Randcare to replace Obamacare
Rand Paul has proposed a replacement to the ACA. I’m rather fond of allowing for tax deductions for health insurance. Then I can stop this ridiculous salary I pay to me. And I’m glad to see Health Savings Accounts return.
January 26th, 2017 at 8:17 pm
What?! A doctor serving in the Senate proposing a healthcare plan! This should be done by a lawyer with beauracratic input.
January 26th, 2017 at 11:48 pm
Found his rightful place and voice as a healthcare functionary. Good. I like what I’ve heard so far.
January 27th, 2017 at 5:16 am
Well, OK then, maybe….I’m still trying to figure where in the Constitution it says the fed dot gov should be involved in some sort of health care scheme in the first place. If: a) the tax system was less of a politically-rigged mess, and; b) 51-jurisdiction competition for your business existed, you wouldn’t need an HSA.
January 27th, 2017 at 5:37 pm
Another summary I read says it gives blanket protection to healthcare companies from anti-trust laws too. So I’ll have to read it myself before I believe it won’t just screw us deeper and harder.
I don’t trust anyone working in that city.
January 27th, 2017 at 6:58 pm
I don’t like it, but some parts of it vaguely resemble a baby step in the not-wrong direction. And it might pass. Is that a win? I’m not really sure that it is. But it isn’t a loss either.
January 27th, 2017 at 10:15 pm
Some NO SHIT numbers from CATO:
– 25% of all health expenditures in a year are consumed by the sickest 1%
– 50% of all health expenditures in a year are consumed by the sickest 5%
– The healthiest 25% of Americans spend only $264 per year on health care
– The annualized cost of health care per person is a little more than $10,000 per person – most of that consumed by the sickest 10%
A note from my own little world:
– My “million dollar baby” was born more than three months early and the bills were about a million bucks. 15 years ago they would have let him die. Today he is doing low-level algebra at the age of 5.
I don’t have answers and I don’t respect anyone who claims they do. I work hard and generally pay more than my fair share – my company has paid dozens of mortgages and put lots of kids through college (and private school).
But I would have lost nearly everything keeping my son alive.
I don’t know the answer. I really don’t. We spend so many hours chasing ObamaCare and other regulatory bullshit on behalf of our employees (we have people in three time zones) that our business manager can no longer recruit. I have ten opening and don’t have people to recruit them. Just hired a new person for that. More cost.
Anyway…there are two general answers to health care: everyone pays basically $10K per year to hold the whole system afloat; or we let them die. There are no magic money trees. Call it what you will, but either everyone pays $10K a year or the top 5% sickest people die every year. Done.
I just looked at these numbers today. CATO had a thing on CSPAN. It was a “WTF” moment for me. Even if we cut costs 20%, every person in the USA would still have to out out $8K per year.
I don’t think national multi-state markets will fix this. Either we pay to keep the sick alive, or they die.
Seriously, I am not lobbying here. But check out those numbers. It’s from freaking CATO, for crying out loud. These are no Obama-loving fools.
January 27th, 2017 at 10:21 pm
OK, may I also add that the half-naked girls in underwear adorning the left bar on Uncle’s page are a step-up from previous ads.
It helps my health. Just sayin’.
January 28th, 2017 at 7:44 pm
Nothing is going to work unless the medical cartels are broken, and true price discovery in health care is allowed.
The only thing that needs to happen is enforcement of current anti-trust and racketeering laws.
January 29th, 2017 at 12:24 am
So, my 83 yo Mom took a fall a few months ago and has some resulting issues, one of which is an occasional palpitation episode, shortness of breath, etc…she lives with my sister who was not going to take the chance that when Mom had a severe bout of this a few weeks ago that it would pass on its own, so…911 and the ER, half a day of tests, observation and treatment. When the bill came Sis sent a text of it to us other siblings and added simply “Thank you Humana!” The bill was $31,972! Except not really because the breakdown says Humana medicare payments $972.52, Humana medicare discounts $30,924.48, and Amount you owe $75.00! WTF kind of voodoo economics is that? Did her visit really cost 32K? Of course not. Did Patrick’s sweet child’s treatment really cost a mil? Unlikely. So why the smoke and mirrors? That is quite literally the million dollar question. Mom’s actual service cost about a grand it seems. What is the purpose of the fat fake bill? To make us grateful to an insurance company like my sister said? To cook the books? To coerce money out of people who don’t have the insurance company to run interference? IDK.
I don’t know about cartels, anti-trust, and racketeering in health care, but I know things are majorly fucked up based on those absurd examples, and as Steve R. intimates, the answer is not top-down (more money) but bottom-up (actual costs and accounting for actual treatment). Then if we are to have a welfare system for that 1%, 2% or whatever, call it what it is and tell me what I’m paying for it so I can decide when enough is enough. Doesn’t matter if it’s paid directly or by insurance, like taxes for gov spending it’s all really out-of-pocket.
R. Paul knows the medical system and its hustles, Trump knows the financial system and its hustles…maybe together they can beat the hustlers and forge a workable and affordable free-market plan that lets us all pay for what we get and get what we pay for, plus a contribution for the welfare that we would all hope would be there if we or our own babies need it…just tell us what it is and what it’s for.
January 29th, 2017 at 12:26 pm
@JTC: A hospital has to treat everyone regardless of ability to pay. I spent 20 minutes in an ER last year. Got a shot, and a smile from a doctor who told me he sees puncture infections all the time and it was smart to come in when I did.
It took months for the bills to come in: I ended up owing about $1400.00 because it was out-of-state. The total bill was quite a bit more.
If CATO was right when they said it cost $10K per person to treat the US population, then my ER bill was me paying another part of that national bill.
This is why there are so many more “urgent care” offices popping up. They have better reimbursement rates from insurers because the are not required to treat everyone, so the overall costs are lower. I’ve used urgent care three time in the past two years (sick kids on travel) and sure enough it was a lot cheaper.
The problem isn’t solving the bills for the otherwise healthy people who need occasional ER medicine – it’s solving the problem of the sickest who consume more than just about anyone else and cannot afford it.
Again, I dunno the answer.
January 29th, 2017 at 3:53 pm
Public hospitals (those are the ones required to take all comers) are welfare conduits, an example of gov control gone amuck and awry; that of course is the fatal flaw of o-care and all other redistribution schemes.
Unless and until we decide if we want socialized medicine, services should reflect costs and a profit like any other business no matter who pays the bill because ultimately it is all out of our pockets. Those that can pay their own way would mostly want to do so once the inflated surcharge to cover those who can’t or won’t is a separated line-item, and doctors and hospitals can operate on a real-world cost-plus business model.
An MD is a skilled mechanic, a hospital a well-equipped garage. The Doc in a Box trend was one way of them achieving the above goal, taking back control of their flat-rate time and facility usage, reflecting real and competitive fee for service; that is why they tend to be comparatively efficient and lower cost.
Until gov is taken out of the equation for the most part, calling subsidized care what it is which is welfare like all other forms of it, and deciding if and/or how we deal with it, there is no answer, and the hustlers will keep billing 32K for a 1K emergency visit, to keep us in the dark about who pays what for and to whom.
We’ll see if The Donald and The Rand can come up with one.
January 30th, 2017 at 12:30 pm
I worked in emergency medicine for many years. Patrick is spot on. Unless we’re willing to let people die because they can’t pay, we subsidize their care every time we pay a bill to the hospital.
I don’t think I want to live in a country where we let people die because they can’t pay for health care. But I do want to see the numbers broken out so that I can see the actual costs of treatment, overhead, and charity care. Without those numbers we can’t make intelligent choices.
Right now it’s almost impossible to get a price for ANY procedure, even the most routine. That’s no way to run a business.
January 30th, 2017 at 5:26 pm
To be crass about it, it doesn’t matter if we’re willing to let people die because they “can’t pay” or not. The complete obfuscation of actual costs means you don’t know what you’re paying for your own treatment or being assessed to pay for others’. The fact is that gov regulation that forces facilities to accept and provide care for all comers means that they charge every one who does pay for dozens who don’t. And deadbeats have been encouraged to take advantage of that situation to go to the ER or hospital admission with no thought or intent to pay; why would they if they know they don’t have to? Deadbeats gonna deadbeat. As I said above, it’s the same with all forms of welfare/income redistribution; if gov is involved there is no accountability, and we have no way of knowing if we are genuinely helping or just being played for chumps.
Does that mean there is no need or moral obligation to help those who through no fault of their own cannot pay? Of course not. But TANSTAAFL; ideally everyone pays for what they get, privately or through their insurance that they have for just that purpose. Even if it places a great strain on them as with Patrick above…he is a productive citizen with substantial assets, it would be sad for him to be economically harmed but I’m sure given the choice he would make any sacrifice and do whatever was necessary to heal his child…and of course it IS his child, not mine or yours so why should we be FORCED to pay which could put us under the same strain? Which is why I said several times and in several ways and which you agree with in your “intelligent choices” statement, break out the real cost of the subsidies so we can do exactly that.