Here's an example. About 20 years ago I had surgery that would not be paid for by medical insurance, so I had to pre-pay all hospital costs, including operating room, recovery, etc. I remember it was about $5000.
Two weeks after surgery I got a bill from the hospital for about $50,000. I called them and said I hope this is a mistake because I don't have this money.
Oh, they said, we thought it was covered by insurance, so we generated a bill for insurance.
So, I said, you were planning to bill insurance $50,000 for something that you actually made a profit on charging $5000.
I knew then we were in a death spiral. Talk about abuse of the system!

“The question is how to save our people and our country as the empire inexorably collapses.”

Don't expect the dudley do-wrong GOP to save the country from the dumb and dumber Dems.

The weak of the healthcare system, like the banking sector TBTF must be allowed to collapse in a free market or the entire system should collapse to restore the free market.

It is not too late to save it, but the DemReps have neither the will nor the ability to resist bribes and get out of the way.

I have mentioned elsewhere in the Gulch about giving tours to ex-Soviet Russian officials of an operating gold mine I was Chief Geologist at back in the 90's.

In the immediate post "collapse" days things were extremely chaotic in Russia. Toilet paper was indeed used as money, teachers were paid with it in many regions. Cigarettes. And of course, vodka.

I remember when the tour was concluding, I was escorting them to the main gate where the security guard shack was and with all the surveillance cameras. One of the Russians indicated to "Wait!" and he ran to their car in the parking lot, pulled out two bottles of Russian vodka, raced back and handed them to me in thanks for the tour.

Now, alcohol is prohibited on minesites and here I was being handed overt Russian currency in front of the security cameras. I was a bit mortified, but nothing came of it. The vodka was quite good by the way. And the label had a cool hologram of the now thriving entrepreneur that was producing Russia's new currency!

Fundamentally, though, there is a problem when your currency is also a consumable. I wonder what the state of healthcare was in Russia in those early days. When looked at in the right light, it may all represent an opportunity to start over should this whole death spiral accelerate and crash and burn.

I am of the "Plan for the worst, hope for the best" mentality. Therefore, I have made some preparations for the worst. However, I think there are a few things that could make the system better. Here are my thoughts:
1. My overarching first principal: Make the medical system a free market.
2. Create a publically accessible database that shows Dr., hospital and insurance companies' rankings and success rates. That way you can determine for yourself, do I want to pay a fair price for a Dr. and hospital that has a 99% success rate for my procedure, or do I want to go to the clinic down the street and pay 50% for a 70% success rate? Also, do I want to pay $100 more per month for insurance that has a 98% payout rate as opposed to an insurance company that has a 50% payout ratio?
3. Make all Dr., hospital and insurance companies openly post a fixed rate schedule for each and every service. That way you know the price up front whether you are an insurance company, or an individual, none of this post billing $50,000 for a $5,000 procedure. Also, this eliminates the billing for each sponge, bandage, stitch, etc. This would also reduce waste since the hospital staff would know that they are not getting paid for dropping 10 sponges on the floor when it was not the patient's fault.
4. Allow insurance and medical services to be marketed and sold across state lines. If Joe Dokes insurance in Arkansas can give me the same insurance coverage for 50% less than Kaiser in Southern California, why force me to use Kaiser? Many insurance companies know that they have a protected turf in their home state. So there is no motivation for them to compete in any meaningful fashion on rates. So they build Taj Mahal offices and waste a lot of money.
5. Tort reform that includes loser pays all costs and eliminates the $50,000 payments to make invalid claims disappear. Also, get rid of punitive damages: only actual costs allowed. Been there, seen that. You can be a professional sue-er by just making unsubstantiated claims. The lawyers look at the claim and say "What will it take to make this just go away?" ...and they make the payout just to avoid going to court. If loser pays all and placating unsubstantiated claimants goes away a lot of these claims would also go away.
6. Allow jurors to question the parties and don't fetter them with unintelligible rules.

I have seen the tort system in action and inaction first hand. It does not work well, but adds substantial cost to the cost of healthcare and the rest of our lives.

Finally, Question: What do call 1,000 lawyers chained together at the bottom of the ocean?
Answer: A good start.

BTW, in my opinion we are about 12 years beyond "saving" this country. As in the movie Frozen, just sing the song, "Let it go...Let it go..."

Let it fall. Look into alternative-medical doctrines. They prescribe diet and exercise. And let's all train on advanced first aid.

"the 40% or more being siphoned off by third-party payers". I have always known this; I am taking huge cuts in my compensation, enough to make staying in business questionable. Patients are suffering because they can't afford insurance and copayments. Meanwhile, the third parties are doing great!
It's contemptible.

More people allowed into medical school, which the AMA has controlled to keep salaries high. More competition.
Stop communities leaders limiting hospitals being built because they protect existing hospitals. More competition.
Stop government from dictating anything to do with medical care. More competition if they aren't mingling with lobbyist.
Allow Insurance Companies to go into every state. More competition.
THIS IS NOT GOING TO HAPPEN. BETTER LEARN HERBAL MEDICINE JUST IN CASE. WE MIGHT JUST TURN THINGS AROUND IF ONLY A FEW OF OUR SYSTEMS WERE CORRUPT.

Yes jbrenner it is time to set up a place to shrug if you can. Just be prepared in case you have to. You don't have to do anything but be ready and have your ducks in a row. Know what you will do and have a backup plan. If you plan to go outside the US you should start looking now. Have a go bag with passport and junk silver. There are a lot of places in your state. A boat or a container home in the woods somewhere say the panhandle.

I believe the objective with Obama Care is to divert 17-20% of the GNP to Washington, because they know better how to spend (redistribute) our property. The current iteration is designed to fail, horribly. Then the government can rush in and fix it with single payer National Health care. If public health and private property rights were the real the underpinning of a plan it would look something like this.

At the time of SS# issuance, each citizen would be covered by a $10M/$50K deductible Major Medical Plan. Beyond that, each citizen is responsible for the payment of their own health care.

Translation: The government will protect you from catastrophe, beyond that is a 10th amendment approach. It's left to the states, or to the individual.

Insurance companies would lose their exemption from the anti trust laws, they would be permitted to write policies across state boundaries, and I believe most important, they could create different levels of risk exposure/premium rates, to satisfy the market.

Additionally, should the brave/foolish individual decide not to purchase the first dollar coverage, they could be expected to make arrangements to work it off in payments, get a Home Equity loan or reverse mortgage to clear the debt, or avail themselves of the US Bankruptcy laws and clear themselves of the debt.

Does that sound cruel? Not really, that's how it used to be, with the exception of the gov't picking up the tab for major medical. Look how far America went using the self reliant model. As it stands, different people are insured, not necessarily more, and when it fails we will be much closer to England, France, or Cuba. Thank you Michael Moore.

I agree with the article and it's predictions and observations on current trends. Basic, almost trivial, economics at work.

But I don't think we need "prognosticate" too much, as we already have glowing examples of public health care failures in many countries, probably the two most known and identifiable to Americans being Canada and the UK. And I know a lot of this was rightfully pointed out in the original fight over Obamacare.

Their "death spirals" are in the advanced stages, based on both overwhelming anecdotal evidence and imperfect but "close enough" statistics.

I am an American living in Ontario, so I observe a lot first-hand. (I still maintain close ties to my native State, Michigan, have a Michigan doctor, and my medical care is still US. I am not part of the Canadian system, as I said, just an observer).

So a few anecdotes and hopefully intelligent observations for those interested:

Our local Ontario hospital, for a town of 4,000, which used to have 100 beds, has over the past two years been reduced to 9 beds by the Province due to lack of money (or as Maggie may have put it: "Other peoples money).

A skeleton crew (no pun intended) at the local hospital provides basic emergency service for minor ailments, or first response to say, a heart attack. Beyond that, life-threatening cases (if they survive) are transported to the nearest "real" hospital, an hour away. (Having made many observations in my time here, this post will be full of little asides. In this case, I will note that the "free" medical care system does not include transport to said hospital. The transport is private, not covered, and the patient and/or his family gets a hefty bill. In some cases, if the patient and family are risk-takers, and the patient somewhat mobile, they will call and use a much cheaper taxi service.)

In another case, a 50-year old friend had failing kidneys, to a life-threatening extent. The earliest appointment with a urologist for an exam: 1 year, due to the lack of qualified specialists. Than man in question took this as "normal", (and, further, is "reliably" informed that it would be worse in the US, which he takes on faith). And besides, he states, the exam and any treatment, are "free". IF he survives the year.

And then I had another friend in the major city of Montreal. Her elderly mother had a terminal illness, and she was being "treated" with "palliative" care, which has a long definition, but I can summarize as "pain relief" vs. actual treatment. This friend also had an elderly father who was in good health. As it happens he fell at home and broke his elbow, and had to go into the hospital for a few days. At least he was near his wife. While in the hospital he caught MRSA, which is a serious infection rampant in Canadian hospitals. He died within a few days of the infection, in the hospital, nothing to do with his broken elbow. The sad irony is that my friend lost her father suddenly and unexpectedly, after worrying over and preparing for her mother's death, which came shortly after.

As another anecdotal aside, many people I know here fear even the most minor injury that might send them to a hospital, are afraid to visit a clinic for a "free" examination, if that clinic or doctor is in a hospital, and most sadly, will generally not visit friends who are hospitalized for fear of MRSA.

For more information on MRSA: http://www.cbc.ca/news/technology/superb...

A few more minor observations on the "free" system here, before my last major example: Hospitals must provide their own equipment, X-Ray machines, CAT, etc., via the residents they serve They do this with PBS like beg-a-thons or hoping a wealthy donor passes away. If they can't raise the money, particularly in a small town, their hospital, if they have one, goes without the latest equipment available.

In addition, "free health care" does not include medicine or prescriptions. Huh? You can buy private plans that will help, but once again, another friend, with serious diabetes, must spend hundreds of dollars of his own money on insulin.

Yes, those two facts, when I learned them, begged the question of exactly what is "free" in this advanced, egalitarian system. This is not exhaustive, but from what I can gather: mortly direct physicians services for routine illnesses, check-ups etc., and major treatments for surgery etc., with a very long wait, and any follow-up medication not included. I guess in summary: the doctor and his/her direct services.

Finally, and this is now starting to be talked about in "early stages", is that palliative, hospice and home-care, which was provided by "home health aides", would be "better" done completely at home, and by trained "family members". Unpaid, of course.

This last is about the ultimate is the death spiral of a health care system, although I'm sure someone out there could imagine something worse.

These are a few examples. At the word limit...shutting up.




.

We must already be underwater, even with VA Healthcare. I call to make an appointment with my PCP (Primary Care Physician). They take the necessary information from me and verify with me that they have the correct record and phone number. Then they tell me someone will call me back. That was three weeks ago.

So, the way I get taken care of, because I can't just do a walk in, is to walk in out of breath and tell them I can't get my breath. Usually within an hour of waiting and holding my chest, I can get to see my PCP. Hey, it works. I wonder where all that new money to the VA actually went? I do know that Seattle VA is building a new multilevel parking structure. What good will it do if you can't get an appointment?

To the more well off Libertarians who can afford an out of pocket increase in "insurance" of $1500 a year, check out MDVIP.com . The basic idea there is that the family doctors get a bump in pay from the MDVIP fees they pay, and in exchange the patrons get FAST access to their family doctor. Your regular insurance also pays him, but the the MDVIP fees allow them to get a more reasonable payback on treating you. In the future, it will be more and more difficult to get appointments with family doctors as their ranks thin and their reimbursements go down. (I am not affiliated in any way with MDVIP, but I have subscribed and love it- I get same day or next day appointments with my doc)

Why should we try to save this country anymore? It is time to shrug.

<Placing Tin-Foil> hat on head:

Step one: Buy some guns and LOTS of ammo NOW...
Step two: Buy 15 Homer buckets from Home Depot and label them, Rice, Beans, Flour, Coffee, Surgar and fill them to the top and vacuum seal them
Step three: Buy vacuum sealed heritage seeds. Only need a hundred dollars or so.
Step Four: Buy lots of water filters and some water purification stuff, another few hundred dollars.
Step Five: go to Costo/Sams/BJ's and buy about 400+ rolls of paper towels and toilet paper. This and coffee will become currency.
Step Six: buy fishing and trapping gear, some survival shovels and make an emergency backpack, and learn how to make jerky, fire and other things to survive in the woods.
Step Seven: make 3 exit plans.

When things go south, if your "LUCKY" with about 2500 bucks, a little preparation, you will not care if the entire economy crashes. YOU and your family will be just fine.

BTW, I have actually completed all seven of those steps. Bought my guns and ammo in 2008 when O'Blabbermouth was elected and before he took office. why? Because "I have FORESEEN these things coming." All you had to do was actually "listen" to what this tyrant was saying. It was almost cut and paste from Hugo Chavez.