It's so bad you have to pay people to move to Vermont

fbrissette said:

Basically, you are saying that the US has the best healthcare system in the world, as long as we disregard any objective measure of performance. By objective measures I mean things like infant mortality rates, life expectency, morbidity rate, and despite spending twice as much as the average of developed countries.

If you are rich, or have a very good insurance plan through your job, your health care system is indeed excellent (I've experienced it when living in Houston), otherwise it absolutely sucks.

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Health care and health care "system" aren't the same thing.

The US has some of the best health care technology. But the "system" has some huge holes that train loads of people fell right through.

That said, ask anyone from Canada. They're quite proud of their health care system. It works pretty well for most, most of the time. But every so often, a patient gets into a bind. Fortunately for some (not necessarily "rich"), they have the option to cross the border into the US to seek care they can't get in Canada, even though they had to pay it out of their pocket!

Let's face it. Most people WILL mortgage their house if that's what it takes to pay for medicine that will save the life of their love ones! So, that's what we have here, the best medicine money can buy.

What we don't do well is routine medical care without mortgaging our house. But people don't seem to want to give up the "best medicine" and shift the money to cover the rest.

US healthcare technology in regards to equipment actually lags behind the rest of the developed world. All the major equipment manufacturers bring their new technologies to market in Europe and Asia 2-3 years before they are approved for sale here. US leads in how quickly new drugs and treatments come to the market vs the rest. That's about an equal difference. It has to do with regulatory differences around the globe.

End of the day, purely from a financial standpoint and percentage of population with insurance coverage, it's pretty hard to say our system is even top ten. I'll take a hybrid system like Japan's any day over ours. And I say this as someone who benefits professionally from capitalism in HC.

Sent from my XT1635-01 using AlpineZone mobile app

fbrissette said:

Basically, you are saying that the US has the best healthcare system in the world, as long as we disregard any objective measure of performance. By objective measures I mean things like infant mortality rates, life expectency, morbidity rate, and despite spending twice as much as the average of developed countries.

If you are rich, or have a very good insurance plan through your job, your health care system is indeed excellent (I've experienced it when living in Houston), otherwise it absolutely sucks.

Click to expand...

You're quoting fake stats - infant mortality rate for instance: In Switzerland, they start counting after a kid is 2.5 yrs old. US starts at one of the lowest rates - 3 months? Don't recall. Hey, it's not your fault. Humans use stats to further their cause.

And you are free to go to Canada - where 'free drugs' exist as long as someone else pays for them or you do in even higher than US tax rates. And please lets not debate 5 million Fins - they're all Finnish fercryinoutloud and ride bikes and eat fresh fish! We got every kind of race and tribe under the sun and sixty six times that number.

I'll give you another example - my rates went from $850 a month in '08 just before Romney/ObamaCare per month for a fam of 4 w $2K deductible. Jan 2018 went to $2500 per month w $4K deductible. most smaller insurance companies went out of business, consolidation and feds telling them to cover this and that.

Imagine you buy a smashed car and government says GIECO has to cover pre-existing. . . . guess where that $1500 per year rate is going.


No one says its perfect - never will be. Its the best care in the world for the most people, period.

Or you can go to UK and wait to get treatment for stuff you need cared for now. Have plenty of customers who lived there and had to purchase private. It's all great until your sick.

Anyone here agree that the RMV or the IRS are great places to do business? And if not, what are your choices? Exactly.

The same people who can't get along on any polarizing issues want THEM to decide how your healthcare is being divvied up? ( note - Congress is NOT under nor do they have to abide by Obamanation Care - THEY get private - and I repeat - same for Social Security - not for them.) Some of us smoke too much dope.

Here is my cure for $34K annual premiums before I can use the plan: Canned it, got an indemnity catastrophic health sharing of cost plan. Covers ANY thing over $500 with any doc or hospital. I pay for everything under that, including scripts.

Highest cost plan for family of 4 $490 per month. Ask you don't smoke or drink to excess. ( akin to driving w good record right?)

Cut my script bill from $958 per month to $482 by cash and generic. Still saving $10K a year so we got a concierge Dr with some of the extra cash and STILL come out w $6K more in pocket.

I don't care if his name is Donald Duck, keep deregulating and let the ( kinda) free market dictate prices. With the savings we all cover those in need, not those in want. Unless it is defense - centralized government does not work.

My senator ( Chief Spreading Bull, Lie-awatha, Faux-cahantas, etc.) want to put ' $100B toward opiate crisis but not $5B towards a defensive wall where the majority of the illicit drug is traveling thru. Perfect illustration. Will Rogers has many more.

Ready to ski wet powder Saturday? If I hit a tree, I gotta pay 1st then they reimburse me. If I live . . . .

deadheadskier said:

US healthcare technology in regards to equipment actually lags behind the rest of the developed world. All the major equipment manufacturers bring their new technologies to market in Europe and Asia 2-3 years before they are approved for sale here. US leads in how quickly new drugs and treatments come to the market vs the rest. That's about an equal difference. It has to do with regulatory differences around the globe.

End of the day, purely from a financial standpoint and percentage of population with insurance coverage, it's pretty hard to say our system is even top ten. I'll take a hybrid system like Japan's any day over ours. And I say this as someone who benefits professionally from capitalism in HC.

Sent from my XT1635-01 using AlpineZone mobile app

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Again they are mostly Asians with similar diets and such. You are correct on lagging w new drugs - a great illustration of government overreach - my customers in that business say its FDA that prevents quicker to market here. And I know we have a boatload of lawyers on here -a few in that profession don't help much. A society of litigation. And take a look at their GDP - flat for 30 years.

How come the Perdue family gets smashed to bits but no one from the FDA - who must have taken years to approve of opiates - get no blame at all? How does that work?

Less freedom and less liberty. That doesn't end our experiment we call US of A well.

1dog said:

How come the Perdue family gets smashed to bits but no one from the FDA - who must have taken years to approve of opiates - get no blame at all? How does that work?

.

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Not to go on another tagent, but the reason is that the Purdue Pharma knew that their drugs had terribly addictive properties and misled folks as to the extent of those issues. Additionally, they aggressively marketed these drugs despite knowing that these drugs were deadly and highly addictive. That's why.

And it is the Sackler family....not the Perdue (sic) family.

Whether you agree or disagree or are somewhere in the middle - here's a great example of free-market creation of wealth and the Brit who gets most of the credit for their success:

As to stats he says: Cowperthwaite answered, “If I let them compute those statistics, they’ll want to use them for planning.”

If that sounds quaintly backward or archaic, let me remind you that the biggest economic flops of the past century were both centrally planned and infatuated with numbers.

https://fee.org/articles/the-man-behind-the-hong-kong-miracle/

Ski Free or Die Trying!

1dog said:

You're quoting fake stats - infant mortality rate for instance: In Switzerland, they start counting after a kid is 2.5 yrs old. US starts at one of the lowest rates - 3 months? Don't recall. Hey, it's not your fault. Humans use stats to further their cause.

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You serioulsy believe what you write ? You seriously think the WHO would do such a terrible job ? Common stats compile neo-natal death rates, 0 to 1-year and 0 to 5-year mortality rates. There are many obvious reasons why the US does a lot worse than all other industrialized coutries. As ABC said, the problem is the system, not the health care itself.

1dog said:

And you are free to go to Canada -

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Well, I am Canadian, so I am definitely free to go there.

deadheadskier said:

I'll take a hybrid system like Japan's any day over ours.

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I'm curious about it.

Many other western countries also have a 2-tier public+private systems. How does it work differently in Japan?

abc said:

Health care and health care "system" aren't the same thing.

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Agreed.

abc said:

That said, ask anyone from Canada. They're quite proud of their health care system. It works pretty well for most, most of the time. But every so often, a patient gets into a bind. Fortunately for some (not necessarily "rich"), they have the option to cross the border into the US to seek care they can't get in Canada, even though they had to pay it out of their pocket!

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I am Canadian. The main problem of our system is not what you state (which essentially never happens), but rather the waiting lists for 'non-urgent' surgeries, and wait times at the ER. You may wait several months for a knee replacement surgery, and spend 8 to 10 hours with a broken arm at the ER. For any real emergency however (trauma, cancer, birth), the system is world class and free for anyone. To give you an example, 10 years ago, I felt like shit, went to my family doctor who quickly diagnosed an arrythmia problem. The ambulance was there in 5 minutes. 10 minutes later, I was at the ER and a cardioversion was immediately performed by a team waiting for my arrival. I had several tests done in the next few hours and was released at the end of the day. NO insurance to deal with. Zero paperwork. Did not cost me anything, beside a high tax rate obviously. People going to the States are typically people not willing to wait for minor surgeries, although this is happening less and less since there is a slowly growing private system availble in Canada to those who do want to skip the wait lines.

Not arguing out system is the best, but it is not leaving anyone behind.

1dog said:

I'll give you another example - my rates went from $850 a month in '08 just before Romney/ObamaCare per month for a fam of 4 w $2K deductible. Jan 2018 went to $2500 per month w $4K deductible. most smaller insurance companies went out of business, consolidation and feds telling them to cover this and that.

Imagine you buy a smashed car and government says GIECO has to cover pre-existing. . . . guess where that $1500 per year rate is going.

Click to expand...

Yes, expanding coverage holes increases the cost of coverage. But you can survive without a car (at least as long as you pick a reasonable place to live); surviving without healthcare when you need it is more of a question (and tends to increase the cost of care once you do get care).

1dog said:

Or you can go to UK and wait to get treatment for stuff you need cared for now. Have plenty of customers who lived there and had to purchase private. It's all great until your sick.

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The last statement is also true for a lot of U.S. plans. I have good coverage now, which I mostly haven't in the past 10-15 years (aside from two years in Montana where the insurers apparently grossly underpriced a low-OOP max plan after ACA implementation). Aside from the low-OOP max plan years, most of the time I'd have been looking at $2k if I got transported to an ER, plus substantially more if I actually needed care, until I hit the $5k-$6k mark and maxed the deductible and cost sharing...and most of those plans were still more than rent. That trend hasn't changed, as far as I can tell, due to ACA—my costs were going up before then, and they've been going up since then, at rates well above everything else.

1dog said:

Anyone here agree that the RMV or the IRS are great places to do business? And if not, what are your choices? Exactly.

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Ever actually dealt with an insurance claim that got miscoded? I'll take the IRS over a health-insurance company, at least I can find the regulations online.

1dog said:

I don't care if his name is Donald Duck, keep deregulating and let the ( kinda) free market dictate prices. With the savings we all cover those in need, not those in want. Unless it is defense - centralized government does not work.

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Claiming that our current health-care system is even a "kinda" free market is a stretch. Show me a restaurant that won't tell me how much a meal will cost when I'm ordering, but will send me a bill weeks later that itemizes the server, food cost, and back-of-house costs separately (probably with a facility charge for the restaurant itself), with prices that vary depending on whether or not someone else is picking up part of the bill, and which line cook happened to prepare the steak, because one is part of the network and the other isn't. You won't find one, because that's a completely screwed-up way to do business, and it's truly not a capitalistic system, because capitalism requires a consumer being able to make informed decisions. You can try with health care (and some people do better than others), but it's damn near impossible. And that's assuming you even have competing options; in most rural parts of the country, that doesn't really make sense.

Anecdotal example: four x-rays in the same room, with the same machine, on the same leg, a few weeks apart. First one was fully covered (prior to Dec. 31, and I maxed out the OOP on my plan that year). Second one (in early January) cost me something like $35 including all the related line items. Third and fourth were $250 because they were considered "out of network". I only found out about the cost as I was sitting in the waiting room prior to the fourth one and opened the EOB from the previous claim.

1dog said:

Ready to ski wet powder Saturday? If I hit a tree, I gotta pay 1st then they reimburse me. If I live . . . .

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FWIW, the total insurance-paid amount last time I did that was something in the neighborhood of $50k (give or take 10, trying to follow all the paperwork got to be more effort than it was worth at a certain point); total billed was closer to $75k. My out-of-pocket cost thanks to an ACA plan was something like $2250 not counting PT, for which I never got billed (and the therapist said something like, "yeah, the billing system is pretty screwed up. I wouldn't recommend asking about it."); my insurance did pay their portion. Best $303 in premium money I ever spent on any kind of insurance.

I strongly recommend making sure your tree-skiing bindings are appropriate to the task and not set for racing GS.

kbroderick said:

Claiming that our current health-care system is even a "kinda" free market is a stretch. Show me a restaurant that won't tell me how much a meal will cost when I'm ordering, but will send me a bill weeks later that itemizes the server, food cost, and back-of-house costs separately (probably with a facility charge for the restaurant itself), with prices that vary depending on whether or not someone else is picking up part of the bill, and which line cook happened to prepare the steak, because one is part of the network and the other isn't. You won't find one, because that's a completely screwed-up way to do business, and it's truly not a capitalistic system, because capitalism requires a consumer being able to make informed decisions. You can try with health care (and some people do better than others), but it's damn near impossible. And that's assuming you even have competing options; in most rural parts of the country, that doesn't really make sense.

Anecdotal example: four x-rays in the same room, with the same machine, on the same leg, a few weeks apart. First one was fully covered (prior to Dec. 31, and I maxed out the OOP on my plan that year). Second one (in early January) cost me something like $35 including all the related line items. Third and fourth were $250 because they were considered "out of network". I only found out about the cost as I was sitting in the waiting room prior to the fourth one and opened the EOB from the previous claim.

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Why not try fixing this aspect before we throw in the towel on the entire system? I'd like to see an easily read, posted in the doctor's office for common items, online for the rest, summary of procedures and fees. Doctor visit, x-ray, set a bone, blood test, stitch a cut, pull a bean out of your 3 year old's ear. Whatever. How many of us have had a car accident and taken the car to a body shop and walked out with a detailed estimate in 15 minutes? Everything is priced, each part, each procedure, each disposal fee, tax, everything. If 20 minutes of a doctor's time is worth $150, but a 20 minute doctor procedure (same doctor) is billed at $500, what possible sense does that make?

A pill costs $10 for one club, but $40 for a different club, and $150 if you walk in off the street? That should be illegal, and drug prices should be posted as well. You can charge whatever you like, but you don't get to offer secret exclusionary pricing.

More than one medical professional has told me that the system is designed to extricate the most money possible from each provider or patient. Note that all businesses operate to maximize profit, but the medical profession does it behind a wall of pricing chess that you are not allowed to see or compare.

Single payer addresses cost reduction by (supposedly) more efficient delivery of services and a unilateral bargaining agent to the medical community. Why not address the cost side of the equation before you governmentize the payment side of the equation and further reduce choice by the consumer?

fbrissette said:

I am Canadian. The main problem of our system is not what you state (which essentially never happens), but rather the waiting lists for 'non-urgent' surgeries, and wait times at the ER. You may wait several months for a knee replacement surgery, and spend 8 to 10 hours with a broken arm at the ER. For any real emergency however (trauma, cancer, birth), the system is world class and free for anyone. To give you an example, 10 years ago, I felt like shit, went to my family doctor who quickly diagnosed an arrythmia problem. The ambulance was there in 5 minutes. 10 minutes later, I was at the ER and a cardioversion was immediately performed by a team waiting for my arrival. I had several tests done in the next few hours and was released at the end of the day. NO insurance to deal with. Zero paperwork. Did not cost me anything, beside a high tax rate obviously. People going to the States are typically people not willing to wait for minor surgeries, although this is happening less and less since there is a slowly growing private system availble in Canada to those who do want to skip the wait lines.

Not arguing out system is the best, but it is not leaving anyone behind.

Click to expand...

I was in the north country the past 2 weeks. Hotel has Canadian TV. I randomly watch a program, some kind of panel discussion. It turned out to be about some rare forms of Lyme disease and the difficulty of getting treatments in Canada. Several of the patients cross the border for treatment in the US, to the tune of something like $20K.

It was interesting for me to watch because I happened to know someone who had that type of Lyme disease (Lyme got in the brain). Never heard of it anywhere else except in the border region between NH and Canada!

My impression of the saga were, the little "waiting period" for non-life-threatening illness can potentially add up in the event you either don't respond to standard treatments, or the diagnosis were incorrect. Because by the time you're "suppose" to be responding, and you don't, you enter another "short" waiting period, another "short" wait, and yet another "short" wait... By the time you've actually got diagnosed, or a treatment that works on YOU, a year or several year of your life had gone down the drain!

mister moose said:

Single payer addresses cost reduction by (supposedly) more efficient delivery of services and a unilateral bargaining agent to the medical community.

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Isn't that what HMO's do?

Typically, the "saving" is pass back to the consumer as lower premiums too.

But somehow, HMO doesn't have a great reputation. Traditional POS type of insurance are still very popular despite the higher cost. That tells me people may moan about the high cost of medical care in general, a substantial portion are still willing to pay extra for the "best money can buy" medical care!

fbrissette said:

I am Canadian. The main problem of our system is not what you state (which essentially never happens), but rather the waiting lists for 'non-urgent' surgeries, and wait times at the ER. You may wait several months for a knee replacement surgery, and spend 8 to 10 hours with a broken arm at the ER.

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Another problem is many of the best Canuck doctors have fled to America. That's been going on since at least the 1990s.

BenedictGomez said:

Another problem is many of the best Canuck doctors have fled to America. That's been going on since at least the 1990s.

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No longer the case really

https://cmajnews.com/2017/06/15/fewer-canadian-mds-heading-to-the-us-cmaj-109-5419/

Key stat from the article

2006: 8162 Canadian docs practicing in the US
2015: The number had dropped to 6709

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1dog said:

You're quoting fake stats - infant mortality rate for instance: In Switzerland, they start counting after a kid is 2.5 yrs old. US starts at one of the lowest rates - 3 months? Don't recall. Hey, it's not your fault. Humans use stats to further their cause.

And you are free to go to Canada - where 'free drugs' exist as long as someone else pays for them or you do in even higher than US tax rates. And please lets not debate 5 million Fins - they're all Finnish fercryinoutloud and ride bikes and eat fresh fish! We got every kind of race and tribe under the sun and sixty six times that number.

I'll give you another example - my rates went from $850 a month in '08 just before Romney/ObamaCare per month for a fam of 4 w $2K deductible. Jan 2018 went to $2500 per month w $4K deductible. most smaller insurance companies went out of business, consolidation and feds telling them to cover this and that.

Imagine you buy a smashed car and government says GIECO has to cover pre-existing. . . . guess where that $1500 per year rate is going.


No one says its perfect - never will be. Its the best care in the world for the most people, period.

Or you can go to UK and wait to get treatment for stuff you need cared for now. Have plenty of customers who lived there and had to purchase private. It's all great until your sick.

Anyone here agree that the RMV or the IRS are great places to do business? And if not, what are your choices? Exactly.

The same people who can't get along on any polarizing issues want THEM to decide how your healthcare is being divvied up? ( note - Congress is NOT under nor do they have to abide by Obamanation Care - THEY get private - and I repeat - same for Social Security - not for them.) Some of us smoke too much dope.

Here is my cure for $34K annual premiums before I can use the plan: Canned it, got an indemnity catastrophic health sharing of cost plan. Covers ANY thing over $500 with any doc or hospital. I pay for everything under that, including scripts.

Highest cost plan for family of 4 $490 per month. Ask you don't smoke or drink to excess. ( akin to driving w good record right?)

Cut my script bill from $958 per month to $482 by cash and generic. Still saving $10K a year so we got a concierge Dr with some of the extra cash and STILL come out w $6K more in pocket.

I don't care if his name is Donald Duck, keep deregulating and let the ( kinda) free market dictate prices. With the savings we all cover those in need, not those in want. Unless it is defense - centralized government does not work.

My senator ( Chief Spreading Bull, Lie-awatha, Faux-cahantas, etc.) want to put ' $100B toward opiate crisis but not $5B towards a defensive wall where the majority of the illicit drug is traveling thru. Perfect illustration. Will Rogers has many more.

Ready to ski wet powder Saturday? If I hit a tree, I gotta pay 1st then they reimburse me. If I live . . . .

Click to expand...

Have you lived outside of the US?

Edd said:

Have you lived outside of the US?

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I'm sure he hasn't. But given all that right wing drivel that he's lacing into the narrative, facts may not matter all that much.

Millions of people here still without health insurance and even more millions with insurance praying (or they should) that they will never get seriously sick (cancer, long term autoimmune diseases, etc.). That's when people find out that what they have may not save them from financial ruin and switch to "go fund me" plan. And all the money spent may not guarantee a good health outcome. You do know what the number one reason for personal bankruptcies is, right?

Even without being afflicted by some nasty, long term malady, it's easy to be financially ground up by our health care costs even for such standard procedures as giving birth.

1dog, ease up a bit on the right wing anger and mockery and try to look how other 1st world countries, in Europe and Asia set up their health case systems.

Bumpsis said:

I'm sure he hasn't. But given all that right wing drivel that he's lacing into the narrative, facts may not matter all that much...

1dog, ease up a bit on the right wing anger and mockery and try to look how other 1st world countries, in Europe and Asia set up their health case systems.

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I get this is a big and important issue. But, after reading this, I'd suggest taking a deep breath and looking in the mirror before you throw stones over others fostering partisan anger.

This was obviously going to be a testy subject, but debating the merits of the US healthcare system vs. RoW is has nothing to do with skiing and really isn't relevant to the subject at hand.

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eastern powder baby said:

I get this is a big and important issue. But, after reading this, I'd suggest taking a deep breath and looking in the mirror before you throw stones over others fostering partisan anger.

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Comparing post 143 to 157 and suggesting that they’re similar in tone and anger is a false equivalency. I suspect you know that.

eastern powder baby said:

I get this is a big and important issue. But, after reading this, I'd suggest taking a deep breath and looking in the mirror before you throw stones over others fostering partisan anger.

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Taking a deep breath is rarely a bad idea, and I'd rather look at policy cost and impacts based on rational measurements than attempt to foster ange, but..

eastern powder baby said:

This was obviously going to be a testy subject, but debating the merits of the US healthcare system vs. RoW is has nothing to do with skiing and really isn't relevant to the subject at hand.

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The cost associated with the US Healthcare system—particularly funding high-cost, good-coverage, union-negotiated plans that most of us are (or should be) jealous of—is one of the big drivers in the cost of living in Vermont. The state is a huge employer on a per-capita basis (c.f. https://www.governing.com/gov-data/...ent-workers-public-employees-by-job-type.html for an unvetted list), and a lot of that cost is associated with employee healthcare for VSEA members and for education employees (and, I believe, retirees). It's magnified in Vermont because—like other low-population states—there are fewer non-governmental employees to spread the cost around, plus a lot of governmental functions (policing, roads, education) get more expensive per capita as population density goes down.