Feeling super depressed about the state of healthcare

Type 1 and LADA
21

How about we just open the VA health system to everyone? Would that be satisfactory?

Alternatively, we can just expand Medicaid to cover anyone that wants to sign up. Does that solve the problem?

There’s a point here: No one yet, in my entire 54 (almost 55) years of life has ever, EVER been coldly frank and honest about what so many of us want, and what it will cost to give it to us.

This is the biggest lie foisted upon us w.r.t. Universal Healthcare – we’re never given an honest plan for what it really would cost, and how we’ll pay for it.

All other plans, including the ACA, are just varying degrees of the same slight-of-hand.

What I’d like to see is 2-3 alternatives ranging from HSA-like plans that are similar to what @John58 has discussed, something in between similar to what we’re doing now, and the full-blown “free” for all option like the UK. Each plan with details about coverage, subsidies, and a real, honest, accounting of the cost.

Would I support Universal Health Care? Depends on what it’s going to deliver, and what it’s going to cost.

I’m utterly pessimistic , though, that we’re going to get anywhere with this issue. The reason is simple: We want much more than we, collectively, are willing to pay for. That’s the way its always been, and I don’t see that it’s changed.

Even though we spend nearly as much on food as we do on healthcare, no one complains about it. We all recognize we need to eat. Health care, for some reason, seems to be something that someone else should pay for.

The whole thing is so irrational that expecting any solution to be crafted that will “solve” the problem is engaging in fantasy.

22

Any real improvement has to start with the basic premise that routine healthcare and medication has to be paid for (and affordable to) the end user… until we are capable of grasping that then there can be no improvement. Insurance can only function properly to insure against the unforeseeable. When “someone else pays for it” costs always go up.

23

Yep Trump wishes to be loved he will be with Obama on the issue of health care so he can then further an agenda. Whatever that is.

24

Yes. That’s what they are proming to do. Because they typically did not get elected by those.

Mind you, I am still hoping that they would not make such an unbelievably bone-headed decision. But I have no illusions about the sanity and the integrity of those who got elected.

2 Likes
25

Any of those alternatives could work – it seems to me the devil is in the details. For instance, I suspect ACA premium problems would be dramatically improved with simple tweaks to the pricing and incentive of the individual mandate and the age-based premium stratification. With a few more million young people signed up, premiums drop for everyone.

But @Dave26, I do agree in one way that this is the unspoken elephant in the room. It’s my perception that Republicans do not genuinely believe that everyone has a “right” to healthcare, but are not being honest about it. I would LOVE it if Paul Ryan would just be honest and say to constituents that universal government-funded healthcare is not their goal, and that they expect civic and religious institutions to play the role of safety net that the government currently does.

Food costs have steadily dropped over the last century. Health care costs have risen precipitously (but so has healthcare effectiveness). It’s human nature to complain about rising costs.

2 Likes
26

Well, they’ve risen more precipitously, with a less steep increase in effectiveness, in the United States than in the rest of the world. We are in a different situation here from many other places: we pay more for less effective medicine.

We do have some degree of choice that other countries do not, although I’m not sure that’s a fair trade. For example, I have diabetic friends from Europe who have particular insulin and pumps covered by national systems (so they pay no or only minimal costs), but don’t get to choose what type of insulin or pump they use.

I also agree that I’d love to see all the cards on the table: at least the progressive wing of the Democratic Party has laid out a platform on healthcare. They state the goal is universal health care. The GOP hasn’t articulated a clear plan other than wanting to repeal Obamacare and then have “cheaper, better plans.” How those plans would magically become cheaper and better is anyone’s guess.

27

Also, while getting people to shoulder the costs of their routine care might make a small dent in overall expenditures, much of the money spent in our healthcare system is for people who are very sick or at the end of their lives. Getting everyone to pay for their own flu shots, pap smears, and even diabetes supplies and medicine might shave off a little bit of the cost, but it will do almost nothing about that incredibly pricy end-of-life care.

There is also some evidence that getting people into routine primary care can offset some more expensive costs – the assumption being that people who get regular checkups get problems discovered before they’re catastrophes (I actually don’t believe this to be true across the board, but only for certain types of health issues and health care delivery). So I would suspect a plan like yours might lower overall costs for routine care, but would do nothing about the bulk of the healthcare expenditures in the country.

28

There are tradeoffs, for sure.

We had a loved one die in Canada because they denied him a second heart valve replacement. He had a poor prognosis and it’s an expensive and risky procedure, so there’s no guarantee it would have helped and probably would have hurt, but there’s no doubt that having a “death panel” deny him that fighting chance pushed him over the edge. And it felt like a violation to his family.

Also, I remember reading that in the UK, mortality from common cancers like breast or prostate is higher because they do not pay for newer, more effective drugs, gene testing, etc.

My impression is that people are much more pleased with the European system 95 percent of the time, but that the 5% is often in important issues of life and death. Like cancer, infertility, etc.

29

The UK is providing a ‘free’ for all and spending half of what the US government spends doing it.
The rest of the developed world, also has universal care at about half the price and with better outcomes than the US.

until there is a fair bipartisan health care bill. This merrygoround is likely to continue and with the money being misspent

30

To sort of bring my thoughts back in the realm of the OP, do we feel depressed about where things are headed, optimistic or pessimistic etc… My rose colored glasses say improvements are achievable and maybe they will do the right thing for once. That does not mean I think many politicians and lobbyists are not cynical manipulators ready to screw us at every opportunity. Federal subsidies for those who need it of course are needed, but should be a whole different law as the solution is 100% political.

My pipe dream is some kind of managed care plan specific to diabetes, transparent about what it covers, etc. so at least we know ahead of time what we are buying. How about a plan that is almost like a pass through for all of our predictable expenses (test strips, insulin, CGM, endo appts, blood tests, etc.)? I would buy that if it was available. Use the group buying power to keep the prices down. The only way something like that will be possible is if they ditch the ACA and let the free market take priority over federal rules.

1 Like
31

Why didn’t this happen before the ACA, if it’s just a matter of “free markets?” Seriously, I am so confused by this argument.

32

GBecause there haven’t been free markets in generations in US healthcare market… furthermore the insurance industry has lobbied hard to ensure that a limited number of options were available state-by-state (democrats had a great opportunity to fix this with ACA but refused due to lobbying pressure and because it was a “republican idea” as if good ideas have a party identity).

Essentially ensuring the exact opposite of free market competition… but that’s the way it’s been for a long time and the ACA didn’t really change that… and insurance companies just keep raising their rates and laughing all the way to the bank.

I truly hope we will see some bipartisan cooperation to come up with some better ideas this time around. Unfortunately it appears to be unlikely.

33

[quote=“jack16, post:29, topic:58553, full:true”]

The UK is providing a ‘free’ for all and spending half of what the US government spends doing it.
The rest of the developed world, also has universal care at about half the price and with better outcomes than the US. [/quote]No.The difference in accounting costs is so extensive that its not even like comparing apples to oranges… It’s like comparing apples to ghosts.

One example of hundreds: Building and facility costs. These are fully accounted for in US health care spending tallies, because of the nature of the private system. In the UK, much of this is buried in other parts of the budget that have nothing to do with the NHS, and therefore isn’t counted when compared.

I also take issue (strongly) with @David49’s assertion that we are getting worse care at a greater cost.

Just looking at diabetics, we are getting vastly better treatment than we were before. The insulins and devices available today, compared to 20 years ago, is amazing, and making large improvements in diabetic’s lives. I don’t need to speculate – many long-time diabetic friends here have testified to such.

Not surprisingly, these things cost money. I’m sure we could dramatically lower the cost of treating diabetes by simply eliminating everything that wasn’t available after 1980. We can all just use metformin, R, N, and pee strips. Who here thinks treatment would be no worse than what they can do today?

Who doesn’t agree that limiting diabetes treatment to metformin (and a few other old, patent-expired drugs), R, and N wouldn’t just about make treating diabtetes about as expensive as a chronic cold?

To say that costs have gone up while outcomes have gotten worse is exactly the sort of BS that makes this problem impossible to ever make any progress on.

Health care gotten more expensive. It has also gotten much much much better, which accounts in part for why it keeps getting more expensive.

We didn’t used to have MRI machines, and the diagnostic expenses they added to the system. If they’re doing absolutely no good, let’s get rid of them. Who’s with me?

1 Like
34

[quote=“Tia_G, post:25, topic:58553, full:true”]But @Dave26, I do agree in one way that this is the unspoken elephant in the room. It’s my perception that Republicans do not genuinely believe that everyone has a “right” to healthcare, but are not being honest about it.
[/quote]I don’t know what Republicans secretly think, Tia.

I do know what I think, though, and I suspect you and I have an irreconcilable difference on this.

I don’t believe anyone has a right to anything that someone else must provide. And when that demand is coupled with force, it’s basically akin to slavery.

Once that cat’s out of the bag, where does it end? By what argument does one say that food is not also a right? Shelter? Clothing? Internet access?

Understand that because I don’t think health care is a right (i.e., one has a right to demand that a doctor treat you – no, the doctor has the fundamental sovereign right, in fact, to tell you to take a hike, as much as s/he might be hated for such behavior), don’t misread that to mean I’m opposed to society providing a health care benefit (not right) to everyone.

35

My assertion was in relation to the healthcare for the cost in other countries, not now compared to a previous time. It’s not a radical suggestion: the US spends more per citizen on healthcare than the vast majority of other countries and gets less in return (in terms of outcomes).

France has new insulins and new technologies as well. How are they able to do that at a significantly lower cost? It’s not just buildings and facilities: they have a fundamentally different model of delivery. There is certainly an argument about whether that model (socialized, single-payer medicine) is better, on balance, than what we have. But they are certainly different.

So please, feel free to take exception to my position: I would far prefer to have a single-payer, government provided healthcare system with no private option at all (including supplemental). I think it would be better for the country, although not for all individuals. But don’t take exception to the facts: we pay more for worse outcomes.

In the US, we pay more, and have gotten better outcomes. Other modernized countries with different healthcare systems have paid the same (adjusted for inflation), or increased costs more slowly, and had the same or better improvement in healthcare outcomes as the US. We’re paying a premium for a lesser product, and that really bothers me.

36

[quote=“David49, post:35, topic:58553, full:true”]

My assertion was in relation to the healthcare for the cost in other countries, not now compared to a previous time. It’s not a radical suggestion: the US spends more per citizen on healthcare than the vast majority of other countries and gets less in return (in terms of outcomes).

France has new insulins and new technologies as well. How are they able to do that at a significantly lower cost? It’s not just buildings and facilities: they have a fundamentally different model of delivery.
[/quote]They do it on the backs of the US. As has been discussed here repeatedly, US patients carry the not-inconsiderable R&D costs for developing these new insulins (among other amazing treatments and devices).

They reduce costs by denying access to expensive treatment options like CGMs.

And they bury significant budgetary costs, like buildings and facilities, in other parts of the operating budget, so these things are not counted in the comparisons.

And, as Tia has shared, they deny treatment when they decide you’re not worth saving. Rejecting newer drugs in the formulary to treat cancer and other conditions, resulting in more people dying from these diseases, when treatment exists.

In my opinion, you all are being incredibly unrealistic about this. I simply can’t see how, when the NHS decision-makers are willing to balance a higher mortality rate for cancer against lower costs by denying proven new drugs, is going to approve and pay for the latest AP system when it hits the market.

I predict our Canadian brothers and sisters will be waiting a very long time before these systems are approved, if ever.

They will be covered immediately by private insurance in the US. That costs money – a lot. That in a nutshell, multiplied across the entire health care system and ailments, is the largest component of why our health care is so expensive. No one’s sitting on a pile of money. Rather, there are diabetics running all around the US wearing Dexcom CGMs, far more than anywhere else in the world.

Because our expensive insurance is covering it.

37

Well, on that front we agree! I think “you all” are also being unrealistic, and resistant to facts. But that is because we clearly have different world views. Which is fine, really. I don’t want to fight about it, and I’m not interested in personal statements or attacks.

It’s fine to have different values when it comes to healthcare. We’ll get an opportunity to see how things work out over the next few years, since there is no chance this administration and Congress is going to go for single-payer :slight_smile: So, we’ll have less regulation of the “free market” private insurers, and we’ll get to see if that really leads to lower prices and better service.

If it doesn’t, will you be willing to change your tune? If, as all independent assessments have suggested, the price of healthcare rises and service declines with an ACA repeal, will you reconsider your position? Or are you dedicated to a position based on philosophy and politics rather than facts?

38

A serious question for those with CGMs covered by insurance: Are you willing to give up your CGM, or pay out of pocket for it, to have Universal Health Care?

I’m not trying to be provocative. I’m trying to have a real, honest discussion. The standard in such systems around the world pretty much is not to cover them. Our own example of “Universal Health Care” here in the US – Medicare – doesn’t cover them.

My CGM has been, perhaps, the most valuable tool I have in my diabetes arsenal. I would say it has had a bigger impact on my control than anything else. I expect that if I had to give up ALL modern tech from the last 30 years, including insulins, save ONE, the one I would choose to keep is my CGM. I know I could achieve better control with a CGM, R and N, than I could with a CGM, Humalog and N.

1 Like
39

[quote=“David49, post:37, topic:58553, full:true”]

[quote=“Dave26, post:36, topic:58553”]
In my opinion, you all are being incredibly unrealistic about this
[/quote]If it doesn’t, will you be willing to change your tune? If, as all independent assessments have suggested, the price of healthcare rises and service declines with an ACA repeal, will you reconsider your position? Or are you dedicated to a position based on philosophy and politics rather than facts?
[/quote]Of course! I’m not ideological, as much as it might sound that way. I want results.

My views are borne from experience. Perhaps my experience with government has been uniquely bad? You, and others, have received excellent service from government institutions in your life? Find the political decision-making process sound and efficient?

Look at what’s going on right now in Washington and have faith that, if only the right legislation were passed, virtue would sweep though the Federal Government, and your health care needs would be taken care of?

I’m not attacking, David. I’m asking sincere questions. You are advocating for giving more control over health care to these people and these institutions. My experience is very bad with government, I see over and over and over poor, politically-driven, corrupt decisions in every aspect of governance.

I say this very seriously: We have an incoming president who’s a belligerent loudmouth, and at least 68 legislators with the maturity of pre-schoolers. These people behave, function, and make decisions for all sorts of posturing, pretentious, political reasons.

Why do you think these people will craft and administer a better system than what we have now? I’m sincerely interested in understanding your faith in government doing this well.

40

@Dave26,

I do know what I think, though, and I suspect you and I have an irreconcilable difference on this.

I’m not sure if we have radically different views. I’m certainly not a libertarian, but I do think it is nonsensical, for instance, to talk about a fundamental right to healthcare in India, where my family is from, and where vast swaths of people don’t even have access to safe drinking water.

Rather, for me, the issue is about priorities: What should we as a society prioritize when we have the means. It’s clear to me that the US has the means to provide adequate healthcare for everyone, even if it’s not the best healthcare in the world for absolutely everybody.

Right now our system is one in which some people get stellar healthcare and many others literally die of easily preventable illnesses because they couldn’t get care. So to me it’s about justice or fairness. I prioritize those highly. I am also cynical, having now spent some time around people in the tech world who came up in clubby Ivy League networks, about the notion that people who earn more are more deserving of that money by any metric. So given that I think there is only a weak correlation between a person’s deservingness and their means, and I think we have the resources to pay for healthcare, then yes, I do believe everyone in this country should have access to healthcare.

2 Likes