1)Socialized Medicine
This is run by the government using their own hospitals and doctors and is available to members of the armed services. Examples: Active duty medical care . Certain aspects of the VA/VHA system.

2)Single Payer
This is healthcare paid by the government completely - but the actual care takes place at private facilities. Examples: Medicare (and state run programs like Medi-Cal), TriCare (For reserves, and retired unless they qualify for VHA.)

3)Employer Based Insurance Private Coverage
These are insurance plans your employee signs up as a group and allows it's employees to enroll in. Sometimes the cost is minimal to the employee, other times they pay the full cost.

4)Private Insurance Coverage
This is insurance you pay for completely on your own. The terms of coverage and the need for profits are what determines the cost.

5)Fee for Service
If you have a lot of money you can just straight pay for services. Like break a leg and cut the hospital a check for $28k or whatever it costs.


Make no mistake , Republicans are against ALL of the options above except for #1, #4, and #5.

#1: because they are flag fuckers - but when push comes to shove they'd want to discharge the most injured/costly troops.

#4:They see personal profits from running these companies - and gaming the system.

#5: The option they want available to the rich and the impoverished alike.

Ryan's plan is pushing #5 the most - making #4 the only other option to most and then making sure over a short period of time more people slip into #5.



Edit: Yes - it's way more complex then whats up here - and I didn't list Medicare, Disability, high risk pools for states, Indian health care, Medicare Advantage (which is Medicare with profits going to insurance companies) etc. They fall into the main 5 I listed in some ways - and some have crossover. But my general point stands.

are so high.....




"Get ready....for your blessing....."

when doctors say 'insurance' they mean their personal liability (malpractice) insurance.

One of the more conservative view points I've always kind of agreed with was tort law reform in medicine as it directly affects malpractice insurance. I know you can't put a dollar value on what someone's life might mean to a loved one but a structured formula to determine damages would work wonders to minimize malpractice costs. But I'd demand that in exchange for tort reform, the medical industry submit to the same reform where structured cost (and justification of those costs) become norm as that would lower health insurance cost.

But none of this will happen because of good ole American Greed.

because they're overworked, work for shitty systems with high turnover, and so many patients out there just don't have great continuing care.

you put the current "reform" plans in place with all the america first, it's going to accelerate the shortages.

Anything that can help the consumer pay for the services from the provider has the potential of disconnecting the consumer from the full financial impact of their decisions... whether it is insurance or a government entity. Either entity helps me afford service I probably couldn't afford on my own. A 10% increase in my premium is bearable if most of the money comes from others.

So, from a theoretical perspective, I can kind of get how the Republicans think that essentially pushing people towards fee for service is the best way to actually push costs down. Ideally, people would prioritize getting value for their money, pushing providers to reduce their profit margins and potentially operate more efficiently.

Practically, we can already see what happens when people are left to fend for themselves against the health care system when we look at the tens of millions of uninsured: they either endanger their lives or their financial stability. I don't think the American consumer is really equipped to negotiate this on their own; the pricing is opaque, the costs are high and the risks to their lives are often higher.

At some point, though, someone has to say "No, you can't afford that". All that these different plans are really doing is passing the buck on that hard decision. Do you want it to be your insurance company that says no, your government or your own checkbook?

First of all, the thought of doctors competing on price kind of scares me. Doctor A says he can treat your heart disease for 10k, doctor B says he will treat it for 5k. Are they both doing the same thing? Is doctor B using cost cutting methods that are potentially harmful?

Along the same lines, would there be low cost providers and luxury providers kind of like the airlines? That's cool for airlines, because air travel is not a necessity. But medical care isn't something that should be segmented based on quality.

Finally given the fact that most medical usage is spontaneous, people aren't going to be shopping around for the best prices like they would for a TV. You are going to go to the hospital, do whatever procedures the doctor thinks is best, and pay the cost.

i pay $0 to go to the ER. urgent care and specialists are $20 and my PCP is $15.

i get blood work and MRI's done and pay nothing out of pocket.

so there's not much incentive for me to care about how much those bills are. my narrow view is that i either pay nothing or not much.

that's not cool and it's not sustainable. there is no other financial transaction i enter into where i don't care about the costs.

i used to go see this dermatologist twice a week to get light treatments. the doc was cool and told me there wasn't a copay each time i came in. i'd just show up twice a week and be in and out in a few minutes. one day i looked at the EOB and he was billing my insurance company like $160 for each treatment. it didn't matter to me because i didn't pay anything.

it shouldnt really work like that...



***
I ain't lyin. This shit i'm making up is true...

The problem is that people have TOO MUCH HEALTHCARE????? This shit's been debunked a ZILLION MILLION TIMES.

You want people to make this choice: Should I go get this medical issue looked at by a professional - or should I use this money on rent instead??

I think YOU think that medical care is a luxury, like having an iPhone, and that the "free hand of the market" and "personal responsibility" should be evaluated.

Well - that's all wrong.

Healthcare is a necessity and a right. It's literally what the entire point of having a social contract and a government is about.

Disagree with it and we end up where the system is today.

Now you - you SHOULD stop your insurance coverage and just go fee for service. Then you could make the full decision of whether your can hold off being diagnosed for a month so you can pay for rent. (I paid April's rent early - AND my cancer metastasized! Yay for freedoms.)

how did my reply trigger yours?


***
I ain't lyin. This shit i'm making up is true...

"i used to go see this dermatologist twice a week to get light treatments. the doc was cool and told me there wasn't a copay each time i came in. i'd just show up twice a week and be in and out in a few minutes. one day i looked at the EOB and he was billing my insurance company like $160 for each treatment. it didn't matter to me because i didn't pay anything.

it shouldnt really work like that..."


You are saying that having access to healthcare without "paying a penalty" to make it hurt (at least a little) is a problem that needs to be considered.

And I reject that.

Or if it is there then have it based on ability to pay.

And limit it to copay, not something like 80% insurance/20% co-insurance (which means out of pocket.)

A $30 copay isn't a joke to someone who is making $8.50 an hour.
A 20% patient portion of a $400 bill ain't a joke either.

We should be sharing the cost across ALL Americans - not just ones within a certain insurance group.

Right now we have something like 25 million American's without medical coverage at all (going to a possible 45 million if Trumpcare were to pass) - I don't think focusing in on "I have insurance and it should cost more and I should really want to use it before I do" is the wrong thing to focus on.

And the second we do talk about preventing abuse - like how to prevent people from abusing it - well we're off into Death panel territory.

Healthcare is a scarce resource like anything else. There is a finite number of doctor-hours, drugs, supplies, etc.
Price is typically the mechanism used to allocate scarce resources.
If there is no price, then people have no incentive to not over-consume.

Like dude said, when you don't have to even think about price you have no concerns at all about seeing a medical provider. So every concern you have will be check out. Even unnecessary things. You'll be going to the dermatologist to get a benign, but unsightly, discoloration taken care of. You will go to the doctor when you have a simple cold.

There has to be something that makes people have skin in the game, which is what co-pays and deductibles do. If there is no cost sharing, then there has to be rationing. And I think that would be much much worse

the way insurance is tiered incentivizes people taking advantage when they can and then not seeing a doctor at all when they need to. patients are always gambling, and the industry is always gaming prices to stay on top of those gambles.

everyone with "skin in the game" is trying to cheat the system, because it's about money and not about care.

pricing as a mechanism for sorting out appropriate levels of BASIC care is a bullshit fantasy. our economy and our psychology don't work that way.

>Healthcare is a scarce resource like anything else. There is
>a finite number of doctor-hours, drugs, supplies, etc.
>Price is typically the mechanism used to allocate scarce
>resources.

So let's increase the number of physicians and clinics and hospitals. You know how you do that?? Did you say "free hand of the market??" - NO- just have the government FUND it.

Did you know they already do that - for the military? Medical Students can join the armed services and have the cost of their training completely paid for by the government. In return they commit to a number of years of services (1 year for each year the are in school) - service that pays pretty well, has a signing bonus and provides medical care to them.

Plus you get paid like 2K a month to go to school.

We could expand that program to train non-military physicians up pretty quickly. they do this is many, many other countries.



>If there is no price, then people have no incentive to not
>over-consume.

Yeah, people TOTALLY want that - I need more operations please. And you can put in rules to prevent abuse without 'rationing it." You only get 1 cancer treatment a year - then you have to wait.


>Like dude said, when you don't have to even think about price
>you have no concerns at all about seeing a medical provider.
>So every concern you have will be check out. Even unnecessary
>things. You'll be going to the dermatologist to get a benign,
>but unsightly, discoloration taken care of. You will go to the
>doctor when you have a simple cold.

Yes, why shouldn't you go when you have a cold? Doesn't NEED to be a physician - could be a clinic near your house and have a nurse or nurse practitioner triage you and go from there. It's not exactly brain surgery.


>There has to be something that makes people have skin in the
>game, which is what co-pays and deductibles do. If there is no
>cost sharing, then there has to be rationing. And I think that
>would be much much worse

There's the binary thinking - think of it as a sliding scale. And you pay by paying taxes. Rich people (or just plain jackasses) get butthurt because an unemployed person gets medical care? Boo-hoo.

there is rationing now - you don't have any money you don't get help. Is that what Jesus/Allah/who-ever-the-fuck-you-pray-to would want??

And WHAT IS MORE IMPORTANT THAN YOUR HEALTH?? Isn't this exactly why we have a government? Or is it just to build walls, or make sure gays don't have as many rights??

Seriously - why isn't this seen as a service of the government?

I suggest it's because the American myth of "rugged individuation" and "manifest destiny.

Took a kid in and got stitches in his mouth all within an hour.

Only a 15 co-pay.

But then them monthly premiums are no joke.



**********
"Everyone has a plan until you punch them in the face. Then they don't have a plan anymore." (c) Mike Tyson

"what's a leader if he isn't reluctant"

15 copay - plus how much in monthly premiums for what period of time?

That's who insurance works - you pay a flat fee each month to have access - if you use the access you should be covered entirely - if not your paying for the person who did use it that month.

That's how insurance works - spreading cost and risks.

covers the premiums and their members



and LMAO at anyone thinking the costs of healthcare are rising due to ANY other factor other than pure greed...but ya'll can feel free to nerd it out

it's the American way!

when he was practicing he didn't participate w/insurance companies


which basically means unless you got a country's embassy paying for your surgery or some kinda mass funding effort, you shit outta luck seeing that guy