We absolutely should but since we have profit motivated insurance companies overseeing profit motivated providers and there is little incentive to improve the building blocks for many conditions. That's why you need one cost driven component in the system.

Uh, this is a transparently dishonest claim by you, and also what the **** sort of weird measure is this?

I'm not going to check your math because it doesn't matter, but also people are likely remembering that you're deeply stupid and assuming you got it wrong.

For example, this thing where you're transparently trying to shift the debate from your unbelievably callous views on letting the poors die in the street to whatever insane point you think you're making about the shirtless hunks of the 30s.


When people who know more than you(~everyone) disagree with you Subfallen, thank them for their generous offer of correction, son. Don't try to patronize us.

I was listening to NPR and they had one of them on and they were ****ing whine about the process, about the lack of hearings, and wah wah wah the Republicans are hypocrites now.


WE TALKING ABOUT HEARINGS? This bill will KILL PEOPLE. The procedurally bull**** way they are pushing this through is notable as trivia, that the bill will kill people is the ****ing substance.

This new procedure is anything but trivia. You think the GOP is going to have secret meetings for just this single bill? If this passes it sets a precedent for how business will be done from this point forward. The Democrats will be shut out of any input, debate, or discussion and will be a token minority party to give people the illusion that Democracy exists in America.

It won't. If this passes, it is an enormous step towards a one-party state not unlike that of Russia.

Straight up Putin tactic, copied by Trump, passed to GOP.

Bypass that whole morality thing and do what it takes to get what you want. Be sure to demonize your opponents in the process.

Relative to the fact that this bill will kill people, yeah, the procedure is little more than a footnote. If you don't want this thing to pass you need to make people care enough to get up and do something about it. Whining about procedure ain't going to cut it. Telling people about how the bill will cause them to lose access to health care and put them or their loved ones at risk of financial ruin or death will.

The Democrats I've seen talking about the bill deployed the procedural argument effectively, in a way that supplements the "killing people" narrative.

They have argued like this: the Republicans are breaking with every tradition of the Senate, working in complete secrecy so that even most Republicans don't know what's in the bill. This is because they are ashamed of their bill. They know that throwing millions off of healthcare to give tax breaks to millionaires will not be popular... (spiel continues)

This imo is better than just "the bill kills people to give tax breaks to millionaires" because it provides in addition good circumstantial evidence that that is in fact the case. Basically, if you don't trust us, then why don't you see how shady the Republicans are acting and think about if you trust them?

The bolded needs to be there. Also people don't care about the traditions of the Senate. Otherwise, I'm on board.

"Will be easy to raise Medicaid reimbursement for those segments of healthcare that need more. Reducing the outlay for prescriptions, medical devices and a huge number of cases of over-treatment due to a hosptal ER safety net and there would be resources to increase reimbursement for physicians, for example."

OOF. 1) It won't be easy - there are multiple players that would very much not be interested in raising Medicaid payments.
2) Neither the GOP or Dems have shown the slightest ability or interest in doing anything about prescription costs, and in fact have actively avoided doing anything. BTW, a useful canary-in-the-coal-mine indicator is the granting of Medicare the right to negotiate drug prices. If and when this happens, you'll know that the decision has been made to do some ****ing thing about health care, because it's a huge easily fixed hole in the sinking ship.
3) ER treatment is tricky - a lot of "overtreatment" (whatever that means) just represents playing catch up on stuff that in an organized heath care system could be dealt with on a routine basis. Where exactly you're going to generate a missing army of primary docs/PA's/NP's to do all this isn't clear to me, but it's something that can probably be done over a decade or two - if we put a ****pile of $$ into it.
A more complicated problem is that the only thing keeping a lot of ER's and hospitals open is the ability to cost shift from payers to non-payer/poor-payers. Note that Medicare is NOT a "good" payer - they're OK at best. Globally, a hospital can break even on Medicare - but in a small hospital, one or two complicated sick as **** Medicare players can cost a lot more than reimbursement allows. Cost shifting from the insured guy down the hall makes up for this, to some degree. If this goes away, you're going to see more hospitals closing. There's been an epidemic of small hospital closings that began back in the 1990's and is still going on.

Which BTW, is a pretty good argument against the "Evil doctors and hospital administrators lining their pockets" theory of why health care is falling apart. If this were true, there's an awesome opportunity for sharp operators to cash in - they can re-open the dozens of rural hospitals that have shut down in the last few years and rake in that sweet easy money. The only reason that hospital closings are slowing down is that pretty much they're all gone already......

MM MD

"Several states have done this with zero impact. That being said it's likely benefits would be seen if the system was rebuilt from the ground up. The reality is there are too many other things in the current system that interfere with the results of tort reform on provider insurance. "

This is a thicket, primarily because it's just about impossible to find an unbiased evaluation of the issue. Not surprisingly, lawyer types produce studies that show no effect, and medical/hospital types the opposite. Several studies have shown a significant decrease in so-called defensive medicine test ordering - but these are pretty much self-reporting studies by docs (Since tort reform, have you decreased your ordering of tests for medmal reasons?) - color me skeptical.

The best scientific wild ass guess numbers seem to grant a 5% or so benefit in terms of decreasing costs. On the one hand, it ain't a lot. OTOH, it's still billions of dollars. So take it as you will.

One area that it DOES affect is MD hiring. Groups in Florida, which is notorious in my specialty for being a lawyers paradise for med mal in my specialty, struggle to get docs. They solve this by paying more. This probably isn't optimal.

MM MD

If health care costs are 23% of USA, #1, economy then that is around $3.6 trillion. So yeah saving $billions is a reasonable estimate.

This is about more than just 23% of the economy or billions of dollars. This is about real people. Real people who were on the chopping block before ObamaCare, who now are able to get medical care, and who will die under RepubliCare.


https://www.youtube.com/watch?v=nVKkkWoXqHg

It can be more than one thing, but yeah, this same phenomenon seems to fool people over and over. Celiac disease was first described in 250 A.D. but confirmatory diagnostic testing didn't exist until at least 1960. The prevalence rate in 1986 was thought to be 1/5000. Today it's closer to 1/100. That said, there's still some increase in prevalence not attributable to better diagnostics.

We'll continue to see this pattern with some "rare" diseases (of which there are about 7,000) that turn out to be not so rare. But the headline will always read METEORIC RISE IN ______ RATES, which seems to get the Infowars sleuths on the case to chain it all back to chemtrails.

It can be more than one thing, but yeah, this same phenomenon seems to fool people over and over. Celiac disease was first described in 250 A.D. but confirmatory diagnostic testing didn't exist until at least 1960. The prevalence rate in 1986 was thought to be 1/5000. Today it's closer to 1/100. That said, there's still some increase in prevalence not attributable to underdiagnosis.

Maybe. OTOH, stuff like celiac disease is "fluffy" - the symptoms are nonspecific, there are graduations of disease (some people are inconvenienced, some are incapacitated) and until relatively recently, making a definitive diagnosis was expensive and painful.

Renal failure - it's pretty cut and dried with standard lab testing. Criteria for dialyisis are pretty standard and agreed on. AFAIK dialysis didn't become widely available until the 1960's - until then you pretty much went home to die.

It's tempting to think that people with hypertension and diabetes are living longer due to better care - and living long enough to have their kidneys fail. Dunno if that's true for more than a small percentage, though. It's a complicated topic.

MM MD

If you're talking about how to frame the opposition, then yeah people will respond to emotional appeals rather than talking about the everlasting impact the normalization of secret meetings for developing laws affecting millions which slowly allow for the development of a one-party state not unlike that of China.

How long have serum creatinine and eGFR been part of just, like, a standard panel your doctor would order when you go in for labs? I don't actually know, but it wouldn't surprise me if it's more common now than it was in 1970.

This seems like the most likely explanation to me. Of course it's complicated but that's what statistical models are for. It would not surprise me if there's an interaction effect between age / metabolic syndrome on renal function. IOW, either in isolation may have linear effects, but in combination there's some saturation point where we begin to see exponential failure.

Only in America can you have the liberal party implement a market-based, essentially right wing set of health care solutions, have it be wildly successful despite the conservative party bashing it endlessly, and then have the conservative party roll it back when they come into power.


https://twitter.com/Hill44/status/779007918834225152



I'm not sure if any political party in any major country has this much disdain for its own constituents. But I guess that's what happens when you've got a system where politicians answer to lobbyists and big corporations rather than their own voters.

Well, I wasn't talking about just obesity, I was talking about the quality of our food and how processed it is. Also the amount of movement in Europe versus the US - just walking, even. While these things are obviously linked to obesity, which impacts health, they're also linked directly to some problems regardless of obesity (afaik, I'm not a doctor).

Also a difference in five percent is ~17M people in the US, and then you have to figure out how much that costs us when it comes to healthcare.

Anyway, I'm not saying that the foods here are the only issue, but they're a big part of it we shouldn't ignore if we want to fix this.

I thought they'd just threaten to pull support in 2018, not actually actively campaign against him... But they're doing what I predicted (eventual carrot for the freedom caucus, stick for the moderates).

Oh, I didn't see that Sandoval vetoed it. I thought there was no cost for the expansion because the people who opted in had to pay for it. Was that not the case? Or were you talking about the cost to medical providers due to reimbursement rates on Medicaid?

Just a note for those keeping score--there were absolutely no "good reasons" for refusing the Medicaid expansion. It was a move of spite against poor people and in some states, black and minority Americans and a way of telling them that they are not getting treated with basic dignity, no matter what the federal government says. It was free money for health care that states turned down because the leadership of many states absolutely does not care about outcomes for those people (Medicaid recipients) in their states. This despite major crises including opioid epidemics in many states that are literally killing thousands of people.

There is no reasonable argument here. The truth is we've just abstracted this issue so much that people can't even think about it properly any more. Medicaid expansion was absolutely a no-brainer from the beginning, and yet states had so much disdain for the idea that they sued to prevent it from being mandatory! Think about it. These states expended legal resources just to be able to tell their poor people to shove it. That takes a real level of commitment and hatred. And Republicans in Georgia just voted in another anti-health care Republican.

This isn't about logic, or even class. This is about race and tribalism. This is about the Grand Ole Party standing in the way of progress and actively killing off people who they find politically inconvenient, including many of their own voters. It's an incredible act of nihilism and cruelty that can only be endorsed by a culture that has gotten so far away from basic empathy and ideas of human kindness and dignity that everything is only numbers on a spreadsheet to us.

Low-Income Adults in States Without Expanded Medicaid Have More Health Problems
https://fivethirtyeight.com/datalab/...alth-problems/

I thought Florida has tough Med Mal reform in place.

First you have to show that the explosion in kidney disease is actually happening and not just illusory owing to more people being able to take advantage of the service than there were before.

It's bad enough, tribal enough, that they have arguments set up against universal health care, against "moochers", or against waste and abuse, talking about how the funds could be better appropriated elsewhere, but that's not what they're doing.

Instead of putting the money to good use, they're pocketing it! Now maybe it's just my imagination, but it seems like Trump is scouring the government for the biggest money scenarios (health, budget, weapons, infrastructure, taxes, government positions, etc.), applying massive cuts, and taking the money for himself and top family & friends.

There's no ****ing policy! Just money changing hands from everyone to them. How is this not being investigated? How is it legal to have an $800 billion direct transfer with no healthcare? Or a hundred billion dollar weapons deal with no weapons? Or 1 trillion infrastructure with no infrastructure? Just vague promises of policy and specific terms for what they get.

It's so criminal.

You're not wrong.


ACA Repeal Would Lavish Medicare Tax Cuts on 400 Highest-Income Households
Each Would Get Average Tax Cut of About $7 Million a Year

http://www.cbpp.org/research/federal...ome-households