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Politics : The Trump Presidency -- Ignore unavailable to you. Want to Upgrade?

To: Wharf Rat who wrote (22028)	6/19/2017 12:17:02 PM
From: i-node	Read Replies (1) \| Respond to of 361394

>>The need for basic care is there, whether or not the patient is able to pay the cost. I would say "demand" only applies to elective cosmetic procedures, whether boob jobs or botox. It is all demand. If the doctor tells me to get an MRI, or I get carried into the ER on a stretcher, or I get a physical -- it is all economic demand. >> How do we fix the cost? The first profit center I'd go after is the health insurance industry, by going to single payer. Right. And you'd be starting entirely in the wrong place because you'd be massively increasing costs, not decreasing costs.

To: Wharf Rat who wrote (22028)	6/19/2017 1:35:12 PM
From: Lane3	Read Replies (1) \| Respond to of 361394

The need for basic care is there, whether or not the patient is able to pay the cost. I would say "demand" only applies to elective cosmetic procedures, whether boob jobs or botox. Call it demand or call it need, it's the consumer's perception of the appropriateness of seeking medical care. The consumer's perception. You take out the cost factor and the consumer's perception changes. It's like going to a buffet--the perception of hunger changes depending on whether one is paying a la carte or all you can eat. If it's all you can eat and free, to boot, consumption is really going up. Which means cost per patient goes up. Obviously when you're having a heart attack there's a legitimate need. But there's plenty of space between your "basic care" and elective cosmetic procedures. There are people who would be judicious in their demand for medical care. And there are people who would storm the buffet. And there are customer service considerations from the provider's perspective. Right now a fat person can read a magazine or search the internet and come up with the latest diet to try. Or that fat person can see a doctor, who will prescribe a controlled substance, which costs a pretty penny, and which requires the patient to see the doctor periodically to assure that the controlled substance isn't misused. One costs nothing; the other costs plenty. With Bernie's system, cost is not a factor in the patient's choice. Doctors encourage their engagement. My doctor says "let me help you." So much for the budget when patients are acculturated to see a doctor whenever they have a cold. There are already plenty of people who do that. With single payer there won't be fewer. And everyone with time on his hands will have a shrink. Which gets into what's covered and what's not and when and how much and for whom. Right now we're used to demand being a function of the consumer's perception as discussed above. If we continue that, costs per person skyrocket. If we don't, then we get into what I discussed the other day about rationing. One what basis do we ration? I'm not going to get into the possible bases right now, just who decides. Remember Hobby Lobby? Is contraception basic care or an abomination? Should fat people just push away from the table or should they be treated for a chronic disease? Do we do cosmetic dental work on teenagers with psychological problems or send them weekly to a shrink? What about end of life care? Even if it's not patient choice versus what others consider excessive, what about what is medically necessary from a technical perspective? Do we do mammograms every year or every two? Do we put statins in the water? Unless we allow coverage of just about everything and blow the budget, all of that will be decided by a political process in a system where participants can't even be civil to each other. That's all about cost per patient. What about when we add millions more patients. We would have to control cost per patient to well under what we're used to for the budget to be able to absorb all those new patients who have been invited to either feast at the buffet or to share the slop line depending on if and how we ration. Who decides what is need for each of us? We use too many, and we are encouraged to tell our docs what the manufacturers say we need. Sure, that's a problem. So, then, who instead decides what we need and on what basis if not our doctors and us? Whom do we want making those decisions? The death-panel thing was way, way overblown, but the underlying issue is valid. Easy to identify a problem and stop doing whatever that is. Harder to deal with the externalities that accompany the change.