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      05-01-2019, 03:27 PM   #67
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Originally Posted by DETRoadster View Post

There's a huge swath of folks you are leaving out. Most of my 30+ employees for example. They are making $40k to $50k / year and have $2500 deductibles for insurance. They are paying $1500 to $2000 a month in rent to live in this city if they live alone Most have to have roommates. Most chose not to have cars to save money. Most are saving for a house and putting off having kids due to costs. They contribute to their 401Ks despite money being tight. By in large they make pretty sound financial choices. More so then I did at that age. And $500 to them for a doctor visit and a Rx is a ton. It's likely their entire discretionary income for a month or more.
I understand what you are saying and think we will just never see eye to eye on this, but that is okay.

I certainly think that health care costs are too high in this country - but more government intervention won't solve it - it will just make it worse. The bulk of healthcare costs are primarily driven by either the government doling out crony capitalism and causing artificial monopolies or due to the lack of tort reform laws being implemented and obscene malpractice payouts causing that cost to be pushed down to the consumer and also causing many doctors to over prescribe and over test to avoid 'what if' scenarios in a court room.

With respect to your situation of your employees, see below:

1. You live in Seattle, one of the most expensive places in the country. Of course a larger percentage of discretionary income will go to basics such as rent, transportation, and food. This is a choice, however, that those who reside in your town make. It isn't forced, especially not for those working for you. They obviously have skill and can go anywhere should they desire.

2. $40,000 gross income in Seattle for a single individual will qualify them for Apple Health Medicaid programs. Maximum income levels for WA State Apple Health Medicaid is MAGI of no more than 193% of the FPL. That translates to $2,720/mo, which comes out to a MAGI of $32,640/year. $40K/yr less any allowable deductions, such as for retirement-plan contributions, student loan interest and health insurance premiums will probably get you there. As such, my original point still applies. In Seattle, you are basically paying poverty wages at $40K per year.

3. Will $500 wipe out all their disposable income for the month? Yup, probably. But it is unrealistic to say that will happen every month and even if it did, they would meet their OOP maximums within just a few months. So while certainly not ideal, it isn't the end of the world.

--------

My question I always ask and never get a rational answer though, is this. How will having the federal government run this program make it any better? Where in history has the federal government run something in this country better, more efficiently, and with lower costs than the private sector? Finally, go visit a VA hospital and ask some of the vets (I am one - I refuse to go) what they think about the quality of that care. It's abysmal. Do you think expanding that on a national scale would make it better or worse?
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      05-01-2019, 03:39 PM   #68
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Originally Posted by MKSixer View Post
This is also incorrect. Hospital costs account for almost 1/3 and drug/device are just under 10%.

Per the CDC:
https://www.cdc.gov/nchs/fastats/hea...penditures.htm
I should have stated Profit. I had profit in there then changed it, then meant to change it back.

Also, to note, your expenditures dont break out expenditures for the medical devices and pharmaceuticals from actual hospital costs (room/board, facilities services, procedures, etc). The prescription drug category listed comes from the Retail outlet sales of medical products category, which is outpatient sales.
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      05-01-2019, 03:42 PM   #69
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Originally Posted by Run Silent View Post
I understand what you are saying and think we will just never see eye to eye on this, but that is okay.

I certainly think that health care costs are too high in this country - but more government intervention won't solve it - it will just make it worse. The bulk of healthcare costs are primarily driven by either the government doling out crony capitalism and causing artificial monopolies or due to the lack of tort reform laws being implemented and obscene malpractice payouts causing that cost to be pushed down to the consumer and also causing many doctors to over prescribe and over test to avoid 'what if' scenarios in a court room.

With respect to your situation of your employees, see below:

1. You live in Seattle, one of the most expensive places in the country. Of course a larger percentage of discretionary income will go to basics such as rent, transportation, and food. This is a choice, however, that those who reside in your town make. It isn't forced, especially not for those working for you. They obviously have skill and can go anywhere should they desire.

2. $40,000 gross income in Seattle for a single individual will qualify them for Apple Health Medicaid programs. Maximum income levels for WA State Apple Health Medicaid is MAGI of no more than 193% of the FPL. That translates to $2,720/mo, which comes out to a MAGI of $32,640/year. $40K/yr less any allowable deductions, such as for retirement-plan contributions, student loan interest and health insurance premiums will probably get you there. As such, my original point still applies. In Seattle, you are basically paying poverty wages at $40K per year.

3. Will $500 wipe out all their disposable income for the month? Yup, probably. But it is unrealistic to say that will happen every month and even if it did, they would meet their OOP maximums within just a few months. So while certainly not ideal, it isn't the end of the world.
Very true. I've been fighting that battle for years and losing. Problem is, for every 1 person who refuses to take the job at that rate there's 10 more who will. It's "industry standard" rate for this type of job in this area. if every other company was paying more, we'd have to change but they arent so we dont.

--------

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Originally Posted by Run Silent View Post
My question I always ask and never get a rational answer though, is this. How will having the federal government run this program make it any better? Where in history has the federal government run something in this country better, more efficiently, and with lower costs than the private sector? Finally, go visit a VA hospital and ask some of the vets (I am one - I refuse to go) what they think about the quality of that care. It's abysmal. Do you think expanding that on a national scale would make it better or worse?
I agree, the government can be a mess but they also do good things. I really have no gripes with NASA, our military, the NIH, the CDC. I think my local government does an OK job at many things.

I'm not suggesting the federal government should just step in and take over healthcare for all Americans but i do think they can step in and create some more boundaries for the free market to then operate within. For example, let my wife buy that $40 inhaler from Canada this is identical to the $200 one here. Open up that market and let the free market adjust.
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      05-01-2019, 03:52 PM   #70
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Originally Posted by DETRoadster View Post
100% agree. I'm not sure what form it takes either but some shit needs to change.

Took my wife to the walk-in clinic on Sunday as her chest cold is not improving and we are skittish about pneumonia, which she had 2 years ago after a bad cold. 15 minute visit. They listened to her lungs, wrote down her story, and prescribed an inhaler. The visit was $300 and the inhaler was $200 ($40 in Canada). All out of pocket because our $5000 deductible has not been met. Can we afford that? Sure. But WTF, lots of folks cannot. Something needs to change.
but how much would it have been if you scheduled an appointment and went to a dr?

also, surprised your insurance didnt cover any of the costs. Every insurance ive been on, and ive been on almost a dozen different plans over the years, even urgent care visits are somewhat covered ($75 copay vs $25 normally), as are prescription costs for a certain percentage. Maybe the urgent care you went to was out of network?

And that leads us back to the Government Universal Healthcare argument of if the government provided everyone insurance and/or healthcare, would you have been in the same situation?
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      05-01-2019, 03:54 PM   #71
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Originally Posted by DETRoadster View Post
For example, let my wife buy that $40 inhaler from Canada this is identical to the $200 one here. Open up that market and let the free market adjust.
FWIW, no one is stopping you from buying that $40 inhaler from canada. Plenty of people go north or south for cheap medical care/prescriptions.

When i worked in AZ, i knew plenty of guys that got dental work done in Mexico for pennies and several women that went south for cheap plastic surgery.
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      05-01-2019, 04:04 PM   #72
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Originally Posted by TheWatchGuy View Post
I should have stated Profit. I had profit in there then changed it, then meant to change it back.

Also, to note, your expenditures dont break out expenditures for the medical devices and pharmaceuticals from actual hospital costs (room/board, facilities services, procedures, etc). The prescription drug category listed comes from the Retail outlet sales of medical products category, which is outpatient sales.
All of the numbers in the CDC report are in aggregate.

Hotel and procedure costs are the biggest non-human capital costs in the hospital category. Drugs and devices barely show up in this.

I've been doing this for a living for the last 21 years and I've worked with the biggest hospital systems in the country on the drug and tissue side as well as the HEOR data acquisition side.

Cheers-mk
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      05-01-2019, 04:08 PM   #73
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All of the numbers in the CDC report are in aggregate.
yeah i looked through the data they used.
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      05-01-2019, 04:09 PM   #74
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I live in Canada but work in the U.S. as a CEO of a company, I can tell you seeing both sides of the equation that flat out, a government oriented system like that of Canada, Sweden, Norway, where ever, will simply not work in the U.S. I cannot be convinced otherwise. I see the group benefit costs to the company I run and every single year it increases by minimum 8% to 12%. We play with the deductibles, decrease some nice to have coverages and ensure a good, solid, meat and potatoes health care for the employee's while still accepting as much premium as we can spare and this is frankly not ideal, but the best course to take in the States.

Small population countries like Canada can function with a system oriented to government because the population is manageable and with reasonable numbers comes reasonable costs.

Don't forget in Canada, tax if you make north of 150K is 33.15% average but the marginal rate is 47.97% at source (that means if you make base $150K but get a bonus for $50K, you pay tax of 47.97% on the $50K), plus deductions for Canada pension, employment insurance, etc...Then go buy anything at a store in Ontario, it's 13% tax on goods and services. Gas has an excise tax of $0.04 a liter buried in it, booze has an environmental tax, volume tax and container tax (sorry, the call it a deposit which is BS), then property tax on home ownership which is about 1% of the assessed value of the home.

I love Canada, it's home and a beautiful country but the services we receive are not cheap. If the U.S. moved to a similar system your tax rates must increase substantially to cover the costs.
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      05-01-2019, 04:09 PM   #75
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Originally Posted by DETRoadster View Post
I agree, the government can be a mess but they also do good things. I really have no gripes with NASA, our military, the NIH, the CDC. I think my local government does an OK job at many things.

I'm not suggesting the federal government should just step in and take over healthcare for all Americans but i do think they can step in and create some more boundaries for the free market to then operate within. For example, let my wife buy that $40 inhaler from Canada this is identical to the $200 one here. Open up that market and let the free market adjust.
Regarding your first paragraph:

1. I agree they do good things, but those things are done better by the private sector. Think Peer Review in the medical industry, Space-X versus NASA, NIH versus private university research, etc.

2. With respect to your local government, that is a whole other conversation. The local government apparatus typically pretty decent because it is so small scale. It avoids the bloat, cannot typically run a long term deficit, and is held much more accountable to the local populace. Those things cannot be said nor applied to the federal government. I feel the same way - I think my local taxes are used wisely in my town and can literally see where the money goes and don't mind paying them.

Regarding your second paragraph:

1. The government needs to step out, not step in to solve the problem. All the problems you are describing are caused by, not prevented by, the government.

2. The reason you can't go across state lines to shop for health insurance or can't go over the border for your inhaler and get it covered by insurance is due to crony capitalism and backdoor deals in Washington between medical lobbyists and politicians. They are the cause of these problems, not the solution.

I can feel you starting to sway. Perhaps it's our joint love for punk rock, but give it more time and I think you will eventually come over to the side of limited government, personal freedom, and personal accountability. Classical liberalism is where we should all be. Friedrich Hayek and Alexis de Tocqueville are the true visionaries - not these fools that so many look to such as John Maynard Keynes and (barf) Paul Krugman.
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      05-01-2019, 04:17 PM   #76
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Quote:
Originally Posted by TheWatchGuy View Post
Quote:
Originally Posted by DETRoadster View Post
100% agree. I'm not sure what form it takes either but some shit needs to change.

Took my wife to the walk-in clinic on Sunday as her chest cold is not improving and we are skittish about pneumonia, which she had 2 years ago after a bad cold. 15 minute visit. They listened to her lungs, wrote down her story, and prescribed an inhaler. The visit was $300 and the inhaler was $200 ($40 in Canada). All out of pocket because our $5000 deductible has not been met. Can we afford that? Sure. But WTF, lots of folks cannot. Something needs to change.
but how much would it have been if you scheduled an appointment and went to a dr?

also, surprised your insurance didnt cover any of the costs. Every insurance ive been on, and ive been on almost a dozen different plans over the years, even urgent care visits are somewhat covered ($75 copay vs $25 normally), as are prescription costs for a certain percentage. Maybe the urgent care you went to was out of network?

And that leads us back to the Government Universal Healthcare argument of if the government provided everyone insurance and/or healthcare, would you have been in the same situation?
Not our plan. Covers exactly $0 of ANYTHING until the deductible is met. One of the numbers of working for a small company. Small insurance pool, not a lot of leverage.
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      05-01-2019, 04:17 PM   #77
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Quote:
Originally Posted by cmyE93M3 View Post
I live in Canada but work in the U.S. as a CEO of a company, I can tell you seeing both sides of the equation that flat out, a government oriented system like that of Canada, Sweden, Norway, where ever, will simply not work in the U.S. I cannot be convinced otherwise. I see the group benefit costs to the company I run and every single year it increases by minimum 8% to 12%. We play with the deductibles, decrease some nice to have coverages and ensure a good, solid, meat and potatoes health care for the employee's while still accepting as much premium as we can spare and this is frankly not ideal, but the best course to take in the States.

Small population countries like Canada can function with a system oriented to government because the population is manageable and with reasonable numbers comes reasonable costs.

Don't forget in Canada, tax if you make north of 150K is 33.15% average but the marginal rate is 47.97% at source (that means if you make base $150K but get a bonus for $50K, you pay tax of 47.97% on the $50K), plus deductions for Canada pension, employment insurance, etc...Then go buy anything at a store in Ontario, it's 13% tax on goods and services. Gas has an excise tax of $0.04 a liter buried in it, booze has an environmental tax, volume tax and container tax (sorry, the call it a deposit which is BS), then property tax on home ownership which is about 1% of the assessed value of the home.

I love Canada, it's home and a beautiful country but the services we receive are not cheap. If the U.S. moved to a similar system your tax rates must increase substantially to cover the costs.
And the populations are largely homogeneous. The population in the US in too heterogeneous. The healthcare needs and cost for the average patient in the Delta Region of Mississippi are wholly different and the costs completely dissimilar to a patient of the same age and gender in Wisconsin.

Great post!!

Cheers-mk
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      05-01-2019, 04:19 PM   #78
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Quote:
Originally Posted by Run Silent View Post
Quote:
Originally Posted by DETRoadster View Post
I agree, the government can be a mess but they also do good things. I really have no gripes with NASA, our military, the NIH, the CDC. I think my local government does an OK job at many things.

I'm not suggesting the federal government should just step in and take over healthcare for all Americans but i do think they can step in and create some more boundaries for the free market to then operate within. For example, let my wife buy that $40 inhaler from Canada this is identical to the $200 one here. Open up that market and let the free market adjust.
Regarding your first paragraph:

1. I agree they do good things, but those things are done better by the private sector. Think Peer Review in the medical industry, Space-X versus NASA, NIH versus private university research, etc.

2. With respect to your local government, that is a whole other conversation. The local government apparatus typically pretty decent because it is so small scale. It avoids the bloat, cannot typically run a long term deficit, and is held much more accountable to the local populace. Those things cannot be said nor applied to the federal government. I feel the same way - I think my local taxes are used wisely in my town and can literally see where the money goes and don't mind paying them.

Regarding your second paragraph:

1. The government needs to step out, not step in to solve the problem. All the problems you are describing are caused by, not prevented by, the government.

2. The reason you can't go across state lines to shop for health insurance or can't go over the border for your inhaler and get it covered by insurance is due to crony capitalism and backdoor deals in Washington between medical lobbyists and politicians. They are the cause of these problems, not the solution.

I can feel you starting to sway. Perhaps it's our joint love for punk rock, but give it more time and I think you will eventually come over to the side of limited government, personal freedom, and personal accountability. Classical liberalism is where we should all be. Friedrich Hayek and Alexis de Tocqueville are the true visionaries - not these fools that so many look to such as John Maynard Keynes and (barf) Paul Krugman.
Lol. Yeah, I have to admit. Folks like you and MK make some pretty compelling arguments! Thanks for expanding my thought process and challenging me to see things from another perspective.
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      05-01-2019, 04:27 PM   #79
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Lol. Yeah, I have to admit. Folks like you and MK make some pretty compelling arguments! Thanks for expanding my thought process and challenging me to see things from another perspective.

Same goes for you, sir. Nice having a different perspective to view life from. Anytime you decide to drive the Dragon, hit me up - I'm just down the road.
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      05-01-2019, 04:29 PM   #80
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Originally Posted by cmyE93M3 View Post
I love Canada, it's home and a beautiful country but the services we receive are not cheap. If the U.S. moved to a similar system your tax rates must increase substantially to cover the costs.
Being Canadian I tend to agree.

It Americans were subject to our tax rates there would be a revolution.

I have no incentive to work whatsoever, luckily my business runs itself.
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      05-01-2019, 04:34 PM   #81
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Originally Posted by TheWatchGuy View Post
FWIW, no one is stopping you from buying that $40 inhaler from canada. Plenty of people go north or south for cheap medical care/prescriptions.

When i worked in AZ, i knew plenty of guys that got dental work done in Mexico for pennies and several women that went south for cheap plastic surgery.
LOL, do they take Kaiser insurance? How about Prime 2nd day shipping?

Moronic have to drive to Mexico back alley in TJ just to get an inhaler don't you think?
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      05-01-2019, 04:43 PM   #82
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LOL, do they take Kaiser insurance? How about Prime 2nd day shipping?

Moronic have to drive to Mexico back alley in TJ just to get an inhaler don't you think?
they take no insurance but its cheap. just you may not have the best experience.

you dont have to go to mexico to get something, but if you want cheap, there are ways to go cheap.

i feel like you completely missed the point of my post in relation to the post i was replying to.
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      05-01-2019, 04:45 PM   #83
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Quote:
Originally Posted by DETRoadster View Post
Lol. Yeah, I have to admit. Folks like you and MK make some pretty compelling arguments! Thanks for expanding my thought process and challenging me to see things from another perspective.

Same goes for you, sir. Nice having a different perspective to view life from. Anytime you decide to drive the Dragon, hit me up - I'm just down the road.
You know I will!
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      05-01-2019, 08:01 PM   #84
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So all you know it alls about healthcare also never mentioned the major healthcare services consolidation that has been happening over the last 10 years all because of insane COST. Even the big hospitals can't keep up with costs. Even if govt never steps in it will continue to happen until every market has a monopoly of 2 or 3 systems then your all really gonna cry about prices. Independent practices are dying left and right and you guys think being taken care of by dr incorporated I'd better then independent doctors are totally crazy. You can make fun of me all you want because it makes crazy republicans feel better about yourself but you have no idea what's going on out there right now. The one guy here who's wife is a doctor is the only guy here who I think can see what is happening

Single payer is coming no matter wha you all want to say. Either it's gonna be the government or it's gonna be a private company monopoly. You pick if you pick monopoly you are insane... have you ever tried to cancel your Comcast cable haha that s what monopoly life is like except with your actual life
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      05-01-2019, 08:16 PM   #85
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So all you know it alls about healthcare also never mentioned the major healthcare services consolidation that has been happening over the last 10 years all because of insane COST. Even the big hospitals can't keep up with costs. Even if govt never steps in it will continue to happen until every market has a monopoly of 2 or 3 systems then your all really gonna cry about prices. Independent practices are dying left and right and you guys think being taken care of by dr incorporated I'd better then independent doctors are totally crazy. You can make fun of me all you want because it makes crazy republicans feel better about yourself but you have no idea what's going on out there right now. The one guy here who's wife is a doctor is the only guy here who I think can see what is happening

Single payer is coming no matter wha you all want to say. Either it's gonna be the government or it's gonna be a private company monopoly. You pick if you pick monopoly you are insane... have you ever tried to cancel your Comcast cable haha that s what monopoly life is like except with your actual life
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      05-01-2019, 08:23 PM   #86
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Originally Posted by cmyx6go View Post
I'm looking for honest opinions on people's preference regarding medical insurance. I'm not sure if it is possible to separate this from politics and not go down the road of whether medical insurance is a right.

I imagine most of us here have private medical insurance, and with that comes the option of staying in network for a co-pay or going out of network and paying for it yourself. In most cases, unless you're really sick you will never meet the deductible for out of network.

I am very fortunate to have the ability to go to any doctor I choose regardless of whether he/she take my insurance. I will not choose a doctor, or change doctors due to who is in or out of network.

The thought of this choice being taken away from me is terrifying. It seems most of the Democrats that have thrown their hat in the race are for medicare for all. I try and tell myself that this won't be an issue. Even if a democrat wins 2020, they'll never get this through, it's a talking point/platform that will never be delivered. BUT, what if? Have any of the democrats here actually thought this through? Are you willing to have the government control your medical care and take away your choices so that everyone has medical coverage?

EDIT: Please correct me if my thought process is incorrect. I can still go to doctors of my choice but will there be less doctors to choose from?
why would you assume that because someone has medicare they cant choose a physician. this is assumption totally false. every single major medical institution in the USA accepts medicare. johns hopkins, harvard, md anderson... all these places accept medicare. the idea that for profit healthcare is somehow better is also absurd. do you really think your insurance carrier wants to pay more than medicare? does your insurance want to pay higher dividends to corporate healthcare shareholders? i can pretty much promise you that for profit hospitals are not providing a higher level of care than a major state funded university hospitals and ive worked for 25 years in both.
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      05-01-2019, 09:27 PM   #87
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What about the doctors? Has anyone thought of them? Any Medicare for All plan would include massive pay cuts to physicians. The current plan for a Medicare for All system includes a 40% reimbursement cut to all physicians. Imagine how you would react to a 40% cut in your pay and before you start saying that physicians make bank and can afford a pay cut, you would be incorrect. Unless your are a high volume invasive cardiologist or orthopedic physician your income is fairly modest. In fact, most primary care physicians make significantly less than 2 bills and come out of training $250,000 in debt. Such a pay cut would have devastating effects on the moral of existing physicians and would drastically reduce the lore of choosing medicine as a career. I don't know about you but I want my doctor to be well paid such that he/she maintains a high interest in the profession and dedication to my personal care. I can imagine a massive exodus of physicians from the profession and a vacuum that would likely be filled by Nurse Practitioners or Physician Assistants. Most people do not realize that the average physician has 20,000 to 25,000 hours of direct patient care before they can practice medicine however a Nurse Practitioner requires only 500 direct patient care hours before they can practice independently in some states. Physician Assistants require 1000 hours. This is nothing compared to physician and in my opinion a very scary scenario. Physician Extenders simply do not know what they don't know which is a $%!# load.

Medicare for All in a country of 330,000,000 people, 50% of whom are obese couch potatoes would be an absolute disaster and pathetically unaffordable. Care would be government run, rationed and provided by bitter, unhappy physicians or unqualified NPs and PAs.
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      05-01-2019, 09:39 PM   #88
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Quote:
Originally Posted by Run Silent View Post
I'll take you up on that. I've been paying out of pocket for Avastin because it is deemed to be 'experimental' for my diagnosis, yet is one of the only treatment options.

Last year, I made my doc richer to the tune of about $13,000 due to Avastin injections. Finally got onto a program and switched over to a new drug as of March of this year. My total out of pocket to date in 2019 has been less than a grand.
That sucks.

The first year of my cancer diagnosis I would have to say I was close to $10k in out of pocket expenses WITH insurance coverage.

Glad you were able to get onto a drug that is covered by insurance.
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