Re What the Republican Health Plan Gets Right

["Dave Farber" <dave () farber net>]

---------- Forwarded message ---------
From: Sidney Karin <skarin () ucsd edu>
Date: Sat, May 6, 2017 at 4:17 PM
Subject: Re: [IP] Re What the Republican Health Plan Gets Right
To: dave () farber net <dave () farber net>


Dave,

For IP if you like.

As an engineer I like to think in cost/benefit terms.  To a first
approximation
Obamacare got the benefit right, but got the cost wrong.  To a first
approximation
the AHCA gets the costs right, but gets the benefit wrong.

I think that a good case could be made that we have already reached the
point that we could spend the GDP on useful (extend life, improve quality
of
life) healthcare,  not including all of the waste inherent in AHCA,
Obamacare
and what preceded it.

If we haven’t reached that point we soon will and in the not too distant
future
we will be capable of delivering useful healthcare in significant multiples
of
the GDP.   This begs the question of what basic health care should be made
available to everyone?  Obviously, not all conceivable health care.  We will
ration health care.  Indeed, we already ration health care, witness such
items
as Lasik surgery.  Those who get it pay out of their own pocket.  Those who
cannot afford it do not get it.

We need a debate about what we think should be available to all and what
will be available only to those with sufficient resources of their own.
Some
things seem obvious, including my Lasik example.  On the other side of the
ledger vaccines seem obvious.  Real emergency care is another.

The debates of recent years seem focussed on the costs and try, or at least
pay lip service to, delivering all available health care to everyone.  That
isn’t
going to work.  It already doesn’t work.  We need to refocus the debate.
Who
should pay how much is only part, albeit an important part, of the problem.

Cheers,

…….Sid



On May 6, 2017, at 11:38 AM, Dave Farber <dave () farber net> wrote:

---------- Forwarded message ---------
From: Mark Blacknell <mb () blacknell net>
Date: Sat, May 6, 2017 at 2:37 PM
Subject: Re: [IP] What the Republican Health Plan Gets Right
To: Dave Farber <dave () farber net>


Jesus.  I was wondering who could come out to defend this plan, and . . .
well.  It's not the brightest and best.

The doctor that wrote the op-ed complained about a patient that saw him too
often for ailments she didn't have.  And whose fault was that?  Obama's,
apparently.  Not the patient's for making poor decisions, or even
(especially) his for failing to educate his patient.  Simple solution?  He
could have declined to see her.  My kids' pediatrician refuses to see
non-vaccinated children.  He could have done the same.

This reminds me a bit of my banker friends, who insisted that they only
behaved so poorly in the run-up to the 2008 meltdown because the government
let them.  They were simply chasing profits, you see, and that's what they
were supposed to do.  It was the government's fault that they weren't
restrained.  (Also, could they have a bailout, please?)

As to his pre-existing conditions claptrap, it strikes me as coming from
someone who has never had job/economic insecurity.  Aside from 22 year olds
who haven't yet figured out that they're not, in fact, immortal, no one
*chooses* to go without some sort of access to health care.

The AHCA is a terrible failure of American government/politics/society.  I
can't imagine defending this particular piece of legislation.

Mark Blacknell




mb () blacknell net
+1.202.270.5909
Washington, DC

On Sat, May 6, 2017 at 1:20 PM, Dave Farber <farber () gmail com> wrote:

> Begin forwarded message:
>
> *From:* Dewayne Hendricks <dewayne () warpspeed com>
> *Date:* May 6, 2017 at 10:19:22 AM EDT
> *To:* Multiple recipients of Dewayne-Net <dewayne-net () warpspeed com>
> *Subject:* *[Dewayne-Net] What the Republican Health Plan Gets Right*
> *Reply-To:* dewayne-net () warpspeed com
>
> [Note:  This item comes from friend Bob Frankston.  Bob’s comment:'The
> author blithely offers a "let them eat cake" piece of advice by saying that
> people with preexisting conditions can just get a job and get coverage via
> their employer. Totally out of step with a gig and entrepreneurial economy.
> Or for that matter, any rational economy that doesn't try to hide the true
> costs of healthcare.’.  DLH]
>
> What the Republican Health Plan Gets Right
> By MARC K. SIEGEL
> May 5 2017
> <
> https://www.nytimes.com/2017/05/05/opinion/what-the-republican-health-plan-gets-right.html
> >
>
> Now that the Obamacare replacement bill has passed the House and is moving
> on to the more centrist Senate, the real debate begins. What is the true
> purpose of health insurance, and what is our government’s goal in ensuring
> we have it?
>
> I learn from my patients every day about the benefits, limitations and
> contradictions of their health insurance. One charming 60-year-old with
> severe seasonal allergies insists on seeing me every few weeks this time of
> year, even though I tell her she doesn’t need to — her antihistamines and
> nasal spray treatment rarely changes. But she worries that her allergies
> could be hiding an infection, so I investigate her sinuses, throat, lungs
> and ears. I reassure her, and her insurance (which she buys through New
> York’s Obamacare exchange) covers the bill.
>
> If she was responsible for more than a small co-payment for these visits,
> I’m sure I would see her less often.
>
> We pride ourselves on being a compassionate society, and insurance
> companies use this to manipulate us into sharing the costs of other
> people’s excessive health care. Meanwhile, 5 percent of Americans generate
> more than 50 percent of health care expenses. Why shouldn’t a patient who
> continues to see me unnecessarily pay more?
>
> The government’s job is to maintain public health and safety. It should
> ensure that insurance plans include mandatory benefits like emergency,
> epidemic, vaccine and addiction coverage. The Republican bill would let
> states apply for waivers to define these benefits differently; it would be
> a big mistake to drop such coverage entirely. But Obamacare went well
> beyond these essentials, by mandating an overstuffed prix fixe meal filled
> with benefits like maternity and mental health coverage that drove smaller
> insurers with fewer options out of the market. The few that remain often
> have a monopoly, and premiums rise.
>
> Speaking of compassion, how about some for the 20-something construction
> worker who can’t afford to pay his rent because his premiums help subsidize
> overusers like my allergy sufferer? Why shouldn’t a patient who is
> risk-averse pay more for coverage she might never need, while that
> construction worker be allowed to choose a cheaper insurance plan that
> might cover only the essentials?
>
> In addition to limiting the menu of essential benefits, the House bill
> would let states create high-risk pools for patients with pre-existing
> conditions who had let their insurance coverage lapse, and who could then
> be charged premiums more in keeping with their health care needs. This is
> the only way to make insurance affordable for most consumers; pre-existing
> conditions will continue to drive up premiums if everyone is compelled to
> pay the same price.
>
> These risk-pool premiums can and should be subsidized by the government. A
> recent report from the Kaiser Family Foundation found that high-risk pools
> can work, but have been historically underfunded. Trumpcare should change
> that — though it will cost more than the House bill’s $8 billion in
> additional funding. Drastic cuts to Medicaid should also be reversed, which
> could help the bill pass the Senate.
>
> [snip]
>
> Dewayne-Net RSS Feed: <http://dewaynenet.wordpress.com/feed/>
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++++++++++++++++++++++++++++++++++++++++++++++++
     Sidney Karin Ph.D., P.E.                  skarin () ucsd edu
                                                              858-534-5075
     Professor Emeritus,
     Department of Computer Science and Engineering
     Director Emeritus,
     San Diego Supercomputer Center
     University of California, San Diego
     9500 Gilman Drive
     La Jolla,  CA  92093-0505



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