[ExI] medical costs

Thu Feb 21 21:34:33 UTC 2008

"Message: 22   Date: Sun, 17 Feb 2008 15:44:32 –0800  From: "Lee Corbin" <
lcorbin at rawbw.com>

Presumably you would want to eliminate the costs you associate with
inconvenience, too!  Why not with our better technology have highly trained
personel at your beck and call over the web?  That is, any time day or night
you want medical care, it's free."

<<Telemedicine accomplishes this.  It may be to access professionals covered
by the same medical payor in the same country or perhaps  in another time
zone or even in time zones abroad by contract between the home country and
another country with a similar system .  Ex.. Canada and Germany and
Australia…MFJ>>

"Not going to happen.  The rationing will take place other ways.  "

<<hate to break it to you it already does .. use the term QALY (quality
adjusted life year) in a research journal database and you will discover
that most developed countries public and private HMO's have an
institutionalized rationing system in place…MFJ>>

"The nice thing about having individuals face the costs themselves is that
we obtain a very
clear first cut on necessity."

<<see further down re the internal billing value VS the direct to consumer
value for the same service quote from The Avantguardian….MFJ>>

Message: 4       Date: Mon, 18 Feb 2008 01:08:07 -0800 (PST)     From: The
Avantguardian < avantguardian2020 at yahoo.com>            Subject: Re: [ExI]
Medical Costs

"Well if you saw how much a hospital bills insurance companies for a piece
of gauze, you could get the feeling that the medical industry had that
attitude. It is a very strange industry to say the least. Most
hospitals are classified as not-for-profit corporations for tax purposes
although huge revenues are generated and quickly dissipated before tax time.
The federal government indirectly sets the costs of
medical care by negotiating Medicare contract rates with the hospitals.

Hospitals bill private insurance for about twice what it charges the federal
government for any particular service. The insurance companies turn around
and typically pay the hospitals between 60% and 80% of what they get billed
for and the hospital eats the remainder. Of course if
you pay out of pocket, you pay the full "retail" rate. So in what other
commodity does the government contract rate for that commodity serve as a
*minimum* price for that commodity? Certainly not hammers and toilet seats
in the pentagon.

The rationing will take place other ways.  How, like charging exhorbiant
tuition for medical school?"

<<This already happens in Canada.  The College of Physicians and
Surgeons,  deems
it  their domain to set how many training seats will be offered at Medical
School…MFJ">>

"Right, people are the best judges of whether they need medical care or not.
Which is why cancer patients end up being diagnosed too late for surgical
resection and macho men having heart attacks insist on driving themselves to
the hospital.

Message: 12     Date: Mon, 18 Feb 2008 20:45:11 -0800
From: "Lee Corbin" <lcorbin at rawbw.com>           Subject: Re: [ExI] Medical
Costs

"The medical industry is "strange" only because a disconnect has been
created between who receives the service and who pays for it.

If a *patient* received such a bill for a piece of gauze, of course he'd be
outraged by it, and he'd make sure that the doctors and the hospital felt
his pain---and most importantly of all, he would take his business to
another doctor and another hospital. But it's only an *insurance* company
that gets the bill---and try as they might to protest and to try to force
doctors and hospitals to economize (or forego procedures)---it finally is
easiest to just raise their rates.

Later on, for all things it will be only the *government* that gets the
bill, and the bureaucrats will find that the easiest path is just to raise
taxes.  Luckily, less than half of the voting population pays 95 percent of
the taxes, and so the electorate won't have any problem with higher taxes.

<<We in Saskatchewan out of a total public budget of about 6 billion spend
38% on medicare.  USA senator Byron Dorgan says that the USA system is
unsustainable and that a plan to reduce its costs will be drafted and
implemented.. ..MFJ>>

" The federal government indirectly sets the costs of medical care by
negotiating Medicare contract rates with the hospitals.

Only a free market is capable of delivering the economies that  we need so
bad."

<< So what is a state/HMO  to do… use the 50,000 USD maximum value of a QALY
allowed before severly rationing access through criteria  (clinical
elegibility to quote  the 13 Feb 13, 2008 pg B-7 piece on an article from
the Estevan Mercury  entitled Coverage approved for Cancer Drug (avastin)…
in which it is stated that :  "until now patients with advanced colorectal
cancer had to pay for Avastin themselves, at a cost of #2,000 CAD per dose.
An estimated 80 patients per year will  (now) be clinically elegible to
receive Avastin."…MFJ>>

"Hospitals bill private insurance for about twice what it charges the
federal government for any particular service. The insurance companies  turn
around and typically pay the hospitals between 60% and 80% of what they get
billed for and the hospital eats the remainder.

It's a real mess, all right. But from your figures (thanks for the
descriptions) it looks like the hospitals still get more from an insurance
company that they do from the government. Doesn't this mean that after the
U.S. socializes, the government will have to get charged more?"

<<What the large HMO's and government systems do is negotiate for drugs and
services and  set criteria for coverage. So if for example the pharma
company supplying avastin want to supply 240 patients at $1000/ dose the
government would  re-do the criteria based on the new QALY numbers.  The
drug company must then  decide if it wants more total revenue with less
margin per unit or less revenue from a smaller sale at full retail ….MFJ>>

"Which is why cancer patients end up being diagnosed too late for surgical
resection and macho men having heart attacks insist on driving  themselves
to the hospital………..You sound as though you want to take this freedom away
too. You'll want to be forcing those macho guys to get checkups whether they
want to or not?

I admit that medical care will be better if people's choices in the matter
are taken away. I mean,even after you make cancer diagnosis completely free,
people will still face "costs", e.g.,
the inconvenience or fear (or humiliation) of getting a checkup."

<< so perhaps ugrade the system so that patients have access to the same
medical literature as medical students at university.  In Saskatchewan
perhaps make a yearly physical mandatory to qualify for medicare, but
provide everyone who has medicare coverage access to PAWS , the University
of Saskatchewan comprehensive journal database so that they can be more
informed consumers who pose a lesser economic risk to the public funded
service?…MFJ>>

Message: 14     Date: Mon, 18 Feb 2008 23:02:30 –0600  From: "Tom Tobin" <
korpios at korpios.com>         Subject: Re: [ExI] Medical Costs

"What *does* seem broken under the current system is the extraordinary care
that goes towards newborn infants, vs. mediocre care for many adults.  Any
adult of at least middling intelligence is worth more than *any* infant, and
it strikes me as insane that medical resources are poured towards the latter
without any thought to cost."

<<The QALY does weight their costing so that the young and middle aged
productive taxpayers get more access and fewer restrictive criteria for high
cost services than the elderly…..it is something no government person or
minion would want to volunteer for open discussion….MFJ>>

"I don't think we can reasonably help that; we can only make it as easy as
possible.  We'd get far more bang for our buck, though, by concentrating on
prevention."

<<I have found one paper that considers the matter of valuing the QALY
derived from preventative dietary measures…MFJ>>

Message: 16     Date: Mon, 18 Feb 2008 23:26:50 –0600  From: Damien
Broderick <thespike at satx.rr.com>            Subject: Re: [ExI] Medical Costs

"And yet (I know it's very wicked to say this) the cost of
medical/surgical/hospital care in Australia and the UK, much of it mediated
by government funding, is significantly less than it is in the USA. As
Stathis posted last year: "The US spends a greater proportion of GDP on
health care than most developed countries but has worse overall health
outcomes than most developed countries." No, no, look away, look away."

<<perhaps part of that is that the millions of uninsured persons  make up a
larger number of the poor health outcomes than those with well funded
private HMO plans….MFJ>>

Message: 17     Date: Mon, 18 Feb 2008 22:15:09 –0800  From: "Lee Corbin" <
lcorbin at rawbw.com>           Subject: Re: [ExI] Medical Costs

"How to resolve this impasse?  Oh, I know---your solution as most people's
is "let's vote!", and then the winning sides gets to force the losing side
to do it their way.

I know that it seems odd not to have the government just *force* the optimal
solution on everyone.  After all, the government can hire extremely smart
people to figure out what is best, and then
see to it that everyone follows the prescriptions of these regulators
(alphabet agencies) or law-makers (federal court justices). But I'm telling
you, it actually worked better back then using the old traditions, called,
incidently---for future reference---freedom and liberty."

<<So how do you handle the trend for people to not bother to vote….a
majority of the actual vote is not a majority of the entire
population?   Non-voters
seem to want the same right to complain after the fact.

Experts may say they are not biased, but policy analysis would suggest
otherwise….MFJ>>

Message: 18     Date: Tue, 19 Feb 2008 00:44:11 –0600   From: Damien
Broderick <thespike at satx.rr.com>            Subject: Re: [ExI] Medical Costs

Each child in a family is now especially, unprecedentedly, precious.
http://www.pbs.org/fmc/timeline/dmortality.htm  "

<<And a public forced to ration will now choose to adopt access criteria
which favors this group…..MFJ>>

Message: 20     Date: Mon, 18 Feb 2008 22:55:28 –0800  From: "Fred C.
Moulton" <moulton at moulton.com>          Subject: Re: [ExI] Medical Costs

"In particular it is useful to document the nature of what you want the
health care system to do and the nature of the persons involved.  Define
the inputs, the outputs, all of the relevant parameters and the criteria
used for making a decision."

<<Try doing a query using the term QALY and read the papers.  The decision
making process is well documented….MFJ>>

Message: 21     Date: Tue, 19 Feb 2008 23:02:40 +1100   From: "Stathis
Papaioannou" <stathisp at gmail.com>

"That doesn't seem to be the case in my experience of Australian public
hospitals. The health bureaucrats fight fiercely to give hospitals as little
money as possible and to get maximum value out of every dollar. If a
hospital under-performs or over-spends, management is liable to be
sacked. The idea is to ensure not only that the finite health budget is
spent equitably, but also efficiently."

<<What these systems have not done is determine how to expand their scope
from delivery of health care services to the delivery of health care
outcomes.   They are not comfortable to create a truly educated customer
base so that medicare becomes customer-driven and funding is based on the

ability of the medicare/patient partnership to deliver actual QALY costing
values which come out lower than those currently on the books….MFJ>>

Message: 23     Date: Tue, 19 Feb 2008 10:08:13 –0600   From: "Tom Tobin" <
korpios at korpios.com>         Subject: Re: [ExI] Medical Costs

"Until we hit serious cognitive enhancement, we're not dealing with
rational, or particularly bright, agents when we're talking about people.
 (Not meant to insult anyone in particular; I don't consider
myself particularly bright or rational in comparison to what I *could* be
with a few choice upgrades.)

I *am* ambivalent about libertarianism vs. the liberal-welfare-state when it
comes to transhumanism, I'll admit; the welfare state is better for
*unaugmented* humans, but becomes stifling for
transhumans/posthumans.  I don't know how to resolve this; I'd be better off
here-and-now under a solid welfare state, but I'd curse myself the moment
the serious cog upgrades came along ... but one
might not *get there* without the welfare state. "

<<I  SOLIDLY DISAGREE, THE WELFARE STATE IS BASED ON MAINTENANCE OF AVERAGE
VALUES AND NOT PROVIDING THE MEANS FOR INDIVIDUALS TO CREATE ENHANCEMENTS.

IF SPORTS ARE ANY INDICATION PEOPLE LIKE TO SEE THEIR NEIGHBOURS STAY DOWN
IN THE SWAMP AND REGULATORY STRUCTURES ARE FOR THE MOST PART FOCUSED UPON

ENSURING NO ONE DOES BREAK RANK…..MFJ>>

Message: 1       Date: Wed, 20 Feb 2008 19:47:42 +1100 From: "Stathis
Papaioannou" <stathisp at gmail.com>       Subject: Re: [ExI] Medical Costs

"It's why gambling is popular."

<<Gambling is not allowed to give the poor a chance to get rich, it is
allowed because the house always wins and the house (the state) finds
exploitation of this desire enormously profitable…MFJ>>

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