Suggested Discussion Outline

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TRUE CONSERVATISM REQUIRES THE ENACTMENT OF
SINGLE-PAYER HEALTHCARE (e.g., MEDICARE FOR ALL)!!!

Our focus-book confirmed what we already knew --

A. The percentage of American Gross Domestic Product (“GDP”) spent on healthcare “is more than twice the average of developed countries”!!!

B. The U.N.’s World Health Organization ranks “the health system performance” of the U.S. as only 37th in the world -- which means that since there are only 35 members of the OECD, American healthcare is outranked BY AT LEAST TWO THIRD-WORLD COUNTRIES!!!”

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None of the ideas being discussed currently in Congress would significantly impact this sad state of affairs.

Which is no surprise because YOU CAN BE CERTAIN that the $500 million/year spent by lobbyists for the healthcare industry (which is about FOUR TIMES the amount spent on lobbying by the next-most-active industry -- oil & gas) is aimed at perpetuating and expanding the outrageous practices described in our focus book.

And trying to fight those practices WITHOUT a SINGLE PAYER healthcare system (e.g., Medicare for All) will CONTINUE to be the equivalent of fighting a raging forest fire with a squirt gun.

After all, why should the enactment of any new laws be expected to have any effect in the light of all of the existing anti-trust laws and patent-law requirements that have been ignored for decades???

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WHY TRUE CONSERVATISM REQUIRES ENACTMENT OF “MEDICARE FOR ALL”

[For more detail than follows below, please read the Suggested Discussion Outline posted in this section, followed by “Saving the US Gov $300 BILLION/year with ‘Medicare For All’” which is also posted in this section.]

But in short --

What all 34 of the world’s other industrialized countries (which have better healthcare at half the cost) have in common is a SINGLE PAYER healthcare system that does NOT tolerate the waste/illegalities described in our focus book.

So that if those costs can be cut in half to bring them in line with the rest of the civilized world, quality U.S. healthcare could be provided 100%-free at NO ADDITIONAL GOVERNMENTAL COST.

(1) The Suggested Discussion Outline recorded that the 2015 U.S. Census documented that 55.7% of the American population has employment-based insurance. Since the cost of such insurance is deductible to the employer and non-taxable to the employee, then a good estimate of the cost of this insurance to the U.S. government would be the 35% corporate income tax rate * 55.7% of the population = 19.50% of the economy’s total current healthcare costs.

(2) The Suggested Discussion Outline recorded that the 2015 U.S. Census also documented the following percentages of the American population receive healthcare from --

19.6% - Medicaid
16.3% - Medicare
4.7% - Military including the V.A.
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40.6% – Sub-Total
19.5% - Percentage of economy’s total healthcare costs financed by reduced employer taxes
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60.1% - Total of economy’s total healthcare costs currently financed by the U.S. government
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Accordingly, it is respectfully suggested that a SINGLE PAYER healthcare system (e.g. Medicare for All) should cut American healthcare costs in half -- bringing them in line with the rest of the civilized world!!!

And since the U.S. Government already pays 60.1% of all U.S. healthcare costs, a SINGLE PAYER healthcare system should produce a 10.1% overall savings (60.1% - 50%).

And since our author trumpeted in almost every chapter that American healthcare costs exceed $3 TRILLION, a 10.1% overall savings should produce a U.S. Governmental spending REDUCTION of $303 BILLION/year.

SO IF TRUE CONSERVATISM MEANS REDUCING THE SIZE AND COST OF GOVERNMENT, WHY ISN’T IT OBVIOUS TO OUR POLS THAT TRUE CONSERVATISM REQUIRES THE ENACTMENT OF “MEDICARE FOR ALL”???
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johnkarls
Posts: 2034
Joined: Fri Jun 29, 2007 8:43 pm

Suggested Discussion Outline

Post by johnkarls »

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Suggested Discussion Outline


The First Short Quiz (posted in the Participant Comments section of http://www.ReadingLiberally-SaltLake.org) addressed many of the important things we already know about healthcare from the zillions of times we have studied it in the past.

The Second Short Quiz addressed many of the important points raised by our author in our focus book, most of which involve egregious practices of various components of America’s healthcare industry.

However, our author does NOT focus on looming problems (e.g., the shortage of doctors and other healthcare resources that will occur, and has already occurred, with the Obamacare expansion of Medicaid).

And our author does NOT focus on the public-policy issues of what to do with Obamacare.

Nevertheless, this Suggested Discussion Outline attempts to be comprehensive since the attendees of our July 12 meeting are guaranteed not to confine themselves to matters addressed by our author.

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I. The Disgrace That Is The American Healthcare System

A. The percentage of American Gross Domestic Product (“GDP”) spent on healthcare “is more than twice the average of developed countries” – p. 2 of our focus book.

B. The U.N.’s World Health Organization ranks “the health system performance” of the U.S. as only 37th in the world (p. 247 of our focus book) – which means that since there are only 35 members of the OECD, American healthcare is outranked BY AT LEAST TWO THIRD-WORLD COUNTRIES!!!

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II. Healthcare Models (in America and around the world)

A. Private (Non-Governmental) Insurance

B. Governmental Insurance – for example –
B-1. Medicare
B-2. Medicaid

C. Governmental Ownership – for example --
C-1. The Veterans Administration
C-2. Military Healthcare for Active-Duty Personnel and Dependents

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III. Major Private-Insurance Problems With Obamacare

A. Insurers can NOT charge more for pre-existing conditions even though they cost more.

B. Older Americans can NOT be charged more than THREE times as much as young, healthy Americans, even though their medical costs on average are FIVE times as much.

C. Points A and B are why the Obama insurance markets are imploding, because (1) insurers are not getting enough young, healthy Americans to “pay the freight” for old and/or sick Americans, and (2) even if the industry as a whole were getting enough young, healthy “chumps,” there is no way to guarantee that each insurer gets its “fair share” of “chumps” which makes the pretense of insurance even more of a charade.

D. Since the majority of Americans (55.7% per the 2015 census) already obtained their health insurance as an employee-benefit (cost deductible to the employer and non-taxable to the employee) and Obamacare did not want to “puncture that balloon” – Obamacare included the famous “employer mandate” requiring employers of more than 50 full-time employees to provide healthcare insurance. Which, of course, has helped to stifle economic growth as employers struggle to STAY BELOW 50 FULL-TIME EMPLOYEES.

BTW, the 2015 census reported the following percentages of ALL Americans --

55.7% - Employment-Based Insurance
19.6% - Medicaid
16.3% - Medicare
4.7% - Military Incl. V.A.

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IV. Problems With Various Components of the Healthcare Industry

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A. Total Lack of Enforcement of the Anti-Trust Laws

A-1. Doctors –

A-1-a. Per our author, the original purpose (and still a main purpose) of the American Medical Association is to limit the size of the nation’s medical schools in order to produce astronomical average incomes for doctors

A-1-b. We have often studied how the Old Soviet Union considered being a doctor as “women’s work” as a result of which Soviet doctors were paid less than grade-school teachers.

A-1-c. Our author reports that the cost of American medical education has nothing to do with high compensation for doctors because medical-education costs can be liquidated quickly on a typical doctor’s compensation.

A-1-d. Our author reports (p. 57) that 27.2% of all American doctors are in the top 1% of wealthiest Americans. [And query whether the other 72.8% aren’t on their way!!!]

A-2. Drug Companies and Device Manufacturers –

A-2-b. Pay For Delay.
A-2-c. Acquiring generic manufacturers and shutting them down.

A-3 Hospitals –

A-3-a. Gobbling up competitors (e.g., Sutter Health has a virtual monopoly for Northern California) and causing them to charge exorbitant fees.

A-3-b. Buying unneeded equipment and lavishing funds on non-medical items (e.g., fine art for lobbies).

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B. Total Lack of Enforcement of the Nation’s Patent Laws

U.S. Patent Law requires an item be “new, useful and NON-OBVIOUS.”

Non-enforcement of the “non-obvious” requirement results in what our author calls “product hopping” (p. 109) which is making a small OBVIOUS change with an about-to-expire patent (for example, changing a drug to “chewable” form), patenting the new small/insignificant-change form, and discontinuing the old form.

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C. Notorious Sec. 510(k) and Device “Product Hopping”

Under notorious Sec. 510(k), no FDA testing and approval is required for new devices so long as they are “substantially equivalent” to a device already sold in the United States for the same purpose.

Our author claims (pp. 128-147) that virtually all devices are brought to market under this provision for “substantially equivalent” devices.

EVEN THOUGH, SHE CLAIMS, VIRTUALLY ALL OF THESE “SUBSTANTIALLY EQUIVALENT” DEVICES HAVE BEEN PATENTED AS “NON-OBVIOUS”!!!

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D. Medicare Financing the Worlds Medical R&D Costs

When Congress enacted the Medicare Prescription Drug Benefit in 2003, it prohibited Medicare from negotiating drug prices.

So the drug companies are free to charge whatever they want, which effectively provides the financing for the world’s medical R&D (and a lot else).

*****
E. The Physician’s Desk Reference (“PDR”)

Our author reports (pp. 190-192) that virtually all doctors buy each year The Physician’s Desk Reference (“PDR”) which is their “Bible” which lists doses, side effects, half-lives, chemical structures, and results of clinical trials of all approved medicines.

Our author also reported that in 2012, Medical Economics (the publisher of the PDR) decided to add for each drug’s listing, a list of similar drugs and the price for each.

Which resulted in the immediate acquisition of Medical Economics by the LDM Group which killed the idea.

If the LDM Group is owned by the pharmaceutical companies, their action was/is a clear-cut violation of the nation’s anti-trust laws.

The U.S. Department of Justice has shown no interest in determining whether the LDM Group is owned by pharmaceutical companies.

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F. End-Of-Life Considerations

F-1. The overwhelming majority of Medicare expenses are incurred during the final illness.

F-2. The overwhelming majority of states do NOT permit assisted suicide during a fatal illness no matter how severe the pain or how short the remaining life expectancy.

F-3. Harvard Medical Prof. and Practicing Surgeon Atul Gwande states as a major theme of “Being Mortal: Medicine and What Matters In The End” (the focus book for our 1/11/2017 meeting) that much if not most end-of-life medical costs could be avoided IF PHYSICIANS WERE HONEST WITH THEIR PATIENTS – in explaining HOW FORLORN are the hopes for “success” for whatever the next heroic medical procedure is, and HOW HORRENDOUS the “quality of life” will be following the so-called “success”!!!

F-4. Harvard Medical Prof. Gwande’s other major theme in “Being Mortal” is that the human body is like an old car and the more that it breaks down and is repaired, the more likely it is that many other things will soon go wrong with it!!!

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G. The Medical Tort Bar

G-1. Tremendous legal resources wasted on medical malpractice lawsuits.

G-2. Eliminate the Medical Tort Bar using the same model as “no fault auto insurance” that eliminated the Auto-Accident Tort Bar about 50 years ago in about half of the states in America and in several foreign countries.

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V. THE UNDERLYING PROBLEM – “THE BEST GOVERNMENT MONEY CAN BUY”!!!

Dana Milbank (Washington Post OpEd Columnist 2000-present, syndicated in more than 200 newspapers) and Robert Kuttner (Business Week Columnist 1984-2005) have been essential guides to our understanding of American politics since we studied for our 2/14/2008 meeting 9.5 years ago their newly-minted best-sellers “Homo Politicus: The Strange and Scary Tribes That Run Our Government” and “The Squandering of America: How the Failure of Our Politics Undermines Our Prosperity” -- because the thesis of both Messrs. Milbank and Kuttner was that NOTHING IS DONE (OR NOT DONE) IN THE CESSPOOL KNOWN AS WASHINGTON DC EXCEPT AS THE RESULT OF CAMPAIGN CONTRIBUTIONS WHICH COMPISE EITHER BRIBERY OF THE POLS OR EXTORTION BY THE POLS!!!

Our author states (p. 198) that the Medical Industry “has become the country’s biggest lobbying force” listing 2015 lobbying expenditures as --

Medical Industry - $500 million
Oil & Gas Industry - $130 million
Securities & Investment Firms - $100 million
Defense/Aerospace Industry - $75 million

Does anyone believe for a moment that a single dollar of the $500 million is spent on lobbying for citizens/patients???

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VI. FUTURE SUPPLY AND DEMAND

A. Ignored by our author.

B. But isn’t it silly to think that costs can be controlled to any significant degree by, for example, permitting health insurance to be sold across state lines, like homeowners’ insurance or life insurance???

B-1. After all, insurance premiums have to cover all of the costs (including the zillions of cost problems described above)!!!

B-2. Though it would solve the problem that health-insurance premiums (unlike insurance that is sold nationally, such as life and homeowners) have to be approved by state insurance commissioners – which is one reason why so many areas of the country have either one insurance company or, increasingly, NO insurance company under Obamacare.

B-3. BUT eliminating such approval will only mean higher premiums for the under/un-served areas. AND, presumably, no premium reductions for well-served areas since insurance companies are always free to enter any geographical area that appears lucrative.

C. Aren’t the real solutions to controlling healthcare costs --

C-1. Policies mentioned above such as enforcing the nation’s EXISTING Anti-Trust Laws and the nation’s EXISTING Patent Law requiring “non-obviousness”???

C-2. Policies to expand supply, such as the U.S. Government establishing HUGE new medical schools so that doctors’ compensation can be properly aligned with salaries of grade-school teachers.

[After all, surgeons have essentially the same skill set as plumbers and psychological studies show that the only reason the public tolerates high compensation for surgeons, just like the public used to tolerate high compensation for airline pilots who have essentially the same skill set as bus drivers, is THE IRRATIONAL FEAR that successful surgery or successfully landing an airliner WILL REQUIRE A MIRACLE!!!]

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VII. THE BEST MODEL FOR ACCOMPLISHING ALL OF THESE OBJECTIVES

A. Private (Non-Governmental) Insurance

B. Governmental Insurance – for example –
B-1. Medicare
B-2 Medicaid

C. Governmental Ownership – for example --
C-1. The Veterans Administration
C-2. Military Healthcare for Active-Duty Personnel and Dependents

It is respectfully suggested by Yours Truly that the “correct answer” is Medicare For All, financed by a gasoline tax (if wealthy Americans are unwilling to “love their neighbors as themselves” and permit financing by a progressive income tax).

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