2053

It is a horrible thing to add as it penalizes people who need healthcare the most. You could just rake up fees for certain conditions so high the insurer would practically only end up with the most healthy and fit. And the rest? In the same boat as they are now, screwed. What about smoking? Or certain jobs? What about certain sports? Should you be penalizes for paragliding? What about football? List goes on and on.

2054

The problem is that “maximizing health” and “minimizing the burden on health care” may well not have as much overlap as you might imagine.

For example, you might say running is a sign of health. OTOH, over the long term running may cause all kinds of lower back and knee problems. So run… but not too much? Or maybe not run at all and do elliptical? Lifting weights might help, but also risk doing significant injury.

In other words, it might well turn out that the lifestyle minimizing costs encourages would resemble something like people sitting around at home, not eating snacks, doing 30 minutes of moderate exercise a day and in no way pushing themselves beyond that because of the risk of injury.

2055

You should certainly be penalized for smoking. There’s no excuse for it, everyone knows how terrible it is.

I don’t know guys I’m not a doctor! We should let doctors decide the measures if we were to go down this route. My life insurance company, Met Life, thought it was a good measure. They probably know what they’re doing.

2056

The next step of genetic councilling is virtualization. Sequencing is step one. Being able to “run” a genetic code on a virtualized atomic level and see what “pops out” is step two. This is a huge step obviously but once it’s available you’ll be able to actually predict, rather than see each genetic marker as an island of information on its own.

2057

Except it makes you look cool.

2058

Life insurance is a different thing than health insurance.

2059

True. If I looked like this I’d smoke non-stop. I’d die young but think of all the chicks…

2060

God I wish I could stand the “taste” of smoking cuz I look like a lame fat asshole, but if I were smoking…

2061

Strollen, thanks for putting some ideas on the table.

The good news is, although I disagree in a number of areas, those ideas are things that people actually desiring to improve US health care could discuss. I consider those ideas a “good faith attempt” at discussing the issues. Those are the kinds of ideas, when put on the table alongside some of the more liberal ideas I listed up thread, could lead to a meaningful negotiation/compromise in the big picture.

The bad news is, the current GOP would never agree to all or most of those ideas. For example, spending money directly on serving poor areas and cutting out private health insurance completely was not in any of the GOP plans this year. Most of the GOP plans cut Medicaid which is the sort of direct spending plan you advocate here. Another example: the Cassidy/Collins automatic enrollment in catastrophic coverage plan is an interesting idea that was proposed but only supported by 2 out of 52 GOP Senators. That’s 4% support. The other 96% of the GOP Senate voted that amendment down.

And that’s the issue with the current political climate IMO. There are some GOPers who have some good ideas to contribute to the debate and in a normal political climate, we could negotiate some bipartisan compromises. However, the less extreme GOPers are only approximately 10% to 15% of the national GOP (at most) and the remaining 85% to 90% are incredibly partisan and extreme to the point of denying reality on many issues, and demonizing the Democrats as worse than hostile foreign powers.

Bipartisan compromise will only be possible once the GOP collapses or retreats from the extremist edge and becomes a party that is willing to sit at the negotiating table. The GOP will also have to give up it’s addiction to lying and “alternative facts” b/c in addition to a reasonable negotiating stance, honest participation is another key requirement for true compromise.

2062

Conservative darling Tomi Lahren’s comments at Politicon this weekend:

LAHREN: I don’t think government does well at health care, I think it’s proven by the V.A. that the government doesn’t do well at health care. So we need to find alternatives. What’s right now is not working. What we had before Obamacare was not working. I think you increase competition, I think that’s the way to do it. … I think that the free marketplace is better.

HANDLER: OK, so do you have a health care plan, or no?

LAHREN: Well, luckily I’m 24, so I am still on my parents’…

2063

The way to do this is to put sin taxes on purchase of cigarettes/alcohol/etc not on healthcare itself`. There, I suggest the opposite approach: giving credits/breaks to those in good health to incentivize them to get coverage at all.

2064

My (sadly, two) friends diagnosed with MS over the last two years really need to step it up if they want those sweet tax credits!

2065

Some cost control can be achieved through moving healthcare from a customer service attitude (the standard in the US) to a health first attitude (how it’s normally in single payer systems). That is, whatever government financed healthcare gets instituted, it needs to focus on health results, not making people happy or felt cared for.

When I say customer service I mean:

  1. Do not spend time listening to patients concerns and being nice for the shake of being nice if the diagnosis is clear.
  2. Do not do extra tests that as a professional you think are not needed, no mater than the patient wants them.
  3. Prioritize waiting lists and be confortable making patients wait for cosmetic or unimportant treatments.

The above do not diminish the effectiveness of a health service, only the public perception of it (and in the case of too many test of treatments, it might actually improve results). But allows to keep things under control.

Case in point: we are going to have a baby, and both me and my wife have both public (single payer) and private ($60 a month for premium service with no deductibles nor limits) health insurance. The public one is free, and so far the meetings with specialists have been 10 minutes affairs, quite impersonal, just doing tests, looking and results and if everything is fine (it is so far), that’s it, let the next patient in. We are getting a lot of tests and meetings done with doctors, though, as per the standard procedures here, sop it’s far from a bad service health wise, but it is impersonal. By focusing on efficiency, they manage to see way more patients per day (about twice the number) than the doctors in private clinics.

Of course, since raising a baby raises questions, we are also going to private doctors through our private insurance, which give us 30-40 minutes per session, record the ultrasound scans (in the public system they don’t give you the recordings) and just answer our questions until we get bored of asking. It is nice, and welcomed, and since we have private insurance anyway we are taking advantage of it, but it is not needed. For labor we will be using the public system, since that’s the one that minimizes risks. We might not have an individual room, but we are willing to sacrifice that comfort for the extra safety of a well working, efficient system (private clinics tend to be less equipped, specially if complications arise, and have -slightly- worse safety records).

It’s hard to make people understand healthcare should be looked at mostly from a result driven standpoint, specially since most of us aren’t expert and get scared when facing health crises, but I feel it’s an important aspect of cost and efficiency in such a system.

2066

There is a reason healthcare providers call it a practice. The results are often as “clear” as people think they really are.

Also if you’re six years old and you slid your face across the pavement because your parents weren’t responsible, is that cosmetic. The cosmetic argument in breast cancer was already made years ago as well. Many professionals do not feel they are doing “extra” tests. They’re practicing medicine and using the tools they’re given. The best way to cut costs for literal “extra” costs is when a patient moves between health systems and wind up with the same test multiple times because the two are not accessing each other’s database. Then you run into HIPAA and what level of comfort everyone has with auto sharing information and upgrading systems in some area.

2067

And many professionals think overtesting is rampart, specially in the US when compared to other health systems with similar results. There are clear test results that do not require a second opinion.

My parents are both doctors (started in the public system, now they work on a private practice), so I will always follow the professional’s opinion. But that choice can be made with the health of the patient in sight or also with the influence of the comercial need of bringing the patient back through what they perceive is “good” service (which sometimes has little to do with health).

2068

So you’re parents are fine with standards, with healthcare systems giving them policies and procedures to follow. They’re not going to bristle at the suits telling them how to practice? I’ve engaged hundreds of physicians, and if you’ve found two that will just take the most efficient and cost effective protocols that’s pretty special.

If someone presents with COPD and you tell the physician here are the 10 things you do, including the tests, that conversation usually dies with a physician telling everyone else in the room they went to medical school to practice medicine and use their judgment, not follow standards the hospital comes up with.

And that, of course, is assuming the health system actually employs the provider. There are several providers with privileges they can’t do much more than make light suggestions to.

2069

Well, wow, that’s a big problem then. Yeah, here medical procedures are standardized nationally (or regionally) through health boards comprised of specialized doctors (suits and politicians manage budgets, but they do not touch standards and procedures), and practicing doctors are given somewhat limited freedom in their practice (there’s freedom, but also very strict guidelines and procedures, specially for access to expensive testing). This is pretty much the standard here and indeed most doctors I know (and since I grew up surrounded by them it’s about 50 or so) think it’s a very effective and fair system.

Arguments over perceived problems in procedures are fought institutionally, with doctors associations exerting pressure, never individually. Doctors wanting to use their judgement over the procedures established by their peers sounds like madness to me from here. That reads to me like a huge culture problem.

2070

It’s called Best Practices. Yes, they exist, and in some cases they’re very precise, but ultimately, they can vary and then of course you add the other problem in the USA system… malpractice. This physician orders a test that was slightly less expensive with an accuracy of say 98% for that they see as a routine problem, they could have used the other test that cost 10x more, is on a brand new machine even, and maybe, maybe it would have caught this problem the other machine didn’t catch, it’s 98.5% more accurate!, maybe… million dollar lawsuit.

2071

Yeah, malpractices here do exist, but there’s a higher burden of proof and in most cases I know of when it was awarded, it was a real mistake, even negligence being made.

2072

ThinkProgress: Trump’s latest attempt to gut Obamacare could backfire spectacularly

As soon as this week, according to Donald Trump adviser Kellyanne Conway, Trump intends to decide whether to cut off payments intended to stabilize insurance markets and make health care affordable for many Americans with modest incomes.

Trump apparently believes that cutting off these payments will help “implode” Obamacare. Yet, if Trump should stop the payments, that could have the unintended effect of expanding access to health insurance, even potentially making some health plans free for many families of modest means.
[…]
As actuaries Dianna Welch and Kurt Giesa note in an analysis of what would happen if the CSR payments are cut off, “CSR are only available under silver-level exchange plans.” Thus, if Trump does cut off these payments, it is likely that premiums for bronze, gold, and platinum health plans would remain fairly constant. After all, shutting down CSR payments has no immediate impact on the cost of insuring a bronze, gold, or platinum health consumer.

Now here’s the part where things get weird. Recall that the value of the tax credits paid out to help people afford their premiums are tied to the cost of the second-least expensive silver plan — so those tax credits gain value as silver-level premiums rise.

So even as premiums in the bronze, gold, and platinum markets stay more or less the same, the amount the government will pay to help cover those premiums will spike in a world without CSR. The result, according to Welch and Giesa, is that many people will be able to obtain bronze plans for no cost at all — or, alternatively, they will be able to purchase much more generous gold plans for barely more than the cost of a silver plan.