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Where are those numbers coming from?

 

"Only one MTF (673rd Medical Group – Elmendorf Air Force Base, Alaska) has an overall  efficiency  score  above  1.00,  meaning  it  produced  its  inpatient  and  outpatient  workload at a cost lower than could have been purchased in the private sector" -Feb 2016

 

 

https://www.ida.org/idamedia/Corporate/Files/Publications/IDA_Documents/CARD/2016/P-5262.ashx

 

 

I always figured Wilford Hall Medical Center was getting a good deal employing Air Force RT's at E-3 pay

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Where are those numbers coming from?

 

"Only one MTF (673rd Medical Group – Elmendorf Air Force Base, Alaska) has an overall  efficiency  score  above  1.00,  meaning  it  produced  its  inpatient  and  outpatient  workload at a cost lower than could have been purchased in the private sector" -Feb 2016

 

 

https://www.ida.org/idamedia/Corporate/Files/Publications/IDA_Documents/CARD/2016/P-5262.ashx

 

 

I always figured Wilford Hall Medical Center was getting a good deal employing Air Force RT's at E-3 pay

 

When I was at Ft Sam Houston a while back, we were given a briefing by the Dean of the Military/Baylor program  for the dual MPH/MBA program at the AMEDD C&S outlining the overall costs of the system. I'll see if I can somehow post the relevant slides.

 

Also, if you look at your own link, it lists the total budget for the MHS in that year as $49 Billion. It also states that there are 9.5 million participants. That equates to a per capita cost of $5,157.

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Not to derail the discussion too much, but I really don't understand this idea of healthcare being a right. When you look at the Declaration of Independence, it states our unalienable rights to life, liberty, and the pursuit of happiness. Many people have a fundamental misunderstanding of the negative rights. A negative right is a right to NOT have things done to us. Don't take my life, don't lock me away, don't restrict my speech, don't infringe on my bearing of arms...These recognized legitimate rights don't place obligations on anyone else other than to not infringe on the rights of others.

 

Saying that healthcare is more of a right than a privilege because everyone needs it is flawed because it's a positive right that requires someone to do or give something to you. If that's the standard, than wouldn't housing, food, clothing be a right? Who can live without food? 

 

Needs vs rights. Health care is a need. Government shouldn't infringe on our right to pursue healthcare, but nobody owes us healthcare. I understand how important access to healthcare is, which is why I'm so against leaving it to our incompetent federal government to handle. 212 veterans died waiting for care with the Phoenix VA, the only pure single payer socialized health system we have, and that's enough of an argument for me.

 

In conclusion, taken from my friend Julie Borowski, "A right is not something someone gives you, it's something that no one can take away"

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"Also, if you look at your own link, it lists the total budget for the MHS in that year as $49 Billion. It also states that there are 9.5 million participants. That equates to a per capita cost of $5,157."

 

 

So, how can the study say only one MTF can produce its inpatient and outpatient workload at a lower cost than in the private sector, but the military pays less per capita than the private sector? I have an exam on Friday, so not enough brainpower to think through that one. I'm sure someone smarter than me can work it out.

 

Could be because of a population of people like myself that never visited sick call, mixed with some random very sick people. That could lead to a lower per capita cost, while <insert stupid things government does> spending on the very very sick people would lead to higher costs in the inpatient outpatient setting.

 

I'm sure there's a better way of putting that. Active duty/retired military is a very unique population. I had a lot of fun working in military medicine, but I can attest to some wasteful spending. Imagine if Tricare had to deal with the normal population of people that aren't required to PT

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The VHA would be a good example of having a population more like the rest of the country. This was from 2006, but I can't imagine it being any better now.

 

"In Fiscal Year 2006, the VHA had 7.9 million enrollees, and a total budget authority of $36 billion.[8] This works out to average per-capita expenditures of $4,557. For the entire population of the United States, the Center for Medicare and Medicaid Services (CMS) estimates the total 2006 U.S. health care expenditures to be $2.1 trillion, for a population of 299.7 million.[9] This implies per-capita expenditures of $7,025 – a considerably higher figure. This is even more stunning when one considers that the VHA enrollee population is older, more disabled, and otherwise more likely to consume health care than the average American.

However, this neglects a crucial fact: most VHA enrollees have other sources of care. According to VHA’s own figures,[10] the average VHA enrollee receives only 36 percent of his or her health care from the VHA. In VHA parlance, this figure is referred to as “reliance” and is defined as the percentage of an individual VHA enrollee’s health care services that the enrollee received from the VHA, instead of from other sources.

When we adjust for 36 percent reliance, we find that if the VHA provided 100 percent of its enrollees’ care (at the same average cost[12]), VHA would have to spend $12,658. Now, instead of appearing to spend 35 percent less per patient than the national average, VHA spends 80 percent more per patient."

 

https://www.americanactionforum.org/research/veterans-health-administration-a-preview-of-single-payer-health-care/#_ftn10

 


 

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Well, I never said anything about saving money, but in many ways I think a single-payer system can be cheaper, because it de-incentivizes the ordering of unnecessary tests, procedures, and medications. The problem with my system is that many of my consultants are civilian and are billing TRICARE for services rendered, and every time I send out a patient I can almost hear the dollar signs ringing...it doesn't help that single-payor systems, in my experience, tend to produce an entitled patient population who don't seem to understand that the first-line acne therapy or mole removal they want from a dermatologist is exactly the same care that I could provide, without costing the government any extra dough. But I usually hold the line. :)

You didn't, but others did.  

 

Yes, a single-payer system COULD be cheaper.  Look at Cuba, cheaper, but sucked.

 

YOU are able to "hold the line" on expenses because you are (still) military, so therefore you are able to prevent (what you consider to be) unnecessary care.  

 

This prevention of care is called rationing.  More on that later.

 

Since I was quoted, I guess it's time to respond. I have no answers, but some observations. ...

 

The power of a free economy is great; it has led to many products and competition has led to lower prices. Unfortunately, when you are sick is not a great time to start casing out prices for things. It's not like Boatswain's purse: your life is at stake and time is of the essence. Regardless of whether you prefer single payer or lots of insurance companies, healthcare is more like a utility than it is a free market. Healthcare is something that we all need. The question is how to pay for it. I submit that, in many of our lives, we will be faced with a healthcare bill that we cannot afford to pay. That's why there is insurance. 

 

....

 

All I ask is that we don't let ourselves be jaundiced by what we sometimes see at work. Life is not that cut-and-dried, as any of us who have had life-threatening diseases can attest. Talk to each other and have respect for one another. Most Americans are decent people who live their lives responsibly. We should be able to stop posturing and shouting and work this out. 

I quoted you, but then forgot what I was going to reply.  Perhaps I should go to every neurologist in the country to figure out why I can't have perfect memory?  (stupid idea, I know, but ties in to my argument below about rationing)

 

FWIW...

The Military Health System operates at around $5,500 per capita for its participants (which includes service members, spouses, dependents, and retirees).

The per capita cost for the nation as a whole is $9,000.

Again, the military health system is able to effectively ration health care through the use of the military chain of command.  Furthermore, very very few military retirees receive their (very expensive) end-of-life care within the military health system.  

 

 

The foundational issue, the absolute foundational issue, regarding healthcare is the need to ration healthcare.  The term "rationing healthcare" is a very dirty word, and often used by the right to scare people away from single payer systems (ie: Obamacare's "death panels").  Meanwhile, those on the left utterly refuse to acknowledge that their programs either DO ration healthcare (Obamacare DID indeed have "death panels", although not named such), or their programs will fail because of the lack of ration.

 

In a purely capitalist system healthcare would be rationed by what people could afford.  The benefit of this is, of course, that expenses will be limited because the cost of care is totally born by the patient/family.  Demented 90 year old Grandma probably wouldn't be admitted for her 3rd ICU visit in a month if it meant her kids wouldn't get their inheritance.  On the flip side, the 23 yo MVA victim would be financially devastated.

 

The further we get from this purely capitalist system, and the further removed the patient is from the cost of their care, the more other rationing systems must be used to keep costs under control.

 

In the military system healthcare is rationed by what your provider (and/or chain of command) tells you will happen (acquiesce or leave the service).

 

With a HMO system, healthcare is rationed by what the HMO will pay for.

 

Medicaid totally removes the patient from the cost of their care, yet rationing remains.  In this case the rationing comes from poor reimbursement, which drives poor Medicaid coverage, and patients wait days/weeks/months for appointments.

 

It's all about how we want to ration care because, no matter what system we have, healthcare WILL be rationed.  

 

Why will healthcare ALWAYS need to be rationed?  Because people will always seek more/better health than they have.  Great grandma wants to live another year, the 60 year old CHFer wants play with his grandkids, the 50 year old divorcee wants to look 30 again, the 20 year old wants bigger boobs, and the 15 year old wants clear skin.  He wants to become a she, and she wants to have IVF.  Meanwhile, going back to my above comment, want a pill to help me remember things better.

 

How much of this is legitimate healthcare?  Remember, Private Manning the traitor got a government funded sex-change operation.

 

Healthcare will always be rationed.  We just gotta figure out how we want to ration it as a society.

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You didn't, but others did.  

 

Yes, a single-payer system COULD be cheaper.  Look at Cuba, cheaper, but sucked.

 

YOU are able to "hold the line" on expenses because you are (still) military, so therefore you are able to prevent (what you consider to be) unnecessary care.  

 

This prevention of care is called rationing.  More on that later.

 

I quoted you, but then forgot what I was going to reply.  Perhaps I should go to every neurologist in the country to figure out why I can't have perfect memory?  (stupid idea, I know, but ties in to my argument below about rationing)

 

Again, the military health system is able to effectively ration health care through the use of the military chain of command.  Furthermore, very very few military retirees receive their (very expensive) end-of-life care within the military health system.  

 

 

The foundational issue, the absolute foundational issue, regarding healthcare is the need to ration healthcare.  The term "rationing healthcare" is a very dirty word, and often used by the right to scare people away from single payer systems (ie: Obamacare's "death panels").  Meanwhile, those on the left utterly refuse to acknowledge that their programs either DO ration healthcare (Obamacare DID indeed have "death panels", although not named such), or their programs will fail because of the lack of ration.

 

In a purely capitalist system healthcare would be rationed by what people could afford.  The benefit of this is, of course, that expenses will be limited because the cost of care is totally born by the patient/family.  Demented 90 year old Grandma probably wouldn't be admitted for her 3rd ICU visit in a month if it meant her kids wouldn't get their inheritance.  On the flip side, the 23 yo MVA victim would be financially devastated.

 

The further we get from this purely capitalist system, and the further removed the patient is from the cost of their care, the more other rationing systems must be used to keep costs under control.

 

In the military system healthcare is rationed by what your provider (and/or chain of command) tells you will happen (acquiesce or leave the service).

 

With a HMO system, healthcare is rationed by what the HMO will pay for.

 

Medicaid totally removes the patient from the cost of their care, yet rationing remains.  In this case the rationing comes from poor reimbursement, which drives poor Medicaid coverage, and patients wait days/weeks/months for appointments.

 

It's all about how we want to ration care because, no matter what system we have, healthcare WILL be rationed.  

 

Why will healthcare ALWAYS need to be rationed?  Because people will always seek more/better health than they have.  Great grandma wants to live another year, the 60 year old CHFer wants play with his grandkids, the 50 year old divorcee wants to look 30 again, the 20 year old wants bigger boobs, and the 15 year old wants clear skin.  He wants to become a she, and she wants to have IVF.  Meanwhile, going back to my above comment, want a pill to help me remember things better.

 

How much of this is legitimate healthcare?  Remember, Private Manning the traitor got a government funded sex-change operation.

 

Healthcare will always be rationed.  We just gotta figure out how we want to ration it as a society.

 

 

Totally agree with above - healthcare HAS to be rationed in some way, shape, or form because it is a finite resource where demand far outpaces supply. Otherwise, we could MRI every twisted ankle. Instead, we have the Ottawa Ankle Rules (from another single-payer system).

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I was a combat vet, and was given a compensation rating from the VA. Because of this I receive health care benefits from the VA. And while the VA is far from perfect I couldn't be happier with my experience. Literally everything is free. No co- pays, and don't even pay for medications. I don't have trouble getting an appointment For either acute or routine apps, and my treatment is satisfactory.

 

I have always had conservative\libertarian leanings, but I do differ on this issue. I definitely think we should be on a path to a single payer system. The US spends almost twice as much on healthcare as any other industrial nation, and these nations offer more or less single payer systems. Furthermore, satisfaction levels among US citizens is also one of the worst as a whole among other industrial nations. It is obvious we are doing something wrong here. My source would be the commonwealth study put out every year that looks at all industrial nations healthcare systems.

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If you go back to most basic reasons for healthcare - consider this...

 

An organized country with a central government has a vested interest in healthy workers who increase the GDP. The government has an interest in vast volumes of population not dying off from epidemics so as to reduce the workforce or military.

 

The government wants citizens to have access to healthcare for these reasons.

 

WHO pays for this is another question. The US allows for a capitalistic society with profit driven businesses of all realms.

 

This unfortunately stimulates the wide divide between the haves and have nots and the haves like it this way.

 

For profit insurance rations healthcare thru fees, limitations, pre-authorizations and exclusions hoping some do not utilize services or give up trying due to frustration. The CEO and upper management are haves and can dictate what the have nots get. This method of rationing makes no sense and is dangerous and inconsistent.

 

National insurance - single payer - can ration healthcare if truly not for profit and governed by science not policy makers. A very difficult balance to achieve.

 

The US public is not ready for single payer because we expect extraordinary services in frankly ridiculous situations - 18 week preemies with profound deficits in the NICU for months at over $20K a day in some instances and vegetative elderly (like my mother in law) who languish in a home at $6000 a month when vegetative with zero quality of life. We don't let people die or with dignity. we don't perpetuate that life ends and cannot be immortal. We go to the ends that don't honestly justify the means.

 

Folks will cry civil rights and liberties if we actually instituted logic driven (Vulcan for Star Trek fans) criteria for treatment and actually required preventative visits and participation. Reducing the crisis approach to a more preemptive approach will require less financially in the end.

 

I believe the citizens of a country should have adequate access to medical care at reasonable NOT for profit prices but I also do not believe in the 1% er rift that currently drives our country with the haves and have nots. Nothing Utopian in mind but something more balanced and equitable.

 

The US currently spends more per capita on medical with dismal outcomes in comparison which honestly cannot be good for our GDP or society.

 

Many will not agree with me. Agree to disagree.

 

This is the cumulation of my experience and beliefs.

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