VAIL SUCKS

[snoseek]

It's the policy of mad men who want to keep as many Americans working 40 hours a week for as long in life as possible to ensure maximum GDP and tax revenue production.

It ain't about clinical outcomes or health system efficiency, that's for sure.

You remove what is essentially an employment mandate if you want to live? How and where people choose to work would be quite different. A lot more opportunistic and periodic hustling vs being slaves to the man M-F.

I use va health if not I would be totally fucked

 

[deadheadskier]

Yes, I do think universal healthcare would be cheaper. IF fully adopted and not the bandaids that exist only because that's what could get passed in our divided government.

I mean there's only dozens of examples globally that proves this point.

 

[Hastur]

Medicare for all would definitely be cheaper. But how are health insurance execs supposed to make 8 figures then? Who is thinking about them?

 

[drjeff]

Medicare for all would definitely be cheaper. But how are health insurance execs supposed to make 8 figures then? Who is thinking about them?

Forget that aspect. How would the system handle that? There's already a significant shortage of healthcare providers now, especially in the primary care field. Then add in who knows how many millions more into the system. And you simply can't train primary care providers overnight. Even if you're looking at Physicians Assistants or Nurse Practioners, let alone M.D.'s/D.O.'s thats probably a shortage that would take at best 10 years, if not more likely heading on 20 years to generate enough well trained providers to meet the demand.

This isn't a simple problem of just "Medicare for all is the answer". There's a BIG workforce issue, with significant training periods and interest generation in those fields that needs to be addressed, almost before any wholesale change can be seriously pondered.

An easier, quicker thing, as has happened in some states, is focus on what is called medical loss ratios (MLR) for the insurance companies, where basically as was set forth in the Afforadble Care Act, a minimum of 80% of premiums collected by insuarnce companies annually have to go to patient care, if not refunds must be issued to those subscribers of the plans. That 80% still generates the BIG profits as all that has happened is the insurance providers charge more, to keep their profit levels high, and often either reimburse providers less or deny more requested procedures. Take the MLR to say 90% and then get some strict caps on how the reimbursement/approval procedures happen for starters. Just have to fight the big insurance lobby, the drug manufacturer lobby and the medical devices lobby, who all seem to just find ways to charge more and more and often with the patient/consumer paying more and more all the while receiving less and less care

 

[skiur]

Medicare for all would definitely be cheaper. But how are health insurance execs supposed to make 8 figures then? Who is thinking about them?

Luigi?


I know, poor taste of a joke.

 

[machski]

Yes, I do think universal healthcare would be cheaper. IF fully adopted and not the bandaids that exist only because that's what could get passed in our divided government.

I mean there's only dozens of examples globally that proves this point.

All I will say is that over the past couple decades at my job, I have flown many a well off Candians to the US for medical care. Why? Because in Canada on their universal system, they get triaged and then put in the que based on the triage level of severity of their problem. Life threatening is obviously immediate, but anything else well. I had one who said she had some type of shoulder issue that was getting worse, the earliest she could get in for a specialist was still 6 months out. She flew to the US and the specialist she saw here wouldn't let her go home, got her straight in for surgery. Said if she waited another week she would have lost most if not all function in that arm. That was the most striking but I've had many that travel across for similar reasons. So no, I'm not certain universal in the US would be better. Then there is the UK's Elite system that most cannot gain access to. It is still fractured no matter the setup.

 

[machski]

Ski patrol is a "job" NOT a career. You want full time benefits get a career. Patrolling should only be used as supplemental income, or volunteer.

Not completely. Director level of patrol is most definitely a career and a full time job. Had to get a copy of my wife's accident report for my accident insurance in the offseason and SR's patrol is absolutely staffed all summer. Many of the full timers do other things in addition for the resort during the offseason(most like to be outdoors so many do work projects across the resort) but someone is always reachable.

 

[ss20]

The most interesting thing SLT brought to light I hadn't heard before, is that the PCMR Ski Patrol Union wants Vail to pay for their benefits packages all year long even though they only work there for 4 or 5 months. I mean, GTHOOH with that ridiculousness!

This might at least partially explain Vail's resistance (and why Vail leaked that fact to SLT). The cost of full annual benefits packages is not cheap.

Ski patrol is a "job" NOT a career. You want full time benefits get a career. Patrolling should only be used as supplemental income, or volunteer.

1. We get year-round benefits at Alta for seasonal work. Rare, but not unheard of in the industry.

2. Ski patrol is absolutely a career, especially out here. It can be competitive to get started on patrol in the Wasatch. Even the corporate resorts try to keep turnover low/patrol happy as they realize cost-cutting on avalanche mitigation and having a first-year throwing charges making $20/hr is a bad idea.

 

[deadheadskier]

Forget that aspect. How would the system handle that? There's already a significant shortage of healthcare providers now, especially in the primary care field. Then add in who knows how many millions more into the system. And you simply can't train primary care providers overnight. Even if you're looking at Physicians Assistants or Nurse Practioners, let alone M.D.'s/D.O.'s thats probably a shortage that would take at best 10 years, if not more likely heading on 20 years to generate enough well trained providers to meet the demand.

This isn't a simple problem of just "Medicare for all is the answer". There's a BIG workforce issue, with significant training periods and interest generation in those fields that needs to be addressed, almost before any wholesale change can be seriously pondered.

An easier, quicker thing, as has happened in some states, is focus on what is called medical loss ratios (MLR) for the insurance companies, where basically as was set forth in the Afforadble Care Act, a minimum of 80% of premiums collected by insuarnce companies annually have to go to patient care, if not refunds must be issued to those subscribers of the plans. That 80% still generates the BIG profits as all that has happened is the insurance providers charge more, to keep their profit levels high, and often either reimburse providers less or deny more requested procedures. Take the MLR to say 90% and then get some strict caps on how the reimbursement/approval procedures happen for starters. Just have to fight the big insurance lobby, the drug manufacturer lobby and the medical devices lobby, who all seem to just find ways to charge more and more and often with the patient/consumer paying more and more all the while receiving less and less care

Wait, you think the existence of Medicaid is part of the reason for provider shortage and expanding these programs / adopting UHI will exasperate the problem? What podcaster told you to believe that?

And I have to stick up for my industry (medical device) at least a little bit. This idea that companies like mine constantly raise prices and just print money for themselves is false. I can tell you that Anesthesia machines and Cardiac monitors are actually less expensive and last longer today than they did 20 years ago. I can also tell you that pricing for such is very transparent and the buying contracts are long lasting. Hospitals all use group purchasing organizations and the vast majority of pricing is negotiated with these large, powerful groups for many hundreds of hospital as a whole. I can't just target a hospital with lots of money like a Mass General and charge them more than Grace Cottage Hospital. We would get thrown out of the GPOs and not be able to sell at all.

 

[thetrailboss]

How did we get from VAIL SUCKS to Healthcare Sucks?

 

[snoseek]

In other news it's looks like it's still 1 run open at wildcat...predictable. I'm sure at some point I'll be missing my epicpass and wildcat this winter but certainly I'm not yet so far.

Fuck vail and fuck us healthcare.

 

[deadheadskier]

All I will say is that over the past couple decades at my job, I have flown many a well off Candians to the US for medical care. Why? Because in Canada on their universal system, they get triaged and then put in the que based on the triage level of severity of their problem. Life threatening is obviously immediate, but anything else well. I had one who said she had some type of shoulder issue that was getting worse, the earliest she could get in for a specialist was still 6 months out. She flew to the US and the specialist she saw here wouldn't let her go home, got her straight in for surgery. Said if she waited another week she would have lost most if not all function in that arm. That was the most striking but I've had many that travel across for similar reasons. So no, I'm not certain universal in the US would be better. Then there is the UK's Elite system that most cannot gain access to. It is still fractured no matter the setup.

These anecdotal examples like yours or Mick Jagger getting heart surgery in NYC only demonstrate that if you have the means, yes there's excellent healthcare available here. You and I are not Mick Jagger.

They do nothing to look at overall cost and results for a population, both of which the US score very poorly on; especially as the wealthiest nation on earth. That's data that matters.

Do 41% of Canadians have medical debt like we do here? Nope. 17.1%, which happens to be second worst in the world. We are number one there by a wide margin.

 

[deadheadskier]

In other news it's looks like it's still 1 run open at wildcat...predictable. I'm sure at some point I'll be missing my epicpass and wildcat this winter but certainly I'm not yet so far.

Fuck vail and fuck us healthcare.

Yup. And Attitash only has the Progression quad, Spillway and a couple of beginner trails open today. They aren't even top to bottom on one side, nevermind being TTB on both and connected by now like most years under Peak.

 

[drjeff]

Wait, you think the existence of Medicaid is part of the reason for provider shortage and expanding these programs / adopting UHI will exasperate the problem? What podcaster told you to believe that?

And I have to stick up for my industry (medical device) at least a little bit. This idea that companies like mine constantly raise prices and just print money for themselves is false. I can tell you that Anesthesia machines and Cardiac monitors are actually less expensive and last longer today than they did 20 years ago. I can also tell you that pricing for such is very transparent and the buying contracts are long lasting. Hospitals all use group purchasing organizations and the vast majority of pricing is negotiated with these large, powerful groups for many hundreds of hospital as a whole. I can't just target a hospital with lots of money like a Mass General and charge them more than Grace Cottage Hospital. We would get thrown out of the GPOs and not be able to sell at all.

No, Medicaid/care isn't the cause of provider shortages, I didn't say that. Expansions in the Medicaid/care roles certainly have played a part in exposing how much of a shortage of care providers, especially the primary care area, and that is something that a medicaid/care for all bringing more people into the system, would further increase the provider shortages. That isn't a problem that would go away quickly, nor is it a problem that happened overnight. It's been a process that has taken probably a good decade or 2 to get to where it is now, and will likely take atleast as long, if not longer to fix from a provider quantity perspective. There are only so many things that can be automated, as at somepoint, many things will take actual people to do properly

And frankly as to the medical devices side of things, yes, those costs DO play a role in the overall picture, whether or not you want to admit that. If I, or a hospital, has to have some new machine/system because it's either mandated or has become the standard of care, that costs $$ to acquire obviously. Then if the insurance company side of things starts decreasing reimbursement rates, as they often do, then that squeezes the actual people who are providing the care, as if one is practicing in an insurance based system, they are often are beholden to charging what the insurance companies say is usual customary and reasonable, and can't bill for the difference. And how often does the "latest and greatest" machine cost the actual provider less than the previous one did

 

[snoseek]

^^^^ how about we poach some people from the rest of the free world who already have this problem figured out?

 

[snoseek]

Yup. And Attitash only has the Progression quad, Spillway and a couple of beginner trails open today. They aren't even top to bottom on one side, nevermind being TTB on both and connected by now like most years under Peak.

Yet another ugly vacation week with lots of pissed off customers in nh.

 

[thetrailboss]

"Well, you know what sucks more than Vail? Healthcare. Keep talking about Healthcare and stay EPIC my friends!"

 

[snoseek]

"Well, you know what sucks more than Vail? Healthcare. Keep talking about Healthcare and stay EPIC my friends!"

I feel like this dude and the world of health insurance are a perfect fit if vail ever falls apart

 

[deadheadskier]

No, Medicaid/care isn't the cause of provider shortages, I didn't say that. Expansions in the Medicaid/care roles certainly have played a part in exposing how much of a shortage of care providers, especially the primary care area, and that is something that a medicaid/care for all bringing more people into the system, would further increase the provider shortages. That isn't a problem that would go away quickly, nor is it a problem that happened overnight. It's been a process that has taken probably a good decade or 2 to get to where it is now, and will likely take atleast as long, if not longer to fix from a provider quantity perspective. There are only so many things that can be automated, as at somepoint, many things will take actual people to do properly

And frankly as to the medical devices side of things, yes, those costs DO play a role in the overall picture, whether or not you want to admit that. If I, or a hospital, has to have some new machine/system because it's either mandated or has become the standard of care, that costs $$ to acquire obviously. Then if the insurance company side of things starts decreasing reimbursement rates, as they often do, then that squeezes the actual people who are providing the care, as if one is practicing in an insurance based system, they are often are beholden to charging what the insurance companies say is usual customary and reasonable, and can't bill for the difference. And how often does the "latest and greatest" machine cost the actual provider less than the previous one did

I can tell you from a fiduciary responsibility standpoint, it is the hospitals often more than their vendors that causes that problem. If you are ever in an OR at Springfield Hospital (VT) take a gander at the $75k Anesthesia machines they have that are the same as Brigham and Women's even though a $20k machine could cover all of their clinical needs. That or hospitals just cutting POs to the vendors they always worked with because that's the path of least resistance and what's easy vs evaluating new technologies that are better and perhaps cheaper.

It's a lot different at Physician owned surgery centers (or dental practices ) where they spend their own money. They will hold onto equipment until they run out of duck tape. But at a hospital when you get to spend someone else's money? Many, many piss poor financial decisions are made. If you really want to look at what segment there is the problem, it's electronic health records cost more than devices. IT is by far the biggest cost center at a hospital after payroll.

I think there are many other more impactful factors than Medicaid that impact provider shortages.

 

[Hastur]

This isn't a simple problem of just "Medicare for all is the answer". There's a BIG workforce issue, with significant training periods and interest generation in those fields that needs to be addressed, almost before any wholesale change can be seriously pondered.

Ok, lets phase it in then.

Every 5 years lower the medicare eligibility age by 5 years. that gives us time to phase in the higher tax rate too.

That should also give us time to train and recruit people.

the largest amount of uninsured are under 44 (with 18 and under being uninsured at a 5% rate which is just criminal for a first world country)