What the Trump administration has done to change the health care system

[rev ronin]

3 hours ago, GetMeOuttaThisMess said:

Why does there have to be a time limit to COBRA?

Why would anyone ever use COBRA in the first place? I've looked at it on a couple of occasions pre ACA and it was ALWAYS ridiculously expensive for a family.  If you can afford COBRA, you can pay for anything out of pocket anyways.

[EMEDPA]

Just now, rev ronin said:

Why would anyone ever use COBRA in the first place? I've looked at it on a couple of occasions pre ACA and it was ALWAYS ridiculously expensive for a family.  If you can afford COBRA, you can pay for anything out of pocket anyways.

if you need 90 days of insurance between jobs it is easier to continue with what you have than to get a new policy for 3 months. have done it twice. yes, it was expensive, but my time is worth something so not spending a long time filling out surveys or getting records sent for insurance I will have for 90 days is worth something. 

[rev ronin]

2 hours ago, Boatswain2PA said:

The moderators allow him to remain despite his only purpose in life seemingly is to spew hate after every post I make.

I could improve this thread by selectively removing the back-and-forth partisan nonsense, as could any of the mods, but right now we're getting about 2/3rds discussion of real problems, and 1/3rd sniping, which is better than some other recent threads.

[rev ronin]

2 minutes ago, EMEDPA said:

if you need 90 days of insurance between jobs it is easier to continue with what you have than to get a new policy for 3 months. have done it twice. yes, it was expensive, but my time is worth something so not spending a long time filling out surveys or getting records sent for insurance I will have for 90 days is worth something. 

At the time I considered COBRA, medical bankruptcy would have been a better option as a solution for catastrophic medical expense.  That is, my net worth wasn't much at the time. One ER visit a month would have been cheaper than COBRA.

[GetMeOuttaThisMess]

When comparing insurance pricing for self with COBRA compared to freestanding, again using a HDHP, it wasn’t that much more expensive and I already knew that network.


Sent from my iPhone using Tapatalk

[EMEDPA]

33 minutes ago, rev ronin said:

At the time I considered COBRA, medical bankruptcy would have been a better option as a solution for catastrophic medical expense.  That is, my net worth wasn't much at the time. One ER visit a month would have been cheaper than COBRA.

If you let your insurance lapse, it is harder to get insurance again later, especially for "pre-existing conditions". 

[ANESMCR]

3 hours ago, Boatswain2PA said:

The moderators allow him to remain despite his only purpose in life seemingly is to spew hate after every post I make.  For some reason he gives me free rent in his vacuous head.

He is about as annoying as gnat.  Best to just ignore him.

A phrase that became very popular in 2016 to a very specific group of people. I’ve refused to insult you as a person in return to the many I’ve received. One saying I wasn’t even an American, the other saying I wasn’t even a PA, and now you demeaning my existence as a person. Once again I’ll let it go. I’m enjoying the thread so far actually.

[rev ronin]

28 minutes ago, EMEDPA said:

If you let your insurance lapse, it is harder to get insurance again later, especially for "pre-existing conditions". 

I've never had health insurance that wasn't employer-provided group insurance, and never would again at this point.  I'm quite satisfied with a faith-based non-insurance alternative.

[ventana]

Back to original post

 

tRump did get PA to order and manage VNA services.  This is a huge win (irrespective of political beliefs) for PA and is a huge deal.  This is one step closer to OTP!!!

 

as for the other topics.   I do believe the right has been successful as labeling the centrists (in healthcare delivery) as extreme leftist.  National healthcare is not a leftist idea.  Medicare for all is not socialism.   
 

I truly believe that we as a country need to have a single payer universal basic health care system.  Doesn’t need to be a high bells and whistles coversge, but something to protect our citizens and our health care delivery.  No one wins with free care and patients with out insurance.  

[ventana]

cobra benefit is real for my family

 

my family state TUFTS health insurance is 1500 per month for the 4 of us

on the exchange I can get the same price but 2000 ded instead of 400 and benefits are no where near as good

I have priced out employer plans, they are 2k per month for less coverage

 

COBRA is the cheapest option for my family - but it runs out in Feb....  so gotta do something....  would be nice if I could stay on it for ever as it is the best insurance in this case (continuing state employment coverage) 

[Pac30]

1 hour ago, ventana said:

cobra benefit is real for my family

 

my family state TUFTS health insurance is 1500 per month for the 4 of us

on the exchange I can get the same price but 2000 ded instead of 400 and benefits are no where near as good

I have priced out employer plans, they are 2k per month for less coverage

 

COBRA is the cheapest option for my family - but it runs out in Feb....  so gotta do something....  would be nice if I could stay on it for ever as it is the best insurance in this case (continuing state employment coverage) 

Well, I would assume part of the reason you can't stay on it, is the pressure losing the insurance exerts on you to take a job, any job to keep health insurance so that rates don't skyrocket on you when you go to select a plan after a lapse because of those pre-existing conditions. This helps corporate America keep wages low, since workers don't have the luxury of telling every low ball offer, or 2% "raise" to shove it.

It's a specification not a bug. 

[ventana]

53 minutes ago, Pac30 said:

Well, I would assume part of the reason you can't stay on it, is the pressure losing the insurance exerts on you to take a job, any job to keep health insurance so that rates don't skyrocket on you when you go to select a plan after a lapse because of those pre-existing conditions. This helps corporate America keep wages low, since workers don't have the luxury of telling every low ball offer, or 2% "raise" to shove it.

It's a specification not a bug. 

unsure what is real and what is memorex....

pre-existing conditions do not count right now, and in MASS they have been excluded for years

unsure also how this applies to taking a job as you suggest and rather it  would ever stop me from asking for a raise.....

 

lets keep it to the facts and not fear please

[Boatswain2PA]

4 hours ago, ventana said:

I do believe the right has been successful as labeling the centrists (in healthcare delivery) as extreme leftist.  National healthcare is not a leftist idea.  Medicare for all is not socialism.  

It's not "extreme leftist", but it is growing socialism.

When Medicare/Medicaid first came out it was called out as a socialist program because it is.  It is society promising to pay for (at least some) of the healthcare of a person, with no real defined benefit to others.  This is the difference between socialist programs like government funded healthcare and things like roads, military defense, food inspections, etc.  A socialist program is there to benefit a person (ie: paying for Grandma's ICU bill), without a real benefit to the community (the community would not be worse off if Grandma died).  However building roads, having a police department to enforce laws, military defense, etc are all COMMUNAL goods for the entirety of the community.  Everyone can use the roads, without enforcement of laws you could not have property rights, and without a military we would quickly be subjugated.  

Since the birth of Medicare and Medicaid (again, socialist programs) there has been a push to expand them to cover more people, and have them cover more things.  

And now there is the push for a national healthcare idea. 

So it's not that those evil conservative/right-wingers are "successful in labeling centrists" as "extreme leftist", it's more that those on the left continue to push to expand the socialist programs (in this case, healthcare for all).

 

4 hours ago, ventana said:

I truly believe that we as a country need to have a single payer universal basic health care system.  Doesn’t need to be a high bells and whistles coversge, but something to protect our citizens and our health care delivery.  No one wins with free care and patients with out insurance

You finally touch upon the crux of the situation, but one that nobody ever really talks about - how do we ration healthcare.

You say it doesn't need to be a "high bells and whistles coverage", but just "something to protect our citizens and our healthcare delivery."

Like what? Do we cover insulin?  We all agree on that.  What about your 98 year old grandmother's 3 week ICU stay?  Where do we draw that line?

How about cosmetic surgery?  I'm ugly and want to look pretty, isn't that healthcare?  

Many people want to live an exceptionally long and healthy life despite eating a diet consisting of chocolate cake and mountain dew while enjoying frequent methamphetamine highs and smoking 3 ppd.  

We have always, and WILL always ration healthcare.  The question is how do we do it, and how much tax money are we going to spend on it.

[Pac30]

 

50 minutes ago, ventana said:

unsure what is real and what is memorex....

pre-existing conditions do not count right now, and in MASS they have been excluded for years

unsure also how this applies to taking a job as you suggest and rather it  would ever stop me from asking for a raise.....

 

lets keep it to the facts and not fear please

 

I don't think I laid things out quite the way I wanted there, ventana. I'm not trying to fear monger, and doesnt really directly apply to your specific situation. From your earlier posts, you and I agree on a lot.

What I mean to say, is that when one's favorable options are so heavily skewed towards employer-provided plans, it exerts some level of pressure on the average worker. Now for us PAs, we don't have the same pressure that a blue collar worker might face to stay in one place and not have to pay the entirety of our plans. 

That's all I'm saying. 

It wouldn't affect your ability to ask for a raise, of course it wouldn't, but it absolutely affects your overall compensation package, by forcing your company to spend money on covering you. I don't have the stats to back up my hunch, but wouldn't it stand to reason that wages would go up if employers didn't have to provide the Healthcare plans directly? 

[Boatswain2PA]

6 minutes ago, Pac30 said:

I don't have the stats to back up my hunch, but wouldn't it stand to reason that wages would go up if employers didn't have to provide the Healthcare plans directly? 

I guess it would depend on how the healthcare IS funded.  If we jack up taxes on businesses to pay for increasing national healthcare expenditures, then no, I don't think wages would go up.

If government wants to raise taxes on individuals to pay for the increasing healthcare expenditures, then wages may go up, but the taxes go up as well.

Or if the government got out of healthcare and reduced restrictions on insurance companies (letting them offer wider variety of plans like catastrophic only) then wages could go up and people could shop around.

[CAAdmission]

For the folks that want a national health plan, what do you see happening to the current insurance industry? Do most of them become federalized employees and the government takes over their operations? Or do they get shut down?

[EMEDPA]

23 minutes ago, CJAdmission said:

For the folks that want a national health plan, what do you see happening to the current insurance industry? Do most of them become federalized employees and the government takes over their operations? Or do they get shut down?

They continue to exist, but only for add on coverage for things not covered by the national plan. Things like cosmetic surgery. 

This is the option in Canada. You get a national health plan, but if you want something that looks more like concierge medicine you can cover it with additional insurance. Want your cholesterol checked every week or the newest and best nasal spray for your seasonal allergies or bi-weekly massages? pay for the extra coverage. 

[MediMike]

22 minutes ago, CJAdmission said:

For the folks that want a national health plan, what do you see happening to the current insurance industry? Do most of them become federalized employees and the government takes over their operations? Or do they get shut down?

My ideal scenario would be similar to what many European countries offer, a NHS with "Cadillac" plans offered by private insurance.

48 minutes ago, Boatswain2PA said:

It's not "extreme leftist", but it is growing socialism.

When Medicare/Medicaid first came out it was called out as a socialist program because it is.  It is society promising to pay for (at least some) of the healthcare of a person, with no real defined benefit to others.  This is the difference between socialist programs like government funded healthcare and things like roads, military defense, food inspections, etc.  A socialist program is there to benefit a person (ie: paying for Grandma's ICU bill), without a real benefit to the community (the community would not be worse off if Grandma died).  However building roads, having a police department to enforce laws, military defense, etc are all COMMUNAL goods for the entirety of the community.  Everyone can use the roads, without enforcement of laws you could not have property rights, and without a military we would quickly be subjugated.  

Since the birth of Medicare and Medicaid (again, socialist programs) there has been a push to expand them to cover more people, and have them cover more things.  

And now there is the push for a national healthcare idea. 

So it's not that those evil conservative/right-wingers are "successful in labeling centrists" as "extreme leftist", it's more that those on the left continue to push to expand the socialist programs (in this case, healthcare for all).

You finally touch upon the crux of the situation, but one that nobody ever really talks about - how do we ration healthcare.

You say it doesn't need to be a "high bells and whistles coverage", but just "something to protect our citizens and our healthcare delivery."

Like what? Do we cover insulin?  We all agree on that.  What about your 98 year old grandmother's 3 week ICU stay?  Where do we draw that line?

How about cosmetic surgery?  I'm ugly and want to look pretty, isn't that healthcare?  

Many people want to live an exceptionally long and healthy life despite eating a diet consisting of chocolate cake and mountain dew while enjoying frequent methamphetamine highs and smoking 3 ppd.  

Not sure how you draw the line between healthcare (Medicaid/Medicare) not benefiting a society while a road does. If you don't have a driver to operate the trick utilizing that road then the road benefits no one.

The military is without a doubt the most "socialist" system in America. We pay taxes to provide food, education, healthcare and housing to employees. Would you say with all certainty that our current military structure benefits all citizens equally? I think my taxes would have been spent in many a better place than Iraq, how did that benefit me? 

That Grandma may provide child care to allow their kid to go to college and develop the working COVID vaccine, does that not benefit society?

Trying to make the argument that expansion of healthcare is an extreme position will fail when looking at the rest of the developed world. In regards to what is covered, it's a little disingenuous to ask an intricate incredibly nuanced and detailed question like that on an internet forum.

[Boatswain2PA]

26 minutes ago, MediMike said:

Not sure how you draw the line between healthcare (Medicaid/Medicare) not benefiting a society while a road does. If you don't have a driver to operate the trick utilizing that road then the road benefits no one.

Grandma's family might benefit from society paying for her healthcare, but society does not.  

Roads are built by communities for everyone in the community to use.  Roads are not (well, SHOULD not) be paid for by the community for one person (or one family) to use.
 

 

26 minutes ago, MediMike said:

The military is without a doubt the most "socialist" system in America. We pay taxes to provide food, education, healthcare and housing to employees.

Life WITHIN the military certainly seems socialized with all the things you list out, and add in the typical authoritarianism that comes along with socialism.  But in this case the good to the military society IS affected by the individual.  For example - we don't just send soldiers to school, we send them to SPECIFIC schools to improve their lethality.  Military triage is different from civilian triage in that we would treat the wounded finger first so the soldier can regain his lethality versus treating the severely wounded.  This is more about military readiness than socialism, with the rest about simple job benefits.

 

26 minutes ago, MediMike said:

Would you say with all certainty that our current military structure benefits all citizens equally? I think my taxes would have been spent in many a better place than Iraq, how did that benefit me? 

No.  But I never said anything about benefiting all citizens equally.  The whole "equality" thing is the farce of socialism.  

The public good of the military comes from it's purpose of defending the nation, and it is always better to defend your nation by bringing the war to the enemy than letting them bring the war here (aka: a good offense is the best defense).  With regard to Iraq in particular, we liberated our ally after they were invaded, then went back to war (well, constitutionally it wasn't a war, but...) because Iraq didn't comply with the peace deal they agreed to.  Like everything else in life/history/etc, there are multiple correct ways to view these events.

But my point stands that the military (and police, roads, etc) is a public good because it protects us all (although not equally).  Whereas paying for an individual person's medical bills is not a public good like this (infectious/public health concerns notwithstanding).

 

 

26 minutes ago, MediMike said:

That Grandma may provide child care to allow their kid to go to college and develop the working COVID vaccine, does that not benefit society?

Hypothetically yes.  Should we ban abortions for the same reason?  

 

26 minutes ago, MediMike said:

Trying to make the argument that expansion of healthcare is an extreme position will fail when looking at the rest of the developed world.

I've never made the argument that it is an extreme position.  Is it a socialist position?  Yes (assuming "the expansion of healthcare" means expanding government funding of individual's healthcare expenses).  

 

26 minutes ago, MediMike said:

In regards to what is covered, it's a little disingenuous to ask an intricate incredibly nuanced and detailed question like that on an internet forum.

The questions I asked were simply to make a point about the crux of the matter - how we ration healthcare.

 

Edited October 20, 2020 by Boatswain2PA

[CAAdmission]

27 minutes ago, EMEDPA said:

They continue to exist, but only for add on coverage for things not covered by the national plan. Things like cosmetic surgery. 

This is the option in Canada. You get a national health plan, but if you want something that looks more like concierge medicine you can cover it with additional insurance. Want your cholesterol checked every week or the newest and best nasal spray for your seasonal allergies or bi-weekly massages? pay for the extra coverage. 

On it's face that sounds reasonable. A few things give me pause:

• I would have more than a little discomfort allowing a government with such a poor history of managing finances to basically be permitted a monopoly on setting reimbursement rates. If they want to massively subsidize medical and nursing education to make student debt go away, that could be another story.
• I wonder if they will be able to handle the complexity. I can see them just hiring all the same clowns currently working in the private insurance industry to run things. Now instead of them being on a 401k plan, we'll be paying them all lifetime pensions. 
• One promise is that the paperwork will be a lot simpler by virtue of being uniform. People who think this probably have accountants do their taxes.

I think a government could run healthcare well. I don't think ours can. I have an extremely jaded view of government. My interactions with it seems to indicate it is a refuge for people who would not make it in private industry - grifters, lazy, dull-witted and incompetent drones.

[Boatswain2PA]

31 minutes ago, CJAdmission said:

If they want to massively subsidize medical and nursing education to make student debt go away, that could be another story.

They already do that through federally guaranteed student loans that drive massive amounts of money to academia, while not letting students discharge these loans in bankruptcy.  Get rid of the federal guarantee on these loans and suddenly banks won't give Suzie $200K to get her PA degree to make $85K/year.  But that is never going to happen because academia gets all that money.

Instead, we will just worsen the problem by making college "free" for everyone, thus allowing academia to jack up prices even more due to the greater (100%) subsidization.  And, of course, the "free" college will be worth exactly what the student pays for it.

34 minutes ago, CJAdmission said:

One promise is that the paperwork will be a lot simpler by virtue of being uniform.

Yeah, gubment is going to simplify paperwork.

And, you forget the best one CJ.  The government is going to perform "cost savings".  What is the easiest way to do this?  Well, since the gubment will run it, everything with healthcare will be political, so we have to ask what is the POLITICALLY easiest way to perform "cost savings"?  Easy answer - pay those evil rich doctors less.  BTW - that is going to drive our pay down as well.

How much is the average PA pay in countries with socialized medicine?  Google says the average PA in the UK makes 31,211 pounds, which comes out to $40,262.


 

[MediMike]

58 minutes ago, Boatswain2PA said:

Grandma's family might benefit from society paying for her healthcare, but society does not.  

Roads are built by communities for everyone in the community to use.  Roads are not (well, SHOULD not) be paid for by the community for one person (or one family) to use.
 

 

Life WITHIN the military certainly seems socialized with all the things you list out, and add in the typical authoritarianism that comes along with socialism.  But in this case the good to the military society IS affected by the individual.  For example - we don't just send soldiers to school, we send them to SPECIFIC schools to improve their lethality.  Military triage is different from civilian triage in that we would treat the wounded finger first so the soldier can regain his lethality versus treating the severely wounded.  This is more about military readiness than socialism, with the rest about simple job benefits.

 

No.  But I never said anything about benefiting all citizens equally.  The whole "equality" thing is the farce of socialism.  

The public good of the military comes from it's purpose of defending the nation, and it is always better to defend your nation by bringing the war to the enemy than letting them bring the war here (aka: a good offense is the best defense).  With regard to Iraq in particular, we liberated our ally after they were invaded, then went back to war (well, constitutionally it wasn't a war, but...) because Iraq didn't comply with the peace deal they agreed to.  Like everything else in life/history/etc, there are multiple correct ways to view these events.

But my point stands that the military (and police, roads, etc) is a public good because it protects us all (although not equally).  Whereas paying for an individual person's medical bills is not a public good like this (infectious/public health concerns notwithstanding).

 

 

Hypothetically yes.  Should we ban abortions for the same reason?  

 

I've never made the argument that it is an extreme position.  Is it a socialist position?  Yes (assuming "the expansion of healthcare" means expanding government funding of individual's healthcare expenses).  

 

The questions I asked were simply to make a point about the crux of the matter - how we ration healthcare.

 

Again, I fail to see how having healthy members of society with access to healthcare doesn't benefit the remainder of society.  And I say "again" because I feel like we have gone around and around on this in the past.  You WILL pay for this individual's healthcare at one point or another.  Whether it is when she shows up in the ED with angina/PNA/DKA/cellulitis or whether it is a nice low cost preventative care appoint is up to you and your decisions regarding taxation.  Look at the per capita spending in other countries and tell me that having universal access, provided by the "gubment" doesn't benefit us as a whole.  And perhaps your grandmother dying wouldn't affect the community, but for those who have grandmother's who are active in the community performing volunteer work, providing child care, still working at a paying job? Or do we not care about their contribution due to age? I'm not quite sure what you're getting at.  The death or illness of an individual has a domino effect throughout society.

GI Bill, Post 9/11 GI Bill, scholarships, grants, Veterans Education, tuition assistance, HPSP, all of these take TAXPAYER money and use it to fund educational benefits for a group of individuals which then benefits society.  Not everything in the military is about lethality as you know.  There is a significant amount of research performed to benefit folks in the civilian world or "society".  TRICARE is funded by taxpayers, the VA system is funded by taxpayers.  Neither of these work on a battlefield triage system and commonly work with other private/public institutions.

Ah, the classic "let grandma die or we should ban abortions" argument.  See, this was already defeated in the 2007 treatsie of "No because we already know that Grandma isn't a baby Hitler while the unborn collection of cells in the womb very well could be".

Completely concede the point of your utilization (lack thereof) of the word "extreme", I apologize!

Annnnnd you snuck some more in there...

20 minutes ago, Boatswain2PA said:

They already do that through federally guaranteed student loans that drive massive amounts of money to academia, while not letting students discharge these loans in bankruptcy.  Get rid of the federal guarantee on these loans and suddenly banks won't give Suzie $200K to get her PA degree to make $85K/year.  But that is never going to happen because academia gets all that money.

Instead, we will just worsen the problem by making college "free" for everyone, thus allowing academia to jack up prices even more due to the greater (100%) subsidization.  And, of course, the "free" college will be worth exactly what the student pays for it.

Yeah, gubment is going to simplify paperwork.

And, you forget the best one CJ.  The government is going to perform "cost savings".  What is the easiest way to do this?  Well, since the gubment will run it, everything with healthcare will be political, so we have to ask what is the POLITICALLY easiest way to perform "cost savings"?  Easy answer - pay those evil rich doctors less.  BTW - that is going to drive our pay down as well.

How much is the average PA pay in countries with socialized medicine?  Google says the average PA in the UK makes 31,211 pounds, which comes out to $40,262.


 

What should the cost of education be? Do you believe we should pursue a University of Phoenix or ITT Tech or *insert for profit institution name here* without regulation? How should an individual fund their education if not through grants and loans? You seem to have a significant amount of distaste for "academia", is there a different educational system you would prefer?

Google also demonstrates that the average costs of PA education in the UK if $26k-28k.  There is also full indemnification working for the NHS, thus avoiding the quagmire of malpractice and concerns regarding liability. There is also less focus on moving the meat.  Pay is also less because folks aren't paying $1000 to walk in the doors of the ED, the pensions, the healthcare etc. etc.

Don't think you're seeing a bunch of PAs and MDs in the soup lines in London.

One thing I've never understood after speaking with you for a number of years on here, with your strong dislike of the idea of paying for and treating individuals who can't pay or receive governmental aid to receive care, why in the name of whatever spiritual deity there may be do you work in the ED?  It's the closest thing to socialized care throughout the entirety of the (non-military) healthcare system.  You treat whoever comes in the door, regardless of their ability to pay.  Why not some private concierge style practice?

[CAAdmission]

14 minutes ago, Boatswain2PA said:

How much is the average PA pay in countries with socialized medicine?  Google says the average PA in the UK makes 31,211 pounds, which comes out to $40,262.

That's a very legitimate concern. Coupled with typical massive wasteful spending it gets scary pretty fast.

[Boatswain2PA]

8 minutes ago, MediMike said:

Again, I fail to see how having healthy members of society with access to healthcare doesn't benefit the remainder of society.

Well of course it does.  Just like if everyone were a millionaire it would be beneficial to society, or if everyone read Chaucer, or...the list goes on.

But what is the cost of paying for all that?  Should we just write a million dollar check to everyone to suddenly make them a millionaire?  There just might be a downside to doing that....

 

10 minutes ago, MediMike said:

You WILL pay for this individual's healthcare at one point or another.

To say this you will have to define what "healthcare" is, but I generally disagree with you.  Vast majority of the people I see in the ED do not need to be there, and most wouldn't go there if they had to pay for that bill.  This isn't just medicaid patients, it's just a problem with a third payer system.  Had a guy last shift, mid 40's professional who came to the ED with a damn scratch on his thumb.  Okay, it was a deep scratch and it bled a little bit, but...just....wow......

Or the woman who demanded we do the Covid testing in the ED despite being asmptomatic and being handed paperwork on where she can get it done for free just a few blocks away.  

Meanwhile my wife works in ICU and had a 60 yo morbid obese smoker uncontrolled diabetic smoker who refuses to take any care of herself, yet demands our healthcare system fix her.  She is dying, but won't accept it, so is in the ICU at $10K/day instead of going to hospice.

Each of these patients are receiving "healthcare", and I don't think I should have to pay for any of them.  If the first guy had to pay for the ED visit out of pocket, he wouldn't have come in.  The Covid-testing lady would have gone to the free clinic for her test if she had to pay for the ED visit out of pocket.  And the woman in the ICU would go on hospice if she (or her family) had to pay her ICU bill.

 

21 minutes ago, MediMike said:

Look at the per capita spending in other countries and tell me that having universal access, provided by the "gubment" doesn't benefit us as a whole.

Multifactorial with severe cultural differences.  Look at how the Republicans stirred up the population with their talk about "death panels" in Obamacare.   One way other countries limit their cost is by having government bureaucrats decide the rationing of care (ala the "death panels").  It works for them, but will be difficult to do in our entitled society and the two-party political system..

 

23 minutes ago, MediMike said:

And perhaps your grandmother dying wouldn't affect the community, but for those who have grandmother's who are active in the community performing volunteer work, providing child care, still working at a paying job? Or do we not care about their contribution due to age? I'm not quite sure what you're getting at.  The death or illness of an individual has a domino effect throughout society.

I think you do know what I'm getting at.  I'm not saying grandma has no value to society, and she will be grieved when she passes.  But we ALL are gonna die, and the loss or morbidity of an individual has little effect on greater society.  It didn't affect you one bit when my grandparents passed away (except one was in the ICU for a looong time, so you helped pay for it).  

 

27 minutes ago, MediMike said:

GI Bill, Post 9/11 GI Bill, scholarships, grants, Veterans Education, tuition assistance, HPSP, all of these take TAXPAYER money and use it to fund educational benefits for a group of individuals which then benefits society.  Not everything in the military is about lethality as you know.  There is a significant amount of research performed to benefit folks in the civilian world or "society".  TRICARE is funded by taxpayers, the VA system is funded by taxpayers.  Neither of these work on a battlefield triage system and commonly work with other private/public institutions.

Sure.  They are also benefits to get people to join/stay in the military.  Housing, for example, kinda has to be provided for the member and their family since we are up and randomly moved to a new location once every couple of years.  
 

30 minutes ago, MediMike said:

Ah, the classic "let grandma die or we should ban abortions" argument.  See, this was already defeated in the 2007 treatsie of "No because we already know that Grandma isn't a baby Hitler while the unborn collection of cells in the womb very well could be"

I'm not familiar with that treatsie.  I think I was replying to your comment about we had to publicly fund grandma's ICU bill so she could provide daycare so little Johnny could go to college and cure cancer (or something like that), so I questioned whether we could use the same argument to save that little clump of cells.  

I would rather stick to the position that all human life has an intrinsic value that should be honored.  We shouldn't kill babies in the womb, and we shouldn't kill grandma.  

However the crux of the issue is how much money are we going to spend providing what kind of healthcare to whom.

 

34 minutes ago, MediMike said:

What should the cost of education be?

Whatever a person wants to spend THEIR money on.  If Suzie wants to spend $3million on getting your masters, then she can have at it.  

But don't put me on the hook for paying for it if she can't pay it back like we do with federally guaranteed student loans.

And let's give the students a way out if they have been duped by the schools.  If a school, working in conjunction with a bank, gets Suzie to go $3M in debt for her music degree that earns her $40K/year, then let her declare bankruptcy.  Suddenly those banks wouldn't fund such stupidity, and the schools wouldn't CHARGE such stupidity.

 

38 minutes ago, MediMike said:

Do you believe we should pursue a University of Phoenix or ITT Tech or *insert for profit institution name here* without regulation?

No.  I'm not an anarchist, reasonable regulations are reasonable.  Not sure where you are going with this....

 

39 minutes ago, MediMike said:

How should an individual fund their education if not through grants and loans?

I have no problem with grants and loans, nor scholarships, nor cash flowing or using savings.  

I have a problem with banks giving enormous loans, which cannot be discharged by bankruptcy, so that students can pay enormous tuition/fees to colleges in exchange for degrees that have very little financial return on investment.

 

42 minutes ago, MediMike said:

You seem to have a significant amount of distaste for "academia", is there a different educational system you would prefer?

See above for my distaste for 'academia'.  But worse yet is the loss of true liberalism that used to be the foundation for our great institutions of learning.
 

44 minutes ago, MediMike said:

Google also demonstrates that the average costs of PA education in the UK if $26k-28k.  There is also full indemnification working for the NHS, thus avoiding the quagmire of malpractice and concerns regarding liability. There is also less focus on moving the meat.  Pay is also less because folks aren't paying $1000 to walk in the doors of the ED, the pensions, the healthcare etc. etc.

All good stuff!

46 minutes ago, MediMike said:

Don't think you're seeing a bunch of PAs and MDs in the soup lines in London.

Didn't suggest they did.  But compare that $40K/year for a PA in the UK to the average of about $110K/year in the US.  

Looks like family physicians make about 50K pounds/year in the UK, or about $64K/year.  
An orthopedic surgeon in the UK averages 86.5K pounds per year in the UK.  They FINALLY compare to US PA average pay at $111K/year.

Socialized medicine will drastically cut our pay.  Guarantee it my friend.

 

53 minutes ago, MediMike said:

with your strong dislike of the idea of paying for and treating individuals who can't pay or receive governmental aid to receive care,

You have misunderstood me then my friend.  I have started and ran (and more than a few times personally funded) a non-profit organization that has helped pay for lots of people's medical bills (as well as other necessities of life).  

What I HAVE said is that modern healthcare has always been, is, and WILL forevermore be rationed.  We can ration it through government bureaucrats who say who can have what procedure done when, or we can ration it by only providing care that people can pay for out of pocket, or any number of mixes between those two positions.  Unfortunately we don't have the open discussion of how we should ration it, instead we just throw bombs at each other like "Obamacare DEATH PANELS" or "Republicans WANT GRANDMA TO DIE!".

 

I do EM because despite my advancing age, I still like the rush of saving someone's life.  I'm very good at rapidly assessing data and making decisions under stress.  And I have a very low tolerance for the administrative hurdles of things like getting pre-authorization, etc (which is a form of rationing care).

58 minutes ago, MediMike said:

Why not some private concierge style practice?

I would love to do this!  But this type of healthcare is rationed as well, this time by finances.  It is limited to people who will pay cash for their healthcare, and those types of people want the best that they can get, so they want a physician.  I have not been able to find one that hires PAs.

However I do know a few NPs who have opened their own concierge practice...but that's another discussion (sigh!).

 

[EMEDPA]

1 hour ago, CJAdmission said:

That's a very legitimate concern. Coupled with typical massive wasteful spending it gets scary pretty fast.

I was offered more like 90k to work there a few years ago. The list of things they were going to cover for me was impressive.