America - The Official Thread

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Shaun
They are required for the business to run but don't generate income for the business.
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That's me. I'm just one big expense to the healthcare system even though without what I do, the hospital wouldn't be able to get paid.

There are a ton of reasons why healthcare costs in the US are asinine. You can point the finger at the government, though, for one of the biggest reasons. Medicare and Medicaid are terrible, expensive, and don't work very well, but they're what a majority of unhealthy and old people have, so health systems cater to them. While I'm not entirely in favour of doing away with Medicare and Medicaid, it needs to be revamped, but thanks to lobbying and politicians needing their "donations" you won't see it change that much.

Another big reason is malpractice. People sue health systems for everything. Did your 101-year-old mother die in the hospital? Lawsuit. Did your 15-week premature baby die in the hospital? Lawsuit. Did you ignore the doctor's instructions and end up paralyzed after a procedure? Lawsuit. Even if the health system is on track to win, it's often cheaper to pay out instead of going to court over it. Civil courts need to better triage healthcare lawsuits because while there are definitely screw-ups from the hospital that require compensation, much of the time, it's just someone not understanding why their loved one died.

After that, there's a sizable percentage of people who just don't pay for their healthcare, even if they're able to. They claim that they're "poor" and then proceed to pay $10 a month on a $100k heart surgery bill. On top of that you have people who treat the ED like it's an urgent care. Have a sore throat? ED. Break a fingernail? ED. Skinned knee? ED. It's stupid and costly while tying up the ED for people who actually need it. The absolute worst offenders of this too are people on government provided healthcare, especially the Native population. Where I work, there's a huge Ute population and they use the ED like it's their family practice. There's nothing we can do about it either. Same goes for the homeless. They claim they have chest pain, get all these tests run in the ED, and really all they want is a bed and some food. Of course they're unable to pay too.

We write off millions in charity care every month and all that does is make it more difficult to run the health system and provide quality care. Meanwhile, everything is getting more expensive and no one wants to work for peanuts, especially medical staff who's gone to school and had some stupid amount of debt.

The problem though is that I haven't the foggiest idea how you fix it without just offing a chunk of the population, which obviously isn't a good solution.
 
Joey D
The problem though is that I haven't the foggiest idea how you fix it without just offing a chunk of the population, which obviously isn't a good solution.
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Something has to be done.

It didn't use to be the case that people would beg for an ambulance NOT to be called, or avoid going to the hospital or doctor because of fees - or be underwater paying for pills. This is a relatively new phenomenon, and it has a lot to do with how we manage insurance.

If I could take one baby step today that I feel would be in the right direction, it would be that tax must be paid on employee healthcare expenses and premiums. Why is that a step in the right direction? Because we absolutely HAVE to decouple employment from healthcare, and right now it's insanely coupled.

We desperately need some kind of basic health insurance or payment process that covers emergencies for everyone who doesn't have something better. I don't know exactly what the right way to do that is, but medicare for everyone is not the worst thing I've heard.
 
Danoff
Something has to be done.

It didn't use to be the case that people would beg for an ambulance NOT to be called, or avoid going to the hospital or doctor because of fees - or be underwater paying for pills. This is a relatively new phenomenon, and it has a lot to do with how we manage insurance.

If I could take one baby step today that I feel would be in the right direction, it would be that tax must be paid on employee healthcare expenses and premiums. Why is that a step in the right direction? Because we absolutely HAVE to decouple employment from healthcare, and right now it's insanely coupled.

We desperately need some kind of basic health insurance or payment process that covers emergencies for everyone who doesn't have something better. I don't know exactly what the right way to do that is, but medicare for everyone is not the worst thing I've heard.
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It didn't used to be that way because the population was younger, and it was easier for younger people to afford to care for older people. Now, America is trending much older. It's also unhealthier too, so the demand for healthcare is greater with fewer people paying into it while the cost of care continues to go up. That's why I said, the best way to solve it is to remove a chunk of the population, but that's a terrible solution. People could be healthier but I'm not sure how you accomplish that when even eating healthy is prohibitively expensive for a large part of the population.

I agree that insurance needs to be decoupled from employment, but I can't see that happening. One of the biggest advantages an employer has over its employees is healthcare and the threat of losing that healthcare keeps a percentage of the employees in line. You don't risk having your job eliminated or being terminated because then you have no health insurance. Sure you could buy it in the open market but the cost there is stupid because there just isn't competition to keep the prices lower.

As for Medicare for everyone, that would be a disaster unless you change a bunch of other stuff in the government first. Right off the bat, your coverage would change based on who holds the power in Congress. Have a bunch of Republicans? Guess your birth control is no longer covered under Medicare, or do you need a hysterectomy? We can't have you removing your baby-making organs now, can we? I know this doesn't happen now, but most people covered under socialized medicine are over the age of 65.

You also need to eliminate fee-for-service and transition to value-based care, which rewards quality over quantity. Doctor's need to be paid based on the quality of outcomes, not on how many outcomes they have. Because of fee-for-service, you have doctors doing a bunch of needless crap because it makes them (and the health system) more money.

There also needs to be some standard (and it doesn't have to be from the government, it could be ISO for example) to get EMRs all talking to one another. The lack of continuity of care adds overhead and makes the patient go to more appointments. If I want to see a specialist, I need to see my PCP, who takes all my information, and then I get referred and have a consultation with a specialist who takes down all the same information before scheduling me for another appointment to actually take care of the problem. With EMRs that talked to one another, all the information should be easily transferred but it doesn't happen.
 
Joey D
I agree that insurance needs to be decoupled from employment, but I can't see that happening. One of the biggest advantages an employer has over its employees is healthcare and the threat of losing that healthcare keeps a percentage of the employees in line. You don't risk having your job eliminated or being terminated because then you have no health insurance. Sure you could buy it in the open market but the cost there is stupid because there just isn't competition to keep the prices lower.
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I think removing the tax incentive for employer healthcare is a start at least. We don't buy car insurance through our employers and that's partly down to it not being tax advantaged.

Joey D
As for Medicare for everyone, that would be a disaster unless you change a bunch of other stuff in the government first. Right off the bat, your coverage would change based on who holds the power in Congress. Have a bunch of Republicans? Guess your birth control is no longer covered under Medicare, or do you need a hysterectomy? We can't have you removing your baby-making organs now, can we? I know this doesn't happen now, but most people covered under socialized medicine are over the age of 65.
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That's a very understandable concern. I was really thinking of it more as a bare-bones plan rather than something comprehensive that would cover a lot of what you describe. Federally, for example, we provide healthcare now to prisoners under the age of 65. If you're in your early 30s and need free healthcare (it's not going to be good healthcare but it will be free), breaking the law is a viable option to get it.

Perhaps the federal prison healthcare system is more in line with what I'm thinking of when it comes to a minimum standard of healthcare for everyone.

Joey D
You also need to eliminate fee-for-service and transition to value-based care, which rewards quality over quantity. Doctor's need to be paid based on the quality of outcomes, not on how many outcomes they have. Because of fee-for-service, you have doctors doing a bunch of needless crap because it makes them (and the health system) more money.
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Hard to disagree but it's very difficult to figure how to implement that.

Joey D
There also needs to be some standard (and it doesn't have to be from the government, it could be ISO for example) to get EMRs all talking to one another. The lack of continuity of care adds overhead and makes the patient go to more appointments. If I want to see a specialist, I need to see my PCP, who takes all my information, and then I get referred and have a consultation with a specialist who takes down all the same information before scheduling me for another appointment to actually take care of the problem. With EMRs that talked to one another, all the information should be easily transferred but it doesn't happen.
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Also hard to argue with and still hard to figure out how to make this happen. This is true in many socialized systems as well. Your PCP in a socialized healthcare system often operates as a gatekeeper for specialists and essentially screens patients to see if they should be given access to a specialist. If you can't convince your PCP that you need a specialist, you don't get one. So this relationship is not necessarily specific to an insurance-based system like the US.
 
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TB
Your comments brought to mind this joke about contractors. I'll spoiler it to not take up too much room for the uninterested.

CUSTOMER: "How much will it cost to do this job?"

CONTRACTOR: "$2,800 Dollars."

CUSTOMER: "That's WAY too expensive for this job!!"

CONTRACTOR: "How much do YOU think it would cost?"

CUSTOMER: "No more than $800 Dollars - MAX!! It's a simple job!"

CONTRACTOR: "I can't prioritize my time for so little."

CUSTOMER: "People in your line of work are so greedy."

CONTRACTOR: "Sorry you feel that way. Why not do it yourself?"

CUSTOMER: "But... but... I don't know how to do any of this."

CONTRACTOR: "For $900 Dollars, I'll teach you EXACTLY how to get this job done. Then you can spend $800 to do the job and you'll still be saving $1,100 Dollars - PLUS... you'll get the knowledge and experience for the next time you want to do a job yourself."

CUSTOMER: "Deal!! Let's do it."

CONTRACTOR: To get started you'll need tools. So you'll have to buy a welder, a grinder, a chop saw, a drill press, a welding hood, gloves and a few other things."

CUSTOMER: "But I don't have all this equipment and I can't buy all of these for one job."

CONTRACTOR: "Well then for another $300 more I'll let you rent my tools... and you'll still be saving $800 Dollars."

CUSTOMER: "That's cutting into my savings. But I'll rent your tools."

CONTRACTOR: "Okay! I'll be back on Saturday and we can start."

CUSTOMER: "Wait. I can't on Saturday. I only have time today."

CONTRACTOR: "Sorry, I only give lessons on Saturday, because I have to prioritize my time and my tools have to be at other jobs with other customers all week long.

CUSTOMER: "Okay!! I'll sacrifice my family plans on Saturday."

CONTRACTOR: "Yeah... me too. Oh... and I forgot... to do your job yourself, you also have to pay for the materials. Everything is in high demand right now, so your best bet is to get your truck and load up at 6AM before everyone else gets there."

CUSTOMER: "SIX AM??? On a Saturday??? That's way to early for me. And also... I don't have a truck."

"CONTRACTOR: "I guess you'll have to rent one. Do you have a couple of strong men to help you load and unload everything?"

CUSTOMER: "Ummm... ya know... I've been thinking. It's probably best if YOU get this job done. I'd rather pay someone to get it done correctly than go through all the hassle.

CONTRACTOR: "Smart move, sign this and please get out of the way so I can work."
Maybe I'm taking this too personally because my wife is an NP and was an ER RN before that and I have a niece that is working in the lab in the hospital and a kid that just applied for a part time job in the lab while he's still in college.

You're not paying for the 5 minutes that you're in the room with someone to draw your blood. Or the 5 minutes with the doctor.

And the machines don't do all the work.

You're paying for the decades of knowledge and the equipment to accurately diagnose your condition and give you options for treatment in 5 minutes.

You're paying for the time it takes them to write up their visit summary into your chart.

You're paying for the losers that don't have insurance and are too lazy to fill out the paperwork to get on Medicaid so they give false information when they check in so they can't be found to be billed later. Since the hospitals are mandated to treat everyone regardless of insurance, that gets passed down to those that do.

Let's flip this for a second - why don't we let any old untrained idiot in the cockpit?
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I wasn't trying to disrespect the professionals, just breaking down the unit cost. Employees typically conduct a lot of operations at work and automation helps make their work that much more efficient, so ultimately each operation's cost is relatively low.
 
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Liquid
Disneyland Dayton could be on the cards.
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We've already got Kings Island and Cedar Point amusement parks in Ohio, the latter being the best rollercoaster park in the country. Glad I looked them up because the Ohio-based owner of these two parks is about to take a controlling share of Six Flags amusement company, although they're keeping the Six Flags name since it's more widely known.
 
Keef
although they're keeping the Six Flags name since it's more widely known
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This is crazy to think about because I've been to both multiple times in my life and Cedar Point blows Six Flags out of the water any day of the week.
 
Keef
The harder the south dies, the more room in the market there is for Midwestern resurgence. I'm okay with this.
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I think there will be a New England resurgence before a midwestern one. But with the absolutely awful and worsening weather and signs of overpopulation, I do think the south is nearing it's peak...at least in it's current well, we can keep building suburbs forever, right? form.
 
cjsrt4
This is crazy to think about because I've been to both multiple times in my life and Cedar Point blows Six Flags out of the water any day of the week.
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I agree. Cedar Point is the best coaster park on the continent, no doubt. But most people in the country have only ever had access to a Six Flags location.

Eunos_Cosmo
I think there will be a New England resurgence before a midwestern one. But with the absolutely awful and worsening weather and signs of overpopulation, I do think the south is nearing it's peak...at least in it's current well, we can keep building suburbs forever, right? form.
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The problem with NE is logistics. The Midwest, particularly from Chicago through Ohio, has always been a logistics hub for most of Americans population. It also has relatively inexpensive cost of living while New England is already extremely expensive with no sign of slowing, and extremely dense. Midwestern urban areas are nowhere near as dense as they used to be and have the capacity for which means developing these areas will be considerably cheaper than New England. This is the same reason the South has boomed, because it's dirt cheap to develop. Their governments just so happen to be very business-friendly but at the expense of everything else in the state. GA and NC are the only ones doing it right, while Texas is basically a gigantic "**** it" which is barely holding itself together.

I see the Midwest as the most moderate and most average region in the entire country, from the people to the policies to the markets. Development will be slow but that's good. As for New England, I spent a ton of time in that area at work and I can't fathom why anybody would want to live there. There isn't anything to resurge, it's incredibly dense and active already, and virtually all the logistical networks are incredibly old and in terrible condition. If anything, I see the hearts of New England like Philly, NYC, and Boston becoming distopian hellholes sooner than later.
 
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