TrumpCare

[DTEJD1997]

I think most people have an incorrect view of the legal profession...

 

Sorry for the long post, hope this is informative!

 

to fix health care, that is to say, to make it affordable, there needs to be as many health care workers as there are attorneys in your description.  i don't believe the problem is of the structure of payment as much as it is supply and demand.

 

well, that is an interesting thought!

 

Obviously, there are simply too many attorneys!

 

Unfortunately, the market for legal education has been distorted for a long,long time.  That is one of the reasons why there are so many law suits against law schools.  ;D

 

 

[boilermaker75]

Obamacare, Trumpcare, single-payer, or whatever you can dream up won’t fix the health care issue because they do not address the problem. Diabetes and brain disease are the country’s costliest diseases and they are mostly preventable. The large increase in health issues today, not just diabetes and brain disease, than 50 years ago, are diet related.

 

 

Edit: 

[Hawks]

Perhaps, someone more knowledgeable than me, can compare Trumpcare, Obamacare, Canadian health insurance and European health care systems. That would be most revealing imo.

[Aberhound]

All the health care systems are terrible. The problem is centralized control and meddling. Let people design their own systems and see what they come up with. Decentralize everything. Until we realize the governments include people without conscience and then learn how to screen for them using brain scans we will suffer. People without conscience are like viruses as they spread their evil by hiring practices and propaganda.

 

In the meantime the less the government does the better the outcome. The best thing you can do for your own health is to ensure your body has access to a broad spectrum of absorbable minerals. Minerals need to be converted by bacteria the same as soil bacteria is needed to make the minerals absorbable by plants. Notice that governments have countless rules and regulations designed to prevent your access and knowledge to these minerals and their importance to your health. Treat the cause of problems not the effects. The health care system is an effect. Bad food and water is the cause. Fix those first.

[Desert_Rat]

It's actually simpler than that given that most people are not vegans or otherwise insistent on miserable food consumption.

 

Remove the high risk participants and our system, the US system, becomes the best in the world again. Older and at risk? medicare or phuck off. Oh, you don't carry insurance but want it now that you're ill? Pre-existing as of a week ago, huh. Phuck off. 20 and not in college studying? You too, phuck off.

 

Of course it would take a admin with balls to roll that out. So it will never happen. So the best healthcare system in the world, which I had all my life until now, is gone. Thanks, Obama.

[Cigarbutt]

Interesting topic. Can bring some relevant info from micro and macro side.

 

Premises before reading on:

-Healthcare advances, organization and access have improved overall +++.

-Prevention is key and large problems are entrenched.

-The perfect system does not exist.

 

The question is: where do you go from there?

 

Opinions:

-The CDN system performs better in the aggregate (mostly because it is socialized).

-The US spends much much more per capita but it is less efficient.

-For the well-to-do (most people on this board, I presume), The US has advantages that still currently outweighs the disadvantages (mostly costs).

 

For those really interested, Ezekiel J. Emanuel from the medical policy division at Pennsylvania University, through Coursera, recurrently gives lectures on the US health care system organization and teaches a special course on the Affordable Care Act (Obamacare).

If you go this route, one has to remember that he believes in government intervention and has been one of the architects behind the ACA legislation.

Even if you can't stand the Left, I would say that he does a reasonable job giving the info and letting you decide for yourself.

The US system developed in a very unusual and atypical way because of many reasons, including the bi-partisan nature of American politics.

The resulting infrastructure is mostly the result of incomplete and often contradictory compromises.

The fundamental problem is (my opinion) that the foundation is fundamentally weak in many ways.

This created a situation where many layers of "improvements" (Obamacare/Trumpcare type programs) were applied over a poor foundation riddled with unintended consequences.

After reviewing the projected new legislation, I would submit that Trumpcare offers some differences but I agree that it is basically an Obamacare-lite or a Obamacare-more Republican friendly type of legislation. If enacted, the number of uninsured will rise but the underlying flaws will not be addressed.

I suggest the following link because 1-it shows somebody looking for a job and 2-perhaps it helps to understand the bi-partisan dynamics of the US political system.

  http://www.salon.com/2016/12/03/obamacare-architect-ezekiel-emanuel-donald-trump-has-an-opportunity-to-do-enormous-good-or-to-create-chaos/

Individual opportunities will happen for investors in this space but the fraction of healthcare expenditures/GDP cannot rise forever especially in the context of the aging demographics. There is also a huge (and largely unpredictable) regulatory risk. One way to spot occasions would be to look for survivors and to identify those that can build market share in a mature market. Long term, I hope I can be of some help here eventually.

 

[Hawks]

Wall St Journal today had a headline comparing health care programs and costs around the world. I'm not a subscriber so can't access it. If anyone has access, care to share?

[Uccmal]

Comparing US health care to Cdn. Health care is kind of like comparing

SHLD to JCpenny. 

 

One is really bad, and the other is not so great.  European countries have better and more cost effective systems than Canada. 

 

And I have no idea why this is the case.

 

Cost containment problems with Canadian health care related to better systems in EU may be due to:

1) a powerful medical lobby and gate keeping.  This serves to limit the number of high level practitioners available keeping costs up.

2) A high preponderance of really big hospitals with really big bureaucracies and dead wood.

3) population density... we have to subsidize low population areas. 

4) Citizen behaviour... ER rooms get full of people with colds and flu.

5) Powerful medical lobby that can get funding for number 2)

I worked in a hospital some time ago, and the amount of deadwood was astounding. 

 

I call it Canada's biggest social and jobs program.  The US has a bloated military, we have a bloated health care system.  Both give good jobs to those who are otherwise unemployable. 

 

Successive governments have tried to rein it in a every level, amd always fail. 

[Cigarbutt]

For somebody who has no idea, I find your insights pretty convincing.

 

If interested in comparative benchmarking:

https://secure.cihi.ca/free_products/Benchmarking_Canadas_Health_System-International_Comparisons_EN.pdf

If interested in aggregate measures:

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

 

I would tend to say that the CDN system compares to European counterparts. The US is a clear outlier in the aggregate: much higher expenditures/capita and failing marks on basic health measures.

 

I also would like to bring another level of comparison ie inter-generational level of health care.

I would submit that, despite significant improvements needed, the level of care that you may receive has nothing to do what perhaps your parents or grand-parents had access to.

Food for thought.

 

 

[cwericb]

In my very humble opinion, the Canadian Medicare system could be greatly and immediately enhanced by a simple modest deductible - say just $25 per visit with a maximum of $250 per  year. Or to put it another way, the price of about two packs of cigarettes per visit. 

 

Not only would it stop tens of thousands of frivolous visits to the doctor or outpatients, it would also inject some cash into the system.

 

For those who really can’t afford it, Social Assistance would be paying it anyway.

[rb]

In my very humble opinion, the Canadian Medicare system could be greatly and immediately enhanced by a simple modest deductible - say just $25 per visit with a maximum of $250 per  year. Or to put it another way, the price of about two packs of cigarettes per visit. 

 

Not only would it stop tens of thousands of frivolous visits to the doctor or outpatients, it would also inject some cash into the system.

 

For those who really can’t afford it, Social Assistance would be paying it anyway.

I've always thought that is a great idea and we'll probably get there eventually. Making doctors issue multiple refills on drugs for chronic diseases is another measure that would lower cost. Doctors will loose their shit when that happens.

[lschmidt]

Whether doctors will "lose their shit" entirely depends on the system in which they work. If in a private system, yes, they will lose revenue. If in a public or salaried system, they benefit from seeing patients less often. The key to understanding why the U.S. system is so expensive is incentives, on many levels.

[Uccmal]

In my very humble opinion, the Canadian Medicare system could be greatly and immediately enhanced by a simple modest deductible - say just $25 per visit with a maximum of $250 per  year. Or to put it another way, the price of about two packs of cigarettes per visit. 

 

Not only would it stop tens of thousands of frivolous visits to the doctor or outpatients, it would also inject some cash into the system.

 

For those who really can’t afford it, Social Assistance would be paying it anyway.

 

Except, except... In Ontario when Mcguinty came into power the liberals started the healthcare premium tax, graduated according to income.  800 a person for me and my wife.  From my perspective, and probably yours as well, I already pay my fair share and more.  Now, dont get me wrong.  I dont care about the extra 1600 but if you then want to start charging me for each visit I will certainly cry foul, and vote for someone else. 

 

Health care is the sacred cow of government.  No government wants to be seen reducing care, so like Buffett's inflation tapeworm, the health care budgets keep on rising.  This is the problem the Reps. are facing in the States.  X number of people who had poor health care have suddenly got better care due to the ACA.  The Reps. cant take that away.  Suddenly, all those voters who voted against Obama care will have their care under the Affordable Care Act taken away.  And there go the votes when they figure out that O-care is the ACA. 

 

 

[Cigarbutt]

Some way want to look at some graphs esp. p.14-25.

https://www.fraserinstitute.org/sites/default/files/sustainability-of-health-care-spending-in-canada.pdf

 

CDN data but, in fact, similar trends appear elsewhere too.

Add demographics and it will be interesting to see the political capital allocation game going forward.

With change come opportunities?

[RichardGibbons]

Health care is the sacred cow of government.  No government wants to be seen reducing care, so like Buffett's inflation tapeworm, the health care budgets keep on rising.  This is the problem the Reps. are facing in the States.  X number of people who had poor health care have suddenly got better care due to the ACA.  The Reps. cant take that away.  Suddenly, all those voters who voted against Obama care will have their care under the Affordable Care Act taken away.  And there go the votes when they figure out that O-care is the ACA.

 

Interesting perspective.  I think I'm one of the more left-wing people on this board, and I'd actually support a nominal $25 usage fee (or something like a $50 initial consultation fee to avoid screwing over the people with persistent issues treated over multiple sessions), particularly if it replaced insurance premiums (my family of four is $1800).

 

There are several reasons why healthcare is challenging, and one of those reasons is that you can't get accurate price signaling.  So, a nominal cost for service isn't that bad, I think.  It would be interesting to look at the statistics when they added the ambulance usage fees.  Did that result in deaths, and did it lower usage and costs?

 

That said, you could be totally right that in Canada, no-fee medical service is a sacred cow, and there's certainly a concern about it being a slippery slope.  But it is a shame that we're too scared to try stuff and look at the outcomes.

[Cigarbutt]

Let's not mix politics and regress here but for context, I usually lean right. Flexible though.

Medical user fees have been used in many countries and the impact has been studied. (My understanding is that many Scandinavian countries use them)

I include a simple link but "academic" studies also point, in general, to the same conclusions.

http://www.cfhi-fcass.ca/sf-docs/default-source/mythbusters/Myth_User_Fees_EN.pdf?sfvrsn=0

 

Interesting to note that sometimes theses fees are referred to as deterrent fees.

My first reflex is to agree with user fees. At first glance, it seems to make sense.

However, when you think about it and look at the studies, the net result is a negative.

-People of the hypochondriac variety will consult even if there are fees

-A significant number of people (especially the poor or those close to their money) will not consult or stop follow-up

-Fee revenues will be negated by higher administrative costs

 

Health care system waste and inefficiency are big problems. Unfortunately, I submit that user fees are not the answer.

 

[RichardGibbons]

Interesting results.  Thanks cigar.

[Cigarbutt]

I know:

-This is mostly an investment forum.

-The topic has political implications.

-Despite being an interest of mine, healthcare has never made it to my investment punch card. (?)

 

But this may be of interest for some, especially for our American friends.

This post is non-partisan (I hope anyways).

 

As most must be aware Trumpcare has not been enacted. I would humbly say that this may be a minor issue in the grand scheme of things.

A link here from a presentation that talks a lot about debt and all but, for relevance with this specific post, look at slides 14, 15 16.

By the way, long term, I would not bet against the US.

The slides show though that a lot of $ is spent on healthcare and aggregate results don't show up.

Time to think outside the box?

Opportunities?

 

[Cigarbutt]

Here's the link:

http://www.pgpf.org/sites/default/files/PGPF-Chart-Pack.pdf

[John Hjorth]

... Medical user fees have been used in many countries and the impact has been studied. (My understanding is that many Scandinavian countries use them)...

 

I'm just trying to shed some light on the Danish situation here, Cigarbutt, without the intent of nit picking your post here. Tiny Denmark is after all only a tiny bit of whole Scandinavia. I have no factual knowledge about the rest of Scandinavia.

 

Medical fees have been subject for political discussions here on and on within at least the last couple of decades without ending in introduction of such, but not within the last few years, because of good public finances.

 

If the through isen't empty, the horses aren't wrangling, ref. the post by Uccmal.

 

What is happening here is that the structure of the GP practices is changing fast from one doctor pratices to partnerships, and the young partners want to invest in their shops, among other things going digital. It gives basis for a much more smooth daily operation, if some patient does not meet in for consultation by appointment, just swicthing to a digital consultation in a digital queue system in stead.

[rb]

Here's the link:

http://www.pgpf.org/sites/default/files/PGPF-Chart-Pack.pdf

In my opinion, things aren't nearly as bad, or as complicated to fix. It'll be ok.

[Cigarbutt]

rb,

I appreciate your encompassing opinion. You're right. Somehow, in the aggregate, we will all be fine.

Ronald Reagan said:"America's best days lie ahead".

Albus Dumbledore said:"'Dark times lie ahead of us and there will be a time when we must choose between what is easy and what is right".

Perhaps hope for the best but prepare for the worst?

Isn't what margin of safety is all about?

[John Hjorth]

... The slides show though that a lot of $ is spent on healthcare and aggregate results don't show up.

Time to think outside the box? ...

 

To me, the out of the box thinking has already started [Question 1 - Last part].

[rb]

rb,

I appreciate your encompassing opinion. You're right. Somehow, in the aggregate, we will all be fine.

Ronald Reagan said:"America's best days lie ahead".

Albus Dumbledore said:"'Dark times lie ahead of us and there will be a time when we must choose between what is easy and what is right".

Perhaps hope for the best but prepare for the worst?

Isn't what margin of safety is all about?

Look there are certain reasons for my optimism, it's not just cause I'm a cheery guy.

 

Firstly, things are probably not that bad to start with. All those slides are hockey stick charts. Never trust hockey stick charts. Also you have to consider the source. That deck is from pete peterson's shop. For decades his shtick has basically been we must cut entitlements or we'll be dead any day now. Somehow the US is still around and kicking.

 

Healthcare cost is definitely a problem in the US and something will have to be done about that eventually. The good news is that this is not something where the US must invent a solution. Pretty much every other place in the world solved the problem. The US can just copy them.

 

In my view in the end the final solution will probably be comprised of some combination of lower military spending, changes to the healthcare system, and somewhat higher taxes. The solution will come when the situation gets worse and people get serious about fixing it. Right now things are not bad enough and people aren't really serious about solving it. Of course when the time comes loads of people will hate the solution, they'll huff and puff but they'll have to swallow it.

 

On the issue of taxes, deficits, and debt you can also think of it this way: The reason the US has constant deficits is because the taxes set constantly too low. So people get to keep money that they would otherwise have to pay in taxes for services. The catch is that they have to use that extra money to buy US treasuries. I'm not sure whether if that can go on forever but a good argument can be made that it can.

[rkbabang]

rb,

I appreciate your encompassing opinion. You're right. Somehow, in the aggregate, we will all be fine.

Ronald Reagan said:"America's best days lie ahead".

Albus Dumbledore said:"'Dark times lie ahead of us and there will be a time when we must choose between what is easy and what is right".

Perhaps hope for the best but prepare for the worst?

Isn't what margin of safety is all about?

 

Very few people prepare for the worst, I certainly don't. To be thus prepared you would need an escape plan to get to a remote area, where you have a well stocked bunker to ride out a few years worth of chaos and a bunch of gold and ammo to trade with after the worst blows over.  Any paper wealth you have is gone in any worst case scenario.

 

I'm not prepared, because I don't think it will ever come to that. I'm more of an optimist.  There will be ups and downs, but we'll be fine.  I'm sure whatever healthplan Trump ends up signing won't be all that great, but will fix some things and cause other problems.  My biggest concern is that it is destracting him from tax cuts and deregulation.