Social Safety Nets

[_ajax18]

In regards to Sjogren's, there is a wide range of severity in the disease. I might as well share some personal information and let you know that I have Sjogren's myself. I count myself fortunate that I have a fairly mild case, although it is quite annoying and problematic. However, I know enough about the disease through my own self-education to know that some people are seriously debilitated by the syndrome, and completely incapacitated, in particular by severe arthritic symptoms. There is a reason sjogren's is listed as one of the diseases that can be considered as justification for disability.

I don't disagree with any of that. And you do have my personal sympathies. I don't have that particular condition but I've worked with people who have, some of them wealthy enough to spend enormous amounts of money to treat "dry eye." And you're right that there is a bias in the lay community in that many people have dry eye, probably 80% need to use artificial tears. Because of that, people hear dry eye and they immediately make a judgment that they know what dry eye feels like for someone else. The same is true for conditions like allergies. Lots of people have allergies, but for how bad and how long? That's what I hate about human relationships and how we judge each other. I hate it so bad that I'd rather not have these relationships and go it alone. That's why I'm so antisocial on this. Even so, I stand by my own judgment (which didn't even matter in this case because it wasn't my call) that this particular case was a scam.

In spite of my hard line stance on my hate of social safety nets, believe it or not I do have a lot of sympathy for what you go through. It sounds like you're one of those people like myself who is forced to live in a world that expects you to be 100% when you're not. You get up and go to work even when you're not sure if you can go another step. I know you don't believe in supernatural things like I do, but I firmly believe that our suffering has a meaning and ultimately a benefit. It's my crutch that keeps me pushing through it. Somtimes that's all you have.

I frankly think there is no perfect solution.

That's part of the lesson of this life. Even when there is no perfect solution, do we still maintain our morals? Or do we begin to justify what we once called immoral.

But I can't understand your desire to throw out the entire system because it did not help you when you needed it.

It's not just me. Honestly I believe that socialism ultimately hurts more people than it helps. I'm sure you'd disagree with that and maybe you think you can even find the data to back it up. It's just the way I see it.

Unless we're willing to accept a permanent, starving and ill underclass (like some countries do),

You see I think that you will always have poor regardless. Jesus was right when he said, "The poor you will always have with you." You can't tell people not to keep having children they can't afford. If you completely socialized this world, you would have 100% poverty.

Simply demanding or expecting that people somehow save enough money to pay for their healthcare when it involves catastrophic care in particular is completely unrealistic.

Sure is. But equally unrealistic would be to take a few barley loaves and five fishes and expect it to feed th world. I'm starting to think that socialized medicine might be even worse for you than it is for me once it's implemented.

[_Analytics]

Economy of scale and advances in technique tends to bring down costs, sure. What I'm suggesting is that the advances in biomedical technology are outpacing that if you try to get the best care possible, which is what people tend to seek out if they can afford it.

From a macroeconomic perspective it’s even more dynamic than that. 30 years ago, your average Joe would live his life with minimal medical intervention and die of a heart attack around age 65. When he died, his health care costs ended with him.

Now, that same guy will be taking a few hundred dollars worth of drugs every month for his high blood pressure, high cholesterol, and acid reflux. But those drugs cause side effects, which are treated with even more doctor visits, procedures, and drugs. All that expensive intervention keeps him alive, which gives him more and more time to be exposed to expensive intervention, which causes the need for even more intervention, until he finally dies in an ICU unit at age 80, leaving behind a $115,000 hospital bill that covered his medical costs for his last 3 weeks on earth.

[_Gunnar]

Economy of scale and advances in technique tends to bring down costs, sure. What I'm suggesting is that the advances in biomedical technology are outpacing that if you try to get the best care possible, which is what people tend to seek out if they can afford it.

I have to admit that you bring up very valid points. But I still think that the costs of medical care don't need to rise as rapidly as they have in recent years, and that more can be done to slow that rise and make the benefits of the new technologies more affordable to those in need of it.

For another thing, I think it is outrageously unconscienable for health insurance companies to claim that they can't make enough profit to stay in business without dracronian rate increases, while at the same time giving huge salary increases to their top executives who are already drawing annual salaries in excess of a million dollars, as Blue Cross in California tried to do not too long ago. Due to massive public outrage, they backed off (at least somewhat) on their demands for rate increases. Who in the world needs a million dollar plus annual salary to provide an adequate, and even comfortable life for themselves and their family?

On the other hand, though, I do realize that even if an executive earning a million dollars year agreed to work for free, that would only save enough money to reduce rates by only a few cents per customer of a company that has millions of customers.

[_Gunnar]

Economy of scale and advances in technique tends to bring down costs, sure. What I'm suggesting is that the advances in biomedical technology are outpacing that if you try to get the best care possible, which is what people tend to seek out if they can afford it.

From a macroeconomic perspective it’s even more dynamic than that. 30 years ago, your average Joe would live his life with minimal medical intervention and die of a heart attack around age 65. When he died, his health care costs ended with him.

Now, that same guy will be taking a few hundred dollars worth of drugs every month for his high blood pressure, high cholesterol, and acid reflux. But those drugs cause side effects, which are treated with even more doctor visits, procedures, and drugs. All that expensive intervention keeps him alive, which gives him more and more time to be exposed to expensive intervention, which causes the need for even more intervention, until he finally dies in an ICU unit at age 80, leaving behind a $115,000 hospital bill that covered his medical costs for his last 3 weeks on earth.

Also valid, undeniably true points, I have to admit! Although some of that can be ameliorated by better health and nutrition education, and encouraging people to live healthier, more active lifestyles.

[_moksha]

What gives me pause, though, is the tendency of at least some medical professionals to charge more (sometimes much more) than twice as much for medical treatments covered by insurance as they charge patients requiring the same treatment who have no insurance, and therefore have to pay directly out of their own pockets.

This tendency is also illustrated by physicians who refuse to see Medicaid patients because Medicaid reimburses them at a much lower rate than private insurance.

[_Analytics]

Also valid, undeniably true points, I have to admit! Although some of that can be ameliorated by better health and nutrition education, and encouraging people to live healthier, more active lifestyles.

Absolutely. Experts have estimated that a full 50% of our medical expenses can be attributed to unhealthy lifestyles.

It reminds me of Michael Bloomberg's nanny state--if the medical costs of your soft drink habit are going to be born by the general population through insurance, should the general population have the right to limit how much you indulge?

I'd be in favor of a "Twinkee Tax", where a sin tax on unhealthy food and drink would be used to help pay for the nation's health care.

[_Analytics]

What gives me pause, though, is the tendency of at least some medical professionals to charge more (sometimes much more) than twice as much for medical treatments covered by insurance as they charge patients requiring the same treatment who have no insurance, and therefore have to pay directly out of their own pockets.

This tendency is also illustrated by physicians who refuse to see Medicaid patients because Medicaid reimburses them at a much lower rate than private insurance.

It cuts both ways. If you look at your EOBs, you'll see that insurance companies have negotiated rates with providers that are often 50% to 90% less than the amount on the bill. If you don't have insurance, doctors, clinics, labs and hospitals will bill you and try to collect from you much more than what they charge insurance companies.

[_Gunnar]

Also valid, undeniably true points, I have to admit! Although some of that can be ameliorated by better health and nutrition education, and encouraging people to live healthier, more active lifestyles.

Absolutely. Experts have estimated that a full 50% of our medical expenses can be attributed to unhealthy lifestyles.

It reminds me of Michael Bloomberg's nanny state--if the medical costs of your soft drink habit are going to be born by the general population through insurance, should the general population have the right to limit how much you indulge?

I'd be in favor of a "Twinkee Tax", where a sin tax on unhealthy food and drink would be used to help pay for the nation's health care.

I can go along with that also. Limiting the size of the soft drink that a fast food restaurant is permitted to sell is really pointless, when nowadays many such restaurants allow unlimited refills of the soft drink, especially if one buys a meal with it.

One thing I really find peculiar, though, is that even though many of them offer unlimited refills, they still, in many cases, list several sized drink options at various prices. Knowing that one can get unlimited refills anyway, why would anyone opt to buy anything but the smallest, lowest price drink offered? Yet I have observed that many people still buy or upgrade to the larger sized drinks! Is this crazy, or what? Some MacDonalds restaurants in my local area, though, sensibly charge one flat fee ($1.00) for any size soft drink, and the customer can choose whatever size cup she or he wants.

[_Gunnar]

This tendency is also illustrated by physicians who refuse to see Medicaid patients because Medicaid reimburses them at a much lower rate than private insurance.

It cuts both ways. If you look at your EOBs, you'll see that insurance companies have negotiated rates with providers that are often 50% to 90% less than the amount on the bill. If you don't have insurance, doctors, clinics, labs and hospitals will bill you and try to collect from you much more than what they charge insurance companies.

I think that another thing that happens is that when medicare is involved, physicians are sure that no matter what they try to bill medicare, medicare will only allow a small percentage of what they billed, so they try to hike up their claim high enough so that even when medicare disallows 50 to 90% of it, they will still get enough to at least meet their expenses and, maybe, make a reasonable profit.

[_MeDotOrg]

One thing I really find peculiar, though, is that even though many of them offer unlimited refills, they still, in many cases, list several sized drink options at various prices. Knowing that one can get unlimited refills anyway, why would anyone opt to buy anything but the smallest, lowest price drink offered? Yet I have observed that many people still buy or upgrade to the larger sized drinks! Is this crazy, or what? Some MacDonalds restaurants in my local area, though, sensibly charge one flat fee ($1.00) for any size soft drink, and the customer can choose whatever size cup she or he wants.

In the 1950s, the average soft drink serving cup was 6.5 ounces. Today it is 16.2 ounces.

What's in practice here is the simple capitalist premise that more is better. Two is better than one. Three is better than two.

Years ago, Gillette came out with their twin blade Trac II razor. Two blades instead of one! Better! Saturday Night Live did a parody commercial, where they showed a 3 blade razor: "Designed for people who'll beleive anything." Hilarious!

Now we're up to FIVE blade razors.

There is certainly no argument that it would be easy to circumvent the 16 ounce limit. But please check out the link to James Surowiecki's article:

"...Bloomberg’s proposal makes clever use of what economists call “default bias.” If you offer a choice in which one option is seen as a default, most people go for that default option."

Interesting reading...