saving from the gardener is also not very little either.

4 years since install, we are already $1600 on the upside from the initial investment. The turf still looks like it was laid down just yesterday. We do have to deal with weeds on the border of the turf and the concrete on an occasional basis. Plus raking 4-5 times a year. So it isn’t truly maintenance free.

As for pets, we got the pet resistant turf, but we actually have a wood chipped area set aside for the dogs as the main area for their business. You are right, if the turf is the primary area for potty time, rinsing afterward can get really old quickly. But from past experience, spots of yellow all around the lawn from dog urine made for more difficult lawn care did it not?

Appearance wise, I do agree there are a lot of turfs out there that look really fake. But that’s likely because the owners went with the cheapest option. Since we were hoping for 10+ years out of the turf, we did go for the grade just below the top of the line. We also made sure to have the turf bordered with flower and shrubs to cut down on the artificial feel. Most visitors have no idea we have artificial turf until I point it out to them.

I’ve seen the really badly flattened artificial turf around La Jolla and SeaWorld, therefore we also made sure to avoid placing the turf on heavy traffic area.

yes during the summer the turf does get hot, but concrete level hot? I would disagree. Our habit is shoes off indoors and shoes/flip-flops on outdoors, so walking or playing on the turf with flip-flops on is not a big sacrifice for us.

I figure for $2400 of after-tax saving per year, I can live with having to wear flip-flops when walking on my turf.

[ocrenter]

[quote=AN]Very interesting map ocrenter. I guess that map invalidate a lot of my examples, hehe. I totally agree with you about live and let live. If people in Sorrento Valley really care, let them have it. Carve out all the houses along Sorrento Valley Blvd. and call it Sorrento Valley. If it makes them feel better, why not let them. I personally think houses in SV are over priced for essentially being MM, since their kids goes to MM schools. But if they like to be able to sell their over priced house to other gullible future buyers, then let them.[/quote]

you’re right, bottom line is the schools. I think that’s why Sabre Springs identifies with RB more despite being closer to Scripps Ranch.

everyone at the end of the day still end up in MM schools and are still within the SD city limits. I think the city council would give them their own “community” just to shut them up.

[ocrenter]

[img_assist|nid=17690|title=north SD communities|desc=|link=node|align=left|width=373|height=255]

According to the City of SD list of communities, Sorrento Valley does not exist. Just Mira Mesa, which is that huge chunk of pink on the map.

I do have to say this is quite odd given most of the communities are much smaller in size, which means Sorrento Valley residents do have a good case to become their own community.

Meanwhile individual communities have no problems joining up together as a singular “community”, for example, Miramar Ranch North and Scripps Miramar Ranch have always operated as essentially one single “community” despite being designated as two separate communities. When Stonebridge came to be, initially they were excluded from the larger Scripps Ranch but now they are fully integrated as part of Scripps Ranch. They fought together to be part of the same council district, and this year Stonebridge is now part of the Scripps Ranch Civil Association.

Same with RB and Carmel Mountain Ranch and Sabre Springs, all three are essentially considered the RB community. Residents of all three communities have no problems stating they live in “RB”. Likewise, folks in Torrey Hills, Del Mar Mesa, and Pacific Highland Ranch have no problems identifying as part of CV.

I say live and let live. If it makes sense, people will group together even though the city designates them as separate entities. Like wise, if a neighborhood has enough of a separate sense of identity, they will eventually go their own way. Mira Mesa’s forced signage may have been the catalyst Sorrento Valley residents needed to motivate them to seek formal separation.

[ocrenter]

[quote=spdrun]First. World. Problems.[/quote]

LOL!!! so true.

[ocrenter]

since you’re getting rid of the existing lawn, might just be easier putting in some artificial turf.

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