Obamacare “repeal”

[ny_quant]

А где-нибудь в ЖЖ уже обсуждают какой это прекрасный план и как Трамп быстро выполнит очередное предвыборное обещание? Кстати, уважуха консерваторам которые против.

Comments

[nefedor.livejournal.com]

Somehow I feel good about those anti-American ideas of yours ;)

[tandem-bike.livejournal.com]

well, 1. is "communist", but just.. unavoidable, in any civilized society, and 2. is.. actually hard to swallow.

we are programmed to think, and proud of, every janitor being treated the same as a congressman. the thing is - a janitor with a university insurance will continue to have the same treatment as a senator. but the person with this "universal" hypothetical one - will get care that is not the same. for most not all conditions. including end of life.

[nefedor.livejournal.com]

Well, I'd say that we're much more programmed to think like that recently in Obama times.

But regardless of origins - this is exactly the problem. As soon as we have parallel basic universal + private extra there will be socialists who'd blow the universal part to unrealistic and unsupportable proportions "just because they all deserve it".

[tandem-bike.livejournal.com]

i don't get it. how so? who will blow what where???

[nefedor.livejournal.com]

Imagine we have it. Perfect way. Nice inexpensive universal and a market for private insurances for those with money.

Imagine a left populist comes to the White House.

Guess what his proposition would be? Of course: extend the universal coverage for this and that. Always extend, never reduce (cause it's unpopular to reduce).

Outcome is obvious: after some time that perfect inexpensive universal will turn into all consuming unbearable monster.

[tandem-bike.livejournal.com]

you are saying that the wishing well is bottomless. but there is no populis, left or right, that would allow free-for-all-unlimited.

[nefedor.livejournal.com]

If people won't do something right away, they can be convinced to do that step by step since each step is smaller and doesn't look as ridiculous as the whole thing. They will add here and there in small adjustments and will inflate the originally cheap "safety net universal" to epic proportions. I believe this is unavoidable unless some hard-to-avoid roadblocks will be created.

[tandem-bike.livejournal.com]

well, that did not happen in the VA system! it really is an exemplary socialist medicine outfit, with the pros and the cons.

[nefedor.livejournal.com]

Here I can't comment because I lack the knowledge. I believe you, of course, and wonder how could they keep it this way.

[tandem-bike.livejournal.com]

well, do you want me to tell you about it? it is simple. everything is run M.A.S.H. style, with the same absurdity at times. teh resources are capped, and when an expensive drug is needed, a vet may hear sorry, sir, not on the formulary. there are some exceptions. you want to see THIS doctor but you cannot, you see whomever they gave you. you want to see the same doctor every time but no way, you will see a different resident staffed by different attendings. you want a motorized wheelchair but "VA no longer pays for those"". etc.

and - a HUGE reliance on volunteers for all kinds of tasks.

[nefedor.livejournal.com]

The main question here is about capped resources. How are they capped - by whom? Who can influence on that cap? Can it be influenced democratically - by majority vote?

[tandem-bike.livejournal.com]

now, here i cannot answer because i don't know. what i do know - democracy has no place there.

i suspect some admins and medical directors get together nad decide to add ( can happen!) or cut a service.

for example, when a new device is introduces, the technical acquisitions committee will meet and discuss its need for teh VA population, consider the cost, the benefits, the PR etc. and provide the servic e- or not.

or - the same people probably convene and decide that it is too cost-ineffective and tough on schedulers to have "personal" doctors for the vets, so anybody will be scheduled into anyone's next availble without regard to whom they saw for the last 10 years.

as a result - sometimes teh patients suffer, sometimes they benefit. it balances out.

[nefedor.livejournal.com]

Yes, I suspect the same. Then this is why VA is not implementable on the national level: we do have democratic means to influence the caps.

[tandem-bike.livejournal.com]

hate to say it, but that's why the end is near.

we need to cap malpractice to 200,000 unless there are "special considerations", which are rare ( i could gieve you examples but no need), cut the MD salaries ( ouch but yes), prodice TWICE more local MDs, import TWICE more pakistani and indian MDs, destroy entitlement plans while building a socialist universal plan, the open the free market to new paradgims of medical insurance.

why am i not advising the president?? i would volunteer signamax first, though.

[nefedor.livejournal.com]

Totally agree - the end is near exactly because of that.

>> cap malpractice to 200,000

I'm making, say, 500K a year. Suppose, some surgeon did a lousy job on me and I've lost ability to work. And he/insurance owes me only 6 month of my pay? Hmmm...
I'm not saying hard no to that, but it looks somewhat unfavorable...

>> produce TWICE more local MDs, import TWICE more pakistani and indian MDs

Would that mean quality drop or not?

[tandem-bike.livejournal.com]

1. life is not fair
2. yes, a quality drop


:-)

i mean both

[ny-quant.livejournal.com]

Clearly, reliance on volunteers won't work on the national level.

[nefedor.livejournal.com]

Well, I'm not sure if they rely on them that hard. There is volunteering everywhere. But even if this is an issue, I still think the cap on pay has larger influence.