HealthCare

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Sweden Gendarme
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Re: HealthCare

Post by Gendarme »

You seem very quick to conclude that there will be no R&D without patents. Have you reflected over the matter or is it simply a knee-jerk response? If the latter is the case it is getting quite silly at this point.
Pay more attention to detail.
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Re: HealthCare

Post by Goodspeed »

Gendarme wrote:You seem very quick to conclude that there will be no R&D without patents.
The importance of patents to R&D, particularly in pharma, has been well known to literally everyone for decades. Plenty of research has been done on it. So no, I'm not "quick to conclude" it.
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Re: HealthCare

Post by lejend »

WickedCossack wrote:
lejend wrote:But I agree I'm at fault due to not replying to your earlier arguments. Don't worry I will. I have the post mostly prepared. Just putting finishing touches on it. ;)


Tis over a week later now, how is it going?

If you've lost motivation you can post the bit you had written, I'd still be interested.


I had the post mostly prepared, but it will take a day or more before I post it. My PC was being crappy, so I backed up my data in a flash drive and did the System Restore thing. The flash drive however sadly doesn't seem to work anymore, so I no longer have access to my prepared post or the bookmarked sources/studies.

But if I can't fix it then I'll rewrite the post from scratch. Patience, my child.

If I recall correctly, these were the main topics I was going to address:

- Medicaid/Medicare health outcomes compared to the uninsured.

- US health care ranking compared to other developed countries.

- ObamaCare and Facebook guy.

- Cost and political feasibility of socialized medicine in America.

- socialism vs free market.

I'd rather address them all at once because all are good topics.

You can watch this while waiting for my reply. :lol: (the first 20 minutes)

phpBB [video]
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Re: HealthCare

Post by kami_ryu »

-- deleted post --

Reason: on request (off-topic bulk delete)
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Re: HealthCare

Post by lejend »

Okay looks like the flash drive won't work no matter what. I'll rewrite my post from scratch, then. It might not be as comprehensive, but I will try to address every point.
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Re: HealthCare

Post by lejend »

All right I've delayed you enough, Cossack, so instead of responding to everything at once, I'll try to address as much as possible today, to keep the discussion going.

You asked how recipients of government health insurance such as Medicaid, fare compared to private-insured, or uninsured, Americans.

Research definitively shows that the private-insured have the best care and the best health outcomes, and that people on Medicaid fare worse or no better than uninsured people. A few example studies:

Medicaid expansion enrollees receive inadequate value from the program. Researchers analyzing the Oregon Medicaid quasi experiment found that expansion enrollees did not have significantly better physical health on any of the three metrics assessed (blood pressure, cholesterol, and blood sugar). The same researchers estimated that enrollees only valued Medicaid at 20–40 cents for every dollar of program spending on their behalf. Large Medicaid expansions also tend to have rippling effects that affect the allocation of healthcare services, increasing the importance of assessing population effects. Tennessee’s large Medicaid expansion in the 1990s failed to produce discernible changes in healthcare utilization and actually showed worse self-reported health and population death rates relative to the changes in Tennessee’s bordering states.


https://www.mercatus.org/publications/a ... l-problems

a landmark study conducted at the University of Virginia that found that surgical patients on Medicaid are 13 percent more likely to die than those without insurance of any kind. The study evaluated 893,658 major surgical operations from around the country from 2003 to 2007, and normalized the results for age, gender, income, geographic region, operation, and 30 background diseases.

Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.

Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.


A University of Pennsylvania study published in Cancer found that, in patients undergoing surgery for colon cancer, the mortality rate was 2.8% for Medicaid patients, 2.2% for uninsured patients, and 0.9% for those with private insurance. The rate of surgical complications was highest for Medicaid at 26.7%, as compared to 24.5% for the uninsured and 21.2% for the privately insured.


A Columbia-Cornell study in the Journal of Vascular Surgery examined outcomes for vascular disease. Patients with clogged blood vessels in their legs or clogged carotid arteries (the arteries of the neck that feed the brain) fared worse on Medicaid than did the uninsured; Medicaid patients outperformed the uninsured if they had abdominal aortic aneurysms.


A study of Florida patients published in the Journal of the National Cancer Institute found that Medicaid patients were 6% more likely to have late-stage prostate cancer at diagnosis (instead of earlier-stage, more treatable disease) than the uninsured; 31% more likely to have late-state breast cancer; and 81% more likely to have late-stage melanoma. Medicaid patients did outperform the uninsured on late-stage colon cancer (11% less likely to have late-stage cancer).


https://www.forbes.com/sites/theapothec ... tastrophe/

This is not surprising. For one, Medicaid significantly underpays doctors and hospitals. For every dollar spent on a Medicaid patient government compensates providers only 60c-90c. As a direct result of that, doctors often refuse to accept Medicaid patients. Recent surveys show that 30% now refuse to accept new patients.

So while Medicaid recipients "technically" have government health insurance on paper, the reality is that it often can't be utilized since many doctors, and particularly specialists, don't actually accept it. This results in a limited network of health care providers for Medicaid recipients, which causes them to either delay treatment or rely on hospitals and ERs. Remember how the government only compensates hospitals 90c for every dollar spent treating Medicaid patients? Hospitals recoup their losses by jacking up prices for everyone else, i.e. private-insured patients. That is one reason why health costs are so high in the US: government intervention.

Summing all that up, what are the pros and cons of government health insurance?

Cons:

- Health outcomes worse than the private insured and the uninsured

[spoiler=Higher administrative costs]Image[/spoiler]

[spoiler= Rife with fraud]Indeed, scamming Medicare and Medicaid is so lucrative that the Russian and Nigerian mobs have gotten involved. And one of the New York crime families has moved to Florida because defrauding Medicare is both more lucrative and less dangerous than some of the traditional organized crime activities.

And Medicaid is just as bad, or worse. New York City has been a huge problem for Medicaid with one former official suggesting that 40 percent of NYC’s Medicaid payments are “questionable. ”...

How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid....

There are no good numbers on how much money private sector health insurers lose in fraud, but working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent. And one of the primary differences is that the private sector insurers embrace software and other new technologies that help them find discrepancies and fraud in health care claims.

https://www.forbes.com/sites/merrillmat ... -billions/[/spoiler]

[spoiler=Domino effect on the rest of the health care market, raising costs for the general population]Image[/spoiler]

[spoiler=THey account for half of all health care spending in the country, costing trillions of dollars per year - a national security crisis]Image

Image

Image

Image

The national debt ranks among some of the most serious threats to the U.S., National Security Director Dan Coats said Tuesday.

"The failure to address our long-term fiscal situation has increased the national debt to over $20 trillion and growing," he said during a broader hearing over dangers posed to the U.S. "This situation is unsustainable as I think we all know, and represents a dire threat to our economic and national security."

https://www.cnbc.com/2018/02/13/us-secu ... hreat.html[/spoiler]

Pros:

- slight improvement in the infant mortality rate for the very poorest recipients.
- People with diabetes might be better off than uninsured, true

I think that while government programs do good in these respects, it does not justify the multi-trillion dollar price tag and all the other harmful effects. The free market can do better and for lower cost.

Basically I don't believe the various government insurance programs are better than private health insurance, so I don't think most people, who are happy with their private insurance, would ever actually abandon what works for them in favor of government health insurance, e.g., single-payer. It would drastically lower their health care quality while costing them more.
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Re: HealthCare

Post by WickedCossack »

Well thanks for the reply.

I'll address your con list considering that your prior spiel ties into that and supports that.

- Health outcomes worse than the private insured and the uninsured


So this isn't true.

There seems little consensus with respect to research comparing the outcomes of patients under social programs in the US.

In the same way you can quote me articles written by republican advisors Avik Roy & Brian Blase I can quote you others citing the opposite conclusion.

For example one of the studies Roy mentions and you chose to highlight in your post was conducted by the UVA in 2011.

A similar study was conducted by the UVA in 2017 even including a few of the same researchers coming to the conclusion that Medicaid coverage is associated with better health outcomes.

I think what is arguable though is that it can be hard to run successful social health programs alongside government sponsored private health care. Admin costs, time and efficiency appear to hurt hurt both.

Now what I can do is point to other comparable high-income countries that have universal healthcare and say that their health outcomes are superior to private insurance health outcomes in America. There is a general consensus on this. I've posted links in my previous posts to support this.

Considering that is the case the logical conclusion for me is that America can improve their health outcomes by adopting some sort of universal healthcare. It has been shown to work in all these other countries more effectively, you can't find better evidence than that.

Higher administrative costs


This is 100% false and not debated whatsoever. Take a look at the graph you posted again more carefully, it shows the exact opposite of what you're trying to say. You won't even be able to find a biased study to support this it's that untrue.

Infact this is one of the arguments in favour of social healthcare. It has significantly lower admin costs which can be put towards better health outcomes.

Rife with fraud


Sure, any governmental run program will have some level of fraud.

My issue with the suggestion that a governmental run program has more fraud than a private run program is the fact that companies can get away with fraudulent practices legally. For one example I listed in a previous post some of the 500,000% price hikes in drugs that put them out of the reach of the poorest. When we look at fraud in a public run system you have to also balance it out against unethical financial behavior of private companies.

-Domino effect on the rest of the health care market, raising costs for the general population
-They account for half of all health care spending in the country, costing trillions of dollars per year


Sure like I said earlier limited social programs running alongside private insurance will hurt both in time, costs and efficiency.

Now nearly all economic research suggests that by switching to universal healthcare you can have a lower cost. Again I can point to every other high-income country as an example of this.

This is why you pay 3x more than I do for healthcare. That's a fact.

Again there is literally no better evidence than showing the system working in other places.

You have yet to argue against the point that universal healthcare has been shown to have lower costs in other comparable countries to the USA. Not to mention better health outcomes.

You can't keep claiming things like well it will cost more, when it just doesn't.

Basically I don't believe the various government insurance programs are better than private health insurance, so I don't think most people, who are happy with their private insurance, would ever actually abandon what works for them in favor of government health insurance, e.g., single-payer. It would drastically lower their health care quality while costing them more.


Again it's hard for me to take this seriously when I pay less than you for better care.
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Re: HealthCare

Post by spanky4ever »

@lejend why not give up, when you have a bad CASE - and you know that this is not good for the common ppls? There could be somethings that the marked cannot fix?
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Re: HealthCare

Post by tedere12 »

Image
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Re: HealthCare

Post by lejend »

iwillspankyou wrote:@lejend why not give up, when you have a bad couse - and you can c that this is not good for the common ppls? There could be somethings that the marked cannot fix?


"Bad cause"? Yeah, that's why I support economic freedom. Not because free-market policies are more moral and better at actually helping people, but because I'm working alongside Dr. Evil to hurt as many people as possible. And I would've gotten away with it too if it weren't for you meddling kids.

@WickedCossack, okay, so I take it our next topic of discussion is comparing America to Europe. I will reply today or tomorrow.
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Re: HealthCare

Post by spanky4ever »

I though of you the other day @lejend and this tune come in to my head - like magic . will share it with you - I realy love this song;
phpBB [video]
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Re: HealthCare

Post by lejend »

iwillspankyou wrote:I though of you the other day @lejend and this tune come in to my head - like magic . will share it with you - I realy love this song;
phpBB [video]


It's majestic.
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Re: HealthCare

Post by spanky4ever »

lejend wrote:
iwillspankyou wrote:I though of you the other day @lejend and this tune come in to my head - like magic . will share it with you - I realy love this song;
phpBB [video]


It's majestic.

its about beeing gay though. Do you still love it :?:
George Michal was gay, and he humiliated himself in a publick toilet! THAT IS A SHAME, that he had to get his kick as a nobody, when he has a SOMEBODY (love this song, cos its somewhat familiar to the pain I have felth)
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Re: HealthCare

Post by lejend »

iwillspankyou wrote:
lejend wrote:
iwillspankyou wrote:I though of you the other day @lejend and this tune come in to my head - like magic . will share it with you - I realy love this song;
phpBB [video]


It's majestic.

its gay though. Do you still love it :?:


You're gay and I still love you, bb. So, yeah.
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Re: HealthCare

Post by WickedCossack »

lejend wrote:@WickedCossack, okay, so I take it our next topic of discussion is comparing America to Europe. I will reply today or tomorrow.


I mean sure, if you're genuinely interested in it. My only concern is when you're posting very basic falsehoods it shows to me that you're not really interested in the actual facts and you're only invested in your own narrative.

Anyone trying to argue honestly would have seen that graph and thought "oh that's interesting, I didn't know that private insurance had higher admin costs." The article the graph came with would have made that clear (which I have to assume you didn't read or else you'd have noticed, or just basic graph reading skills in general). I just can't wrap my head around what the context was that could lead you to posting that while trying to argue in good faith.

Now this is the second time you've done it as previously you used statistics of satisfaction rates to argue in favour of private insurance over social healthcare programs. A cursory glance at your own link definitively showed that people were more satisfied with the social healthcare programs.

For your own sake you should really do a bit of introspection and check if you're really being honest with yourself because when I see arguments presented in this way I really have to wonder.
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Re: HealthCare

Post by lejend »

WickedCossack wrote:
lejend wrote:@WickedCossack, okay, so I take it our next topic of discussion is comparing America to Europe. I will reply today or tomorrow.


I mean sure, if you're genuinely interested in it. My only concern is when you're posting very basic falsehoods it shows to me that you're not really interested in the actual facts and you're only invested in your own narrative.

Anyone trying to argue honestly would have seen that graph and thought "oh that's interesting, I didn't know that private insurance had higher admin costs." The article the graph came with would have made that clear (which I have to assume you didn't read or else you'd have noticed, or just basic graph reading skills in general). I just can't wrap my head around what the context was that could lead you to posting that while trying to argue in good faith.

Now this is the second time you've done it as previously you used statistics of satisfaction rates to argue in favour of private insurance over social healthcare programs. A cursory glance at your own link definitively showed that people were more satisfied with the social healthcare programs.

For your own sake you should really do a bit of introspection and check if you're really being honest with yourself because when I see arguments presented in this way I really have to wonder.


Just a quick reply to this before I respond to your previous post. Number 1, if I'm really wrong about something, simply pointing it out would be much more productive than accusing me of dishonesty. :|

Regarding Medicare's administrative costs, nothing I said was false. Medicare does have higher administrative costs per payee. You're probably looking at administrative costs as a percentage of total expenses, which is completely irrelevant for the purposes of this discussion.

Many people wrongly believe that Medicare is more efficient than private insurance; that view was often stated by champions of Obamacare during the debate preceding the law's enactment. These advocates argued that Medicare's administrative costs — the money it spends on expenses other than patient care — are just 3% of total costs, compared to 15% to 20% in the case of private, employer-sponsored insurance. But these figures are highly misleading, for several reasons...

Administrative costs are calculated using faulty arithmetic

But most important, because Medicare patients are older, they are substantially sicker than the average insured patient — driving up the denominator of such calculations significantly. For example: If two patients cost $30 each to manage, but the first requires $100 of health expenditures and the second, much sicker patient requires $1,000, the first patient's insurance will have an administrative-cost ratio of 30%, but the second's will have a ratio of only 3%. This hardly means the second patient's insurance is more efficient — administratively, the patients are identical. Instead, the more favorable figure is produced by the second patient's more severe illness.

Medicare has higher administrative costs per beneficiary

A more accurate measure of overhead would therefore be the administrative costs per patient, rather than per dollar of medical expenses. And by that measure, even with all the administrative advantages Medicare has over private coverage, the program's administrative costs are actually significantly higher than those of private insurers. In 2005, for example, Robert Book has shown that private insurers spent $453 per beneficiary on administrative costs, compared to $509 for Medicare. (Indeed, Robert has written the definitive paper on this subject, from which the above figure is taken.


https://www.forbes.com/sites/theapothec ... 828452140d
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Re: HealthCare

Post by WickedCossack »

lejend wrote:Just a quick reply to this before I respond to your previous post. Number 1, if I'm really wrong about something, simply pointing it out would be much more productive than accusing me of dishonesty. :|

Regarding Medicare's administrative costs, nothing I said was false. Medicare does have higher administrative costs per payee. You're probably looking at administrative costs as a percentage of total expenses, which is completely irrelevant for the purposes of this discussion.


We are absolutely interested in the admin costs per payee as a percentage.

The argument Avik Roy makes that because someone is paying £210 admin fees for a £10,000 op (2.1%) compared to £200 admin fees for a £1,000 op (20%) and saying "look, technically he paid £10 more!" is laughable. Of course we are interested in percentages, why on earth is that "completely irrelevant"? There's nothing more relevant. Hilariously he even acknowledges that Medicare patients are substantially sicker thereby acknowledging the reasons for absolute admin costs.

Yes when you make arguments like that it comes across as incredibly dishonest.

I also loled at this other quote from Roy from the opinion piece you quoted: "In addition, Medicare's massive size leads to economies of scale that private insurers could also achieve, if not exceed, were they equally large." Great theory crafting! By leaving healthcare up to the markets you've already accepted that they can't reach the same economies of scale! You can't sit there and argue "weeeeell if they were only just the same size" knowing full well that's not pragmatically going to happen. I do appreciate that he accidentally acknowledges some of the economic benefits of universal healthcare though!
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Re: HealthCare

Post by lejend »

WickedCossack wrote:
lejend wrote:Just a quick reply to this before I respond to your previous post. Number 1, if I'm really wrong about something, simply pointing it out would be much more productive than accusing me of dishonesty. :|

Regarding Medicare's administrative costs, nothing I said was false. Medicare does have higher administrative costs per payee. You're probably looking at administrative costs as a percentage of total expenses, which is completely irrelevant for the purposes of this discussion.


We are absolutely interested in the admin costs per payee as a percentage.

The argument Avik Roy makes that because someone is paying £210 admin fees for a £10,000 op (2.1%) compared to £200 admin fees for a £1,000 op (20%) and saying "look, technically he paid £10 more!" is laughable. Of course we are interested in percentages, why on earth is that "completely irrelevant"? There's nothing more relevant. Hilariously he even acknowledges that Medicare patients are substantially sicker thereby acknowledging the reasons for absolute admin costs.

Yes when you make arguments like that it comes across as incredibly dishonest.

I also loled at this other quote from Roy from the opinion piece you quoted: "In addition, Medicare's massive size leads to economies of scale that private insurers could also achieve, if not exceed, were they equally large." Great theory crafting! By leaving healthcare up to the markets you've already accepted that they can't reach the same economies of scale! You can't sit there and argue "weeeeell if they were only just the same size" knowing full well that's not pragmatically going to happen. I do appreciate that he accidentally acknowledges some of the economic benefits of universal healthcare though!


I think you've got it backwards. In this analogy it is Medicare that would cost $10,000 per beneficiary, not private health insurance. Medicare has higher administrative costs, in actual dollars, but since Medicare's total expenses are so drastically higher than those of private health insurance, Medicare's administrative costs appear lower due to making up a smaller percentage of total costs. Again:

The explanation is really quite simple, and it's provided here by Robert Book of the Heritage Foundation. The statistic cited by Alter and Krugman uses administrative costs calculated as a percentage of total health care costs (For Medicare it's roughly 3 percent and for private insurers it's roughly 12 percent).

But here's the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a "miracle" is really just a statistical sleight of hand.

Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of "administrative costs" (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.

But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. As you can see here, between 2001-2005, Medicare's administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.


https://www.realclearpolitics.com/artic ... 97193.html

Image

Try thinking of it like this:

-Your monthly expenses are $2000, including $200 on food. So 10% on food.
-My monthly expenses are $600, including $100 on food. So 16% on food.

If I copied your food plan, would I pay $200 (i.e., 33% of my total expenses), or $60 (i.e., 10% of my expenses)?
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Re: HealthCare

Post by WickedCossack »

lejend wrote:I think you've got it backwards. In this analogy it is Medicare that would cost $10,000 per beneficiary, not private health insurance. Medicare has higher administrative costs, in actual dollars, but since Medicare's total expenses are so drastically higher than those of private health insurance, Medicare's administrative costs appear lower due to making up a smaller percentage of total costs.


I don't have it backwards. Go read this again:

The argument Avik Roy makes that because someone is paying £210 admin fees for a £10,000 op (2.1%) compared to £200 admin fees for a £1,000 op (20%) and saying "look, technically he paid £10 more!" is laughable.

To make it even more clear the £210 admin fees for £10,000 is the medicare (2.1%) and the £200 admin fees for $1,000 is private (20%).

lejend wrote:Try thinking of it like this:

-Your monthly expenses are $2000, including $200 on food. So 10% on food.
-My monthly expenses are $600, including $100 on food. So 16% on food.

If I copied your food plan, would I pay $200 (i.e., 33% of my total expenses), or $60 (i.e., 10% of my expenses)?


$60. You shouldn't even have to ask this. I really don't think you have a clue what you are reading. I don't know what else to say here.
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Re: HealthCare

Post by lejend »

WickedCossack wrote:
lejend wrote:Try thinking of it like this:

-Your monthly expenses are $2000, including $200 on food. So 10% on food.
-My monthly expenses are $600, including $100 on food. So 16% on food.

If I copied your food plan, would I pay $200 (i.e., 33% of my total expenses), or $60 (i.e., 10% of my expenses)?


$60. You shouldn't even have to ask this. I really don't think you have a clue what you are reading. I don't know what else to say here.


Really? Come on, mate. I am no math genius, but that's not right.
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Re: HealthCare

Post by WickedCossack »

lejend wrote:Really? Come on, mate. I am no math genius, but that's not right.


Lol I'm done. I don't know what to say here. I really don't. Am I being trolled?
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Re: HealthCare

Post by deleted_user0 »

unless you establish whether or not administrative costs are linked to total expenses (aka, administrative costs are higher when total costs are higher), you're not going to resolve this dispute. just saying.
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Re: HealthCare

Post by WickedCossack »

umeu wrote:unless you establish whether or not administrative costs are linked to total expenses (aka, administrative costs are higher when total costs are higher), you're not going to resolve this dispute. just saying.


It's not a direct relationship but it's fairly close. Just look at the graph he posted though, even if there is just a very very very very very very very loose relationship the absolute admin costs are so close that you'd still save.
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Re: HealthCare

Post by lejend »

If everyone abandoned private health insurance and just got on Medicare, total administrative costs in health care, in dollars, would increase, not decrease.

Advocates of a public plan assert that Medicare has administrative costs of 3 percent (or 6 to 8 percent if support from other government agencies is included), compared to 14 to 22 percent for private employer-sponsored health insurance (depending on which study is cited), or even more for individually purchased insurance. They attribute the difference to superior efficiency of government,[1] private insurance companies' expenditures on marketing,[2] efforts to deny claims,[3] unrestrained pursuit of profit,[4] and high executive salaries.[5]

However, on a per-person basis Medicare's administrative costs are actually higher than those of private insurance--this despite the fact that private insurance companies do incur several categories of costs that do not apply to Medicare. If recent cost history is any guide, switching the more than 200 million Americans with private insurance to a public plan will not save money but will actually increase health care administrative costs by several billion dollars.

Fuzzy Math

Medicare patients are by definition elderly, disabled, or patients with end-stage renal disease, and as such have higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Administrative costs are incurred primarily on a fixed or per-beneficiary basis; this approach spreads Medicare's costs over a larger base of patient care cost.

Even if Medicare and private insurance had identical levels of administrative efficiency, Medicare would appear to be more efficient merely because of an artifact of the arithmetic of percentages--Medicare's identical administrative costs per person would be divided by a larger number for patient care costs.

Imagine, for a moment, that Fred and Jane each have a credit card from a different bank. Fred charges $5,000 a month, and Jane charges $1,000 a month. Suppose it costs each bank $5 to produce and send a plastic credit card when the account is opened. That $5 "administrative cost" is a much lower percentage of Fred's monthly charges than it is of Jane's, but that does not mean Fred's bank is more efficient. It is purely a mathematical artifact of Fred's charging pattern, and it would be silly to compare the efficiency of bank operations on that basis. Yet that is how many analysts compare Medicare with private insurance.

...

Why Measuring Administrative Costs as a Percentage Is Misleading

Administrative costs can be divided broadly into three categories:

Some costs, such as setting rates and benefit policies, are incurred regardless of the number of beneficiaries or their level of health care utilization and may be regarded as "fixed costs."
Other costs, such as enrollment, record-keeping, and premium collection costs, depend on the number of beneficiaries, regardless of their level of medical utilization.
Claims processing depends primarily on the number of claims for benefits submitted.

Claims processing is the only category that is at all sensitive to the level of health care utilization, and it is more correlated with the number of claims than on the cost or intensity of service provided on each claim. Furthermore, it represents only a very small share of administrative costs. For example, in the case of Medicare, the total claims processing expenditure in FY 2005 was $805.3 million,[8] which represented 4.04 percent of Medicare's administrative costs--which is, in turn, only 0.234 percent (less than 24 cents for every $100) of total Medicare outlays.[9]

Clearly, only an extremely small portion of administrative costs are related to the dollar value of health care benefit claims. Expressing these costs as a percentage of benefit claims gives a misleading picture of the relative efficiency of government and private health plans.

Medicare beneficiaries are by definition elderly, disabled, or patients with end-stage renal disease. Private insurance beneficiaries may include a small percentage of people in those categories, but they consist primarily of people are who under age 65 and not disabled. Naturally, Medicare beneficiaries need, on average, more health care services than those who are privately insured. Yet the bulk of administrative costs are incurred on a fixed program-level or a per-beneficiary basis. Expressing administrative costs as a percentage of total costs makes Medicare's administrative costs appear lower not because Medicare is necessarily more efficient but merely because its administrative costs are spread over a larger base of actual health care costs.


https://www.heritage.org/health-care-re ... -insurance

This is related to what I was talking about in the OP. The free market is more efficient than central planning. At this point it's a law of economics that everyone readily admits, except when it comes to the health care market for some reason. :cry:

Anyway, I will reply to your original post soon.
No Flag lejend
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Re: HealthCare

Post by lejend »

WickedCossack wrote:Well thanks for the reply.


Apologies for replying late again.

So this isn't true.

There seems little consensus with respect to research comparing the outcomes of patients under social programs in the US.

In the same way you can quote me articles written by republican advisors Avik Roy & Brian Blase I can quote you others citing the opposite conclusion.

For example one of the studies Roy mentions and you chose to highlight in your post was conducted by the UVA in 2011.

A similar study was conducted by the UVA in 2017 even including a few of the same researchers coming to the conclusion that Medicaid coverage is associated with better health outcomes.


I think there is a consensus that private insurance is better than government insurance, in America. There is more disagreement on whether government insurance is worse than being uninsured, but studies show that in most cases the uninsured fare better than the government-insured.

The study you linked does indeed show that Michigan's Medicaid population has experienced improved health outcomes, but this doesn't tell us anything about how good Medicaid is, because after Michigan expanded Medicaid's eligibility requirements, a lot of young and healthy people were enrolled in Medicaid. So it isn't an apples to apples comparison. The study I linked adjusted for "age, gender, income, geographic region, operation, and 30 background diseases", while this one did not.

From your article:

Another possibility, he said, is that patients newly eligible for Medicaid are younger and lower-risk, which could explain the lower risk scores and better outcomes for Michigan patients in the 18 months following Medicaid expansion.


I think what is arguable though is that it can be hard to run successful social health programs alongside government sponsored private health care. Admin costs, time and efficiency appear to hurt hurt both.


That's most likely true.

My issue with the suggestion that a governmental run program has more fraud than a private run program is the fact that companies can get away with fraudulent practices legally. For one example I listed in a previous post some of the 500,000% price hikes in drugs that put them out of the reach of the poorest. When we look at fraud in a public run system you have to also balance it out against unethical financial behavior of private companies.


Right. I was just thinking of fraud from a monetary perspective. Up to 20% of a program's expenses being fraudulent is a big deal; that is hundreds of billions of dollars down the drain per year. Not very efficient.

You've mentioned drug prices a few times. I'd need to do more research on each individual case before commenting, though I can safely rule out that prices are chosen just to be mean. Medicine research is extremely expensive, and patents don't last that long, so oftentimes drug manufacturers need to ask for high prices to profit while they still can. The alternative is that the medicines aren't developed at all. There are free market methods of reducing the cost of R&D, and I support that.

Now what I can do is point to other comparable high-income countries that have universal healthcare and say that their health outcomes are superior to private insurance health outcomes in America. There is a general consensus on this. I've posted links in my previous posts to support this.

Considering that is the case the logical conclusion for me is that America can improve their health outcomes by adopting some sort of universal healthcare. It has been shown to work in all these other countries more effectively, you can't find better evidence than that.


I disagree completely with that. I've seen no evidence that other developed countries have better health outcomes than private-insured Americans. It's just a myth, a very popular one in Europe.

Advocacy researchers often put out "studies" giving the US health care system poor marks, but if you look at their methodology, you'll realize that the rankings are based on very poor and arbitrary metrics.

They generally tend to ignore areas in which America's system excels over other countries'. Americans have lower waiting times, better access to new/expensive treatments, better treatment of chronic illnesses. People can get a wide range of tests and treatments done at higher rates. Americans have higher cancer survival rates.

The only way they portray America's health insurance as comparably poor, is by examining broader demographic data that isn't even related to health insurance, such as life expectancy, which are then blamed on America's private health insurance system, even though researchers say that's incorrect. The reason for America's lower life expectancy isn't due to the health care system, it is because of higher deaths from e.g. injuries. Once you adjust for that America has a higher life expectancy than Europe.

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If you look at the actual performance of the health care system, Americans likely have the best health care in the world.

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According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology : 1

    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. [See Figure I.] U.S. Cancer Care Is Number One. fig1

    American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.

    Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

    For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows:

    Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2

    Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.

    The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).

Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.

Results for Canada. Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada: 3

    For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

    For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

Early Diagnosis. It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government. 4

    In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

    The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.

Access to Treatments and Drugs. Early diagnosis is important, but survival also depends on getting effective treatment quickly. However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs . 5 The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment. A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff. 6

Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries. A report in the Annals of Oncology by two Swedish scientists found: 7

    Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria.

    Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe.

One of the report's authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster.

Conclusion. International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles. No country on the globe does as good a job overall as the United States.


Sources:

http://archive.is/AJj6X
https://www.forbes.com/sites/theapothec ... 4d5c532b98

You have yet to argue against the point that universal healthcare has been shown to have lower costs in other comparable countries to the USA. Not to mention better health outcomes.

You can't keep claiming things like well it will cost more, when it just doesn't.


Every single socialized medicine plan I am aware of is projected to be unaffordable. California, Colorado, and Vermont all abandoned their universal health insurance plans due to high cost. A conservative estimate of the cost of Sanders' "Medicare for all" plan, is $2-3 trillion dollars per year. Do you know what the entire government budget is right now? $4 trillion, $1 trillion of which goes to health care spending, so we can deduct that. I'm legitimately curious how government spending can be increased by $1-3 trillion, without raising taxes on the poor and the middle class or going even deeper into debt.

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