115 Comments

Echoing economists Amy Finkelstein (MIT) and Katherine Baicker (UC), basic universal coverage provided to everyone [with the option/market for individuals to purchase further coverage]is the most efficient delivery of healthcare. Defining what services fall under "basic" is the hard part.

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Planet Fitness is $10/month. Walking is free. An Apple a day keeps you know who, away.

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Well explained. Thanks for sharing this.

It's really disappointing how something as crucial as healthcare, which should indeed be considered a basic human right, is being taken advantage of and turned into a huge profit-reaping industry.

It just shows that if people don't exercise self-control and have a solid set of moral values, then we can easily get seduced and corrupted by the attraction of money, thus eroding our sense of morality and humanity for others.

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Ukraine has healthcare courtesy of the US taxpayer . . . and so does the millions invading the Southern border . . .

EVERY YEAR THE UNITED STATES SENDS AN EIGHT-THOUSAND DOLLAR HEALTH INSURANCE DEDUCTABLE FOR EVERY NATURAL BORN U.S. CITIZEN, JUST TO ISRAEL ALONE.

We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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Maybe too reductionist, but this piece shows that people want health w/o paying for it, want life w/o death, and in my experience just want w/o consequences. Yes, it's really hard to have any kind of ill-health, not to mention a diagnosis that often shortens our lives dramatically. The moment we are born we are headed for death, quickly or painfully slowly. At least in the US, many have an unhealthy, unrealistic expectation about our trajectory through life and medicine/healthcare. As well as the consequences (and inevitable complications) of medical interventions. Consequences/complications of all sorts. Until people have more realistic expectations, I don't think any amount of reorganization of healthcare is going to yield better health - however you define health.

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Ukraine has healthcare courtesy of the US taxpayer . . . and so does the millions invading the Southern border . . .

EVERY YEAR THE UNITED STATES SENDS AN EIGHT-THOUSAND DOLLAR HEALTH INSURANCE DEDUCTABLE FOR EVERY NATURAL BORN U.S. CITIZEN, JUST TO ISRAEL ALONE.

We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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Until our country - starting with our local communities - completely reorganizes the way we do medicine, US healthcare is "headed for disaster" on all counts. "Medicare for all" will not fix things; insurance companies will continue to focus on useless "box checking" to meet "quality measures". The elephant in the room, that I do not hear anyone at a level to enact some change to be focusing on, is that the aging population is going to decimate our health care system! "Medicare for all" - how would that possibly happen when we don't have near enough physicians to see all these patients; not even enough ARNP or PA's! The oldest baby boomers are just now turning 80 - real frailty tends to set in at 85 and the initial front has not reached that yet. Per population data, more people will turn 65 this year than any other year in history! This huge group of 60-80 y/o people are just starting to put stress on the entire medical system. I'm not sure anything else matters. Until we stop approaching 85 year olds pretty much the same way we approach 65 year olds, until we have more community organization as to how we use our specialists, until we stop distracting primary care with fake "quality measures" and forms/documentation ,etc, nothing else really matters in the long run. We are headed for disaster.

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Ukraine has healthcare courtesy of the US taxpayer . . . and so does the millions invading the Southern border . . .

EVERY YEAR THE UNITED STATES SENDS AN EIGHT-THOUSAND DOLLAR HEALTH INSURANCE DEDUCTABLE FOR EVERY NATURAL BORN U.S. CITIZEN, JUST TO ISRAEL ALONE.

We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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Good point.

I'm old enough and have been in the group health insurance business long enough to remember my reviewing this or that company's health insurance "handbook" and regularly found that maternity benefits had been sold to that company as a rider to the basic plan. Can you imagine that being the case somewhere in the US today? I think my parents paid 70 or 80 dollars for my delivery (uninsured)--that was the total bill--which included a five day stay for my mom at the local hospital. Products and services always go up significantly in cost once insurance (speaking of health insurance) becomes a covered benefit.

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One of the reasons that medicine is doomed is because it has ceased to be about health and now has become about "fixing" symptoms. Doctors have become drug pushers.

Read "How we do Harm" by Dr. Otis Webb Brawley, M.D.

Watch the documentary "Medicating Normal" and "The Medicated Child"

If we went back to everyone paying as they go we'd have better results. Drug companies will promote drugs with cherry picked results (watch the documentary) for profit. (Some) doctors will continue to take money to line their pockets from those same companies. The government in collusion with social media will dox anyone with an opinion that's different.

Who can you trust anymore?

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Maybe I'm struggling to make this connection but I seem to see 2 things happening simultaneously.

1. As a people the western world is becoming extremely risky adverse. Safety has become all important and cost is of no consequence. We have more people afraid of germs with Cloroxes homes than ever before. If the Wright brothers were safety concerned they never would have gotten off the ground.

2. We fear everything to the point of screening for everything....just in case.

This need for safety that has been driven in to the Western world has led to a perverse need to have tests constantly.....to keep us safe and protected.

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Absolutely true. If we applied the same standards of safety in "health" to everything else, no one would dare drive a car or, perhaps, not even leave their home. But wait; most accidents occur in the home. What is one to do?

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We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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I have read that blood tests are not terribly accurate for diagnosing cancer. Does anyone here have lnowledge about this?

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HC (including Medicare), SS, and debt interest payments will soon take the lion’s share of tax revenue. Game over.

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Of course he is correct.

This system is too far gone to fix. While not a supporter of universal healthcare, it is the only way to control the outrageous spending. However, while the vast majority will receive universal care, the well to do will continue to receive concierge care. If the politicians could figure out a way to avoid overt government oversight and side step the inevitable voter backlash when dissatisfaction erupts, they would have done it a long time ago. The current system however rewards Pharma companies, medical device makers, insurance companies, etc. That's an awful lot of re-election funding to replace. Bring on the universal healthcate.

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The "only way to control" with who in charge? Someone (and it'll be the government) will handling it just like they do Medicare. Why can't a person opt out of Medicare? Why is it that if you want a procedure and Medicare doesn't approve it you can't pay cash for it?

I say make it a cash system and if you want supplement those under a certain criteria and be done with it. Then you can "shop" doctors with your feet!

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I agree with you completely. The path to a cash and value system is impossible with our current political and regulatory system given the dependency of so many people profiting from it. Unfortunately, we are doomed to experiencing the inadequacies and counterproductivity of government controlled healthcare which will result in the people finally realizing the value of a true marketplace and realistic value for worth. Its going to be long and painful, but that's human nature. We haven't come as far as we think. We might as well get started with the process. Unfortunately, I won't live long enough to see if I'm vindicated.

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Opt out of the system. I haven't had "insurance" since Obamacare started. We opted for a HealthShare (and actually haven't even had to use it but once). We've now opted out of that because one of us is "eligible" for Medicare. Not taking it. Going cash. The only time I plan to rely on the medical establishment is in a TRUE emergency then I'll be a cash patient. That's how I plan to live.

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Good luck. Stay healthy. Best wishes.

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Thanks!

And remember if you go to a doctor/hospital and Medicare won't pay for it then even if you have cash you can get it. Go out of the country and then it's all out of your pockets.

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Perhaps it has to implode, then be remade in such a way as to actually benefit the patient.

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We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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My plan for sensible healthcare reform...

1. Consolidation

a. Consolidate all four federal health care bureaucracies into ONE universal primary care system. The federal government will divest it’s responsibilities in the disparate needs and requirements of special populations and complex medical care and focus on an efficient, consistent, and fiscally stable universal primary care system that covers all primary care services for everyone in the United States from birth to death.

b. Services covered may include:

i. Routine Prenatal Care

ii. Routine Labor and Delivery

iii. Primary Pediatric Care

iv. Primary Adult Care

v. Routine office based procedures

vi. Routine Vaccinations

vii. Home Health

viii. Long-term Skilled Nursing Care

ix. Outpatient Mental Health Care

x. Long-term Institutional Mental Health Care

xi. Routine Pharmacy Benefits

c. Federal reimbursement models for those who are unable to pay for catastrophic health insurance may cover emergency services, complex medical care, and hospital care.

d. In addition, a safety net of regional medical centers would rely on multiple funding sources, including local, state and federal support as well as subsidies for medical training programs.

2. Realignment

a. Medical education, research institutions, allied health professions, hospital systems, pharmacies, and outpatient facilities must stay in their own lanes to optimize healthcare delivery efficiently and effectively.

i. The ACA encourages consolidation to “coordinate care for improved patient outcomes, better quality care, and cost savings.” Unfortunately, this consolidation often reduces competition, limits services and raises costs.

b. Redesign and realign the Medical Industrial Complex (MIC) to meet the needs of our population, not the needs of investors by prioritizing value-based products and services over profit-based products and services.

3. Regulation

a. The Health Insurance Industry (HII) must be outlawed from practicing medicine and be reined in and tightly regulated. Future health insurance products should exclusively focus on covering patients’ catastrophic health care financing.

b. Healthcare management must be severely restricted and focus on customer service rather than denial and delay of care.

c. Compliance and healthcare certification of clinical standards and quality must be streamlined, relevant and useful. Reimbursement must be divorced from certification.

d. Publicly traded, investor-driven, for-profit and "not-for-profit for-profit" medical systems would be outlawed. Predatory profit schemes without regard to service or utility or purpose would be outlawed. The primary role of antitrust law is to protect consumer welfare through low prices, high quality, efficiency, innovation, and choice. The FTC and the DOJ must aggressively enforce our antitrust laws.

e. We must create industry wide billing standards and price transparency.

f. Stop the undue influence of the pharmaceutical industry on providers, researchers and government agencies. Allow for federal negotiations of wholesale drug prices.

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Quite a list of recommendations. Since I have neither the time nor the patience to respond to each one, I will address only the first and last.

The first is a proposal for more consolidation. It is hard for me to imagine more consolidation than we already have. The Medicare and Medicaid bureaucracies already rule the roost in that HMOs and now corporatized medical organizations have partnered with them and largely accept the prices and services that are allowed. Taxpayers (and government debt) supply the money and the organizations carry out the rationing of care that is required. Combining multiple bureaucracies into one doesn't seem like a great idea. Take a look at the US Postal Service whose idea of innovative thinking is to close on Saturdays.

The last item is a real howler. Stop the undue influence of the pharmaceutical industry by allowing for federal negotiations of wholesale drug prices. In order to see how that might turn out just look at the cozy relationship that has evolved between the federal government and the manufacturers of munitions or the aerospace industry---some real bargains there.

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Ukraine has healthcare courtesy of the US taxpayer . . . and so does the millions invading the Southern border . . .

EVERY YEAR THE UNITED STATES SENDS AN EIGHT-THOUSAND DOLLAR HEALTH INSURANCE DEDUCTABLE FOR EVERY NATURAL BORN U.S. CITIZEN, JUST TO ISRAEL ALONE.

We can't afford healthcare for American children because we need to keep bombing everybody else's for the love of Jesus and Israel . . .

https://cwspangle.substack.com/p/we-cant-afford-healthcare-for-american

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One commentor correctly pointed out that we should return to the days before HMOs began in 1974. But we really need to go back a little further---to the days before the government instituted Medicare and Medicaid in the mid 1960s. Those were the seeds of destruction that led to the current sad state of affairs. It is hard to believe that anyone would think that more government control would solve anything. Misleading terms like "single payer" apparently put blinders on some people's eyes. This always means government control.

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Well said.....and so sadly true.......how can we stop this bus!!!

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See my comment above. A good first step would be to eliminate Medicare and Medicaid. I would also eliminate drug laws that require prescriptions. Any adult should be able to purchase whatever drug they wish without a prescription. They may choose to consult a doctor or not. And, before anyone asks, I do mean any drug.

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Private pay would drive costs downward. Patients would (without insurance) be incentivized to locate and use more cost-conscious providers with good reputations. Health insurance insulates both the insurance members AND the providers from the actual cost of a given course of any covered treatment. I’m not saying it’d be perfect. But neither is our current methodology. Not-for-profit insurers are not the answer. Last time I checked, we have our share of those here, and they do a terrific job of premium shadowing.

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Did you ever notice when we went from going to the doctor if you were sick to "your insurance pays for a yearly check up"? What about dentists "your insurance pays for two dental visits a year" ... when did that start? Do we really need to see a dentist twice a year. Maybe if people pulled the cash out of their own pocket they would think more.

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