V A as a representation of a single payer system

Knight

Knight

Well-known Member
Promoting a single payer system sounds good until the payer is the U S Gov. via taxes collected. I thought what if anything does the CBO have as input relative to private & the single payer system known as the VA Administration for vets health care. Several paragraphs but this one stood out to me to comment on.

Why Might Costs Differ Between VHA and the
Private Sector?
CBO’s analysis indicates that VHA pays lower prices for
pharmaceutical products than private-sector health care
systems do (largely because of federal price controls) and
may also pay less to doctors. For other medical goods and
services, however, CBO could not determine whether
VHA or the private sector has lower unit costs. In addition
to any differences in prices per service, veterans
might receive a larger amount or more complex mix of
services if they were treated by private-sector doctors and
hospitals than by VHA because those providers have
stronger financial incentives to deliver more expensive
care. At the same time, having the government provide
health care through VHA may not be efficient. All of
those factors make it hard to draw firm conclusions about
relative costs.


https://www.cbo.gov/sites/default/f...13-2014/reports/49763-VA_Healthcare_Costs.pdf

After so many years as a program run by our government the CBO finds it hard to draw firm conclusions? I think that's bureaucratic double speak for, it hasn't worked well, fails to provide what it is intended to do and not likely to anytime soon.
 

Butterfly said:
It will help if when we DO get to a single payer system, the government doesn't load it down with highly paid bureaucrats and 27,000 miles of red tape, like they do most government programs.
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I agree Butterfly about the single payer. A friend of ours has had a lot of health issues since he's been in the service years ago, recently had a liver transplant, he's grateful he has the VA and rarely has any complaints.
 

Butterfly said:
It will help if when we DO get to a single payer system, the government doesn't load it down with highly paid bureaucrats and 27,000 miles of red tape, like they do most government programs.
Click to expand...
I think that was the point the non partisan congressional budget office was trying to make.

Doesn't it seem a little odd that super computers can figure out the trajectory, time and everything involved in putting a vehicle on Mars. Wouldn't it make sense to feed a super computer info like the problems other countries that have had single payer systems in place for many years. The needs of the different areas of America, the quantity of catastrophic health care cases, break down the health issues that need the most attention. Start with an understanding of the needs and work out from there.

It's no secret weight and smoking cause a LOT of the health care needs. Not all weight is by choice but when there is a choice and people cause their own problems is it really fair to penalize those that make good choices by having their premiums pay for poor choices.
 
Knight said:
I think that was the point the non partisan congressional budget office was trying to make.

Doesn't it seem a little odd that super computers can figure out the trajectory, time and everything involved in putting a vehicle on Mars. Wouldn't it make sense to feed a super computer info like the problems other countries that have had single payer systems in place for many years. The needs of the different areas of America, the quantity of catastrophic health care cases, break down the health issues that need the most attention. Start with an understanding of the needs and work out from there.

It's no secret weight and smoking cause a LOT of the health care needs. Not all weight is by choice but when there is a choice and people cause their own problems is it really fair to penalize those that make good choices by having their premiums pay for poor choices.
Click to expand...


I feel strongly that the blame game has no place in medical care. EVERYONE deserves good medical care, regardless of whether their bad choices may have led to/exacerbated their problem.

The blame game just leads to more red tape, litigation, etc., and also makes the inhumane assumption that if you somehow caused your problem you don't deserve treatment.

If you are in a car wreck that you caused, do you not deserve care because you made a poor decision? Does a failed suicide attempt not deserve treatment because of a poor decision? What about STDs and HIV -- poor decisions? What about alcoholism and drug addiction -- no care because of poor choices? What about the person who knows something is wrong but waits months to seek treatment and now the problem is bigger and badder -- poor decision, so no treatment?? A diabetic who won't stick to his/her diet? And on and on and on.

Insurance companies would have a heyday finding ways anyone's problems were their own fault.

Blame is a VERY bad idea when it comes to medical care.
 
With millions now having access to a doctor via Obama care assumptions go out the window unless doctors don't know the difference between natural causes and cause by choice.


A lay person can't look at a 300 lb. person and determine the cause, but a doctor that has a multitude of ways to test for the why of that weight does.



In a single payer system this thought popped up.

[h=2]UK Proposal for Explicit Weight Discrimination in Healthcare[/h]We have a global epidemic in our midst. All over the world, people are blurting out things that they know are wrong. The latest, startling example comes from the UK National Health Service (NHS) in North Yorkshire. Last week, local administrators announced plans for explicit weight discrimination in healthcare.
The plan was to make people with obesity wait for up to a year for surgeries like hip and knee replacements. Part of the proposal was to lift the restriction for people who lose enough weight to take them below a BMI of 30. The ban would have applied to smokers as well.


That was quickly condemned.


The article ends with reality
"In healthcare, discrimination like this is actually quite routine and well-documented. But it’s mostly implicit and hidden from routine public view. In a sense, the NHS bureaucrats in North Yorkshire did us a favor with their proposal."

http://conscienhealth.org/2016/09/uk-proposal-explicit-weight-discrimination-healthcare/


Which is better covered up denial or motivating a person via the increase cost to them of paying higher premiums to stop the kind of choices that they are making.

You mentioned car accident. Don't people that have more car accidents pay higher premiums? Life insurance premiums are higher when health issues are identified & sometimes even denied.
 
Butterfly said:
Rationing health care based on alleged "guilt" is neither humane nor fair, no matter how you frame it.

This smacks of the "death panels" some feared with Obamacare.
Click to expand...
Rationing health care was an idea generated in the UK by the NHS. If you really read what I wrote you would understand that paying additional premium cost for making a choice that is KNOWN to cause health problems isn't any different than a person with several DUI arrests paying dearly for insurance.
https://www.esurance.com/info/car/how-a-dui-affects-car-insurance-premiums



A person that chooses to smoke can pay more for life insurance.
https://resources.ehealthinsurance.com/life-insurance/life-insurance-smokers


IMO if a person chooses to have poor health then like other insurances they should pay higher for that choice.


By having a doctor confirm a persons health status whether it's by choice or natural cause is NOT guilt. It's an established fact that a person has control over.
 
Knight said:
IMO if a person chooses to have poor health then like other insurances they should pay higher for that choice.


By having a doctor confirm a persons health status whether it's by choice or natural cause is NOT guilt. It's an established fact that a person has control over.
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I'm pretty sure most people don't choose to have poor health. Nor can a doctor "confirm" causes of disease. Lung cancer cells don't wear signs that say "first-hand smoke", "second-hand smoke", "air pollution", "bad luck", or any other identifiers.

I think some people are happy to assign blame for an illness if someone has a risk factor. Overweight people are often blamed for every illness they may develop.

Be happy if you have escaped serious illness.
 
nvtribefan said:
I'm pretty sure most people don't choose to have poor health. Nor can a doctor "confirm" causes of disease. Lung cancer cells don't wear signs that say "first-hand smoke", "second-hand smoke", "air pollution", "bad luck", or any other identifiers.

I think some people are happy to assign blame for an illness if someone has a risk factor. Overweight people are often blamed for every illness they may develop.

Be happy if you have escaped serious illness.
Click to expand...
If I understand you right you are posting that people don't know that smoking cigarettes is bad for their health. Or that consuming food in excess that is loaded with high fat & calories is forced on them.

What Causes COPD?

Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD.
In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.
Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)
Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.
Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.http://www.nhlbi.nih.gov/health/health-topics/topics/copd/causes

For COPD there is a wealth of tests a doctor can do.
https://www.nhlbi.nih.gov/health/health-topics/topics/copd/diagnosis

I admit I don't use the same logic as others. I don't share the logic that people have no choice in what they do to their own detriment. And to the detriment financially of others that do care about having as good health as possible.

Rather than best guess the CDC can explain best.

[h=3]Obesity is common, serious and costly[/h]
  • More than one-third (36.5%) of U.S. adults have obesity. [Read CDC National Center for Health Statistics (NCHS) data brief PDF-704KB]
  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. [Read guidelines]
  • The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.


Our good health my wife and I doesn't come from poor eating habits and no exercise it comes from paying attention to causes of poor health.
 
Knight said:
If I understand you right you are posting that people don't know that smoking cigarettes is bad for their health. Or that consuming food in excess that is loaded with high fat & calories is forced on them.
Click to expand...
No, what I am posting is I'm pretty sure most people don't choose to have poor health. Nor can a doctor "confirm" causes of disease.

I think some people are happy to assign blame for an illness if someone has a risk factor.

Be happy if you have escaped serious illness. You may be very lucky and blessed with good genes. And your healthy lifestyle may have helped.
 
nvtribefan said:
No, what I am posting is I'm pretty sure most people don't choose to have poor health. Nor can a doctor "confirm" causes of disease.

I think some people are happy to assign blame for an illness if someone has a risk factor.

Be happy if you have escaped serious illness. You may be very lucky and blessed with good genes. And your healthy lifestyle may have helped.
Click to expand...

AND, as I said before, it would be a VERY slippery slope to blaming the patient for everything he suffers. Our medical caregivers should not be dispensing judgment from on high about the worth of a patient's life, regardless of his /her lifestyle. This would be the ultimate discrimination, and smacks of Nazi Germany's sorting out of those fit to live and those not.
 
Butterfly said:
AND, as I said before, it would be a VERY slippery slope to blaming the patient for everything he suffers. Our medical caregivers should not be dispensing judgment from on high about the worth of a patient's life, regardless of his /her lifestyle. This would be the ultimate discrimination, and smacks of Nazi Germany's sorting out of those fit to live and those not.
Click to expand...
How did it get to a person losing their life from a person paying more for heath insurance if they CHOOSE to endanger their own health?

Did it occur to you that the money paying for health care for people that make bad choices could be redirected to those people that for no other reason than they were born with a condition that causes them to need high cost health care. Suppose for instance that 20 billion was redirected to people that were skipping meds because they couldn't afford them.


Just like the ACA mandating that healthy young people either buy insurance they can't afford or pay a fine. Having people that make choices that CAUSE all kinds of high cost health care problems could pay extra to pay for those that can't afford the health care THEY need.
 
I agree about the weight issue being epidemic which directly correlates to a situation that I see as: just because we can, doesn't mean we should.

All this technology was supposed to free up our time for a life of leisure. So now we have all this leisure time and nothing to do and doing nothing doesn't pay very well! Robots are taking over factory & menial jobs so people with little education have nowhere to work and no way to survive. Not everyone is cut out for college or executive jobs. We have cars so we don't walk anywhere and anything can be delivered to your house - which is GREAT for those who cannot get out but the rest of us - really?? Cell phones replaced radios and that was great for those working on a job site or on the road who need to communicate but for the average housewife or teenager - really? I have one for emergencies but never use it. We really need to get off our sofas and get busy ( and that even means me!)

That said - I agree that health care shouldn't be so limited. I have no problem paying for an appointment - if the cost is reasonable! We used to pay $38 every time we went to the Dr. with a child. I didn't mind that. We went because we had to. I do not want to pay for the Dr's mal-practice insurance or tee time. If I didn't like the Dr., I chose another one. The fact that the insurance companies have inflated those prices that hurts us all.
 
Good points. But what about the underlying cause of insurance rates being high? A little research into what happened when government got involved in who got free treatment and why could bring this back to the potential disaster in gov. was to be the administrator of a single payer system.
 
Knight said:
How did it get to a person losing their life from a person paying more for heath insurance if they CHOOSE to endanger their own health?

Did it occur to you that the money paying for health care for people that make bad choices could be redirected to those people that for no other reason than they were born with a condition that causes them to need high cost health care. Suppose for instance that 20 billion was redirected to people that were skipping meds because they couldn't afford them.


Just like the ACA mandating that healthy young people either buy insurance they can't afford or pay a fine. Having people that make choices that CAUSE all kinds of high cost health care problems could pay extra to pay for those that can't afford the health care THEY need.
Click to expand...

I think most people have made some less than wise choices during their lifetimes. I know I have. But the older I get, the more sure I am that I'm not qualified to sit in judgement of anyone else's actions.
 
When money is involved people manage to change. Rather that make a profit like car or life insurance companies do when they penalize people by charging them more for their poor choices like DUI or smoking. Tacking on cost to insure a person that has and continues to make poor choices that are detrimental to their health and in turn costing others may be the incentive for those people to change. If no change then the extra could be applied to lower or eliminate the cost to people that are struggling to pay for health care.

Unless you live where there is no communication, no doctors, & no way possible to know that a 32 ounce big gulp and two corn dogs to drink and eat while walking thru a mall on your way to the next food court is bad for your health. Then I could agree that when you don't know then you shouldn't pay extra.
 
I, for one, am very happy for the care I receive at the VA. The care I have received there is far and away better than the 5 mins spent with me by an outside Dr.
 
Jeb you are one of the lucky ones. You mentioned that it's better than seeing a doctor on the "outside". I'm trying to imagine what a single payer system run by our government would look like with over 300 million people to provide health care for if this is how Vets are treated.

This from https://veterans.house.gov/accountability.


Washington, DC
Diana Rubens, the VA executive in charge of the nearly 60 offices that process disability benefits compensation claims, collected almost $60,000 in bonuses while presiding over a near seven-fold increase in backlogged claims.

Washington, DC
VA construction chief Glenn Haggstrom collected almost $55,000 in performance bonuses despite presiding over a host of major construction projects plagued by years-long delays and combined cost overruns of $1.5 billion. The Government Accountability Office documented the delays and cost overruns for projects in Las Vegas, Denver, New Orleans and Orlando, Fla., in an April 2013 report. When questioned at a House Committee on Veterans’ Affairs hearing in May, Haggstrom could not explain what he did to earn the bonuses.

St. Louis, Missouri
More than 1,800 veteran patients of the St. Louis VA Medical Center may have been exposed to HIV and Hepatitis as a result of unsanitary dental equipment. The facility has remained under fire for patient deaths, persistent patient-safety issues and critical reports. Despite the problems at the medical center, the facility’s director from 2009 - 2013, RimaAnn Nelson, received nearly $25,000 in bonuses during her tenure there.

Fayetteville, North Carolina
A December 2012 audit of the Fayetteville VA Medical Center found facility employees did not complete required suicide prevention follow-ups 90 percent of the time for patients at a high risk of suicide. The audit also found the center “noncompliant” in cleanliness of patient care areas, environmental safety, dental clinic safety, training and testing procedures. In July 2012, during an investigation that substantiated patient misdiagnosis complaints, VA’s inspector general found the responsible physician failed to properly review medication information 56 percent of the time, a step that is “critical to appropriate evaluation, treatment planning, and safety.” Fayetteville VA Medical Center Director Elizabeth B. Goolsby received a performance bonus of $7,604 in 2012.

Dallas, Texas
Dallas VA Medical Center Director Jeff Milligan and regional director Lawrence Biro have received a combined $50,000 in bonuses since 2011 despite a series of allegations from VA workers, patients and family members regarding poor care at the facility as well as more than 30 certification agency complaints against the medical center in the last three years.
Philadelphia, Pennsylvania
The director of VA’s Philadelphia regional office, Thomas Lastowka, received a $23,000 bonus in 2011 despite a doubling in the backlog of disability compensation claims at the office between 2010 and 2011.

Phoenix, Arizona
Phoenix VA Regional Office Director Sandra Flint has received more than $53,000 in bonuses since 2007 despite a doubling in the office’s backlog of disability compensation claims since 2009.

Columbia, South Carolina
Columbia VA Regional Office Director Carl Hawkins received almost $80,000 in bonuses despite a doubling in the office’s backlog of disability compensation claims and inappropriate shredding of disability claims documents.

Waco, Texas
Carl Lowe, the former director of the VA regional office in Waco, Texas, raked in more than $53,000 in bonuses as the office’s average disability claims processing time grew to historic levels, forcing veterans to wait longer than anywhere else in the country.

Buffalo, New York
David West, a VA health official in New York, pocketed nearly $26,000 in bonuses while overseeing chronic misuse of insulin pens that potentially exposed hundreds of veterans to blood-borne illnesses.

Dayton, Ohio
For nearly 18 years, the dental clinic at the Dayton VA Medical Center allowed unsanitary practices, potentially exposing hundreds of patients to hepatitis B and hepatitis C. Dayton VA Medical Center Director Guy Richardson then collected an $11,874 bonus despite an investigation into the exposures. After nine of the exposed patients tested positive Hepatitis B and Hepatitis C, Richardson was promoted.

Pittsburgh, Pennsylvania
After persistent management failures led to a deadly Legionnaires’ disease outbreak in the VA Pittsburgh Healthcare System, VA Pittsburgh director Terry Gerigk Wolf received a perfect performance review and regional director Michael Moreland, who oversees VA Pittsburgh, collected a $63,000 bonus.

Atlanta, Georgia
Despite four preventable patient deaths, three of which VA’s inspector general linked to widespread mismanagement, former Atlanta VA Medical Center Director James Clark received $65,000 in bonuses over four years. Additionally, the facility’s current director, Leslie Wiggins, maintains that no employees responsible for the mismanagement linked to the deaths should be fired.

Along side the article are other updates from Oct 4th, 2016.
 
Knight, the problem with VA has been the lack of funds - like every other part of Government - and the unbelievable increase to VA from older vets and those returning from the middle east. How do you handle that with no or only slight increases in their budget?

Seems a lot of people will fall all over themselves to vote for someone that says they will cut their taxes without giving a thought to how we pay for services we want and need. And on top of that, those "tax cuts" are going to the riches people in the world, not to the average tax payer, but they still keep voting for the same people that told them they would cut their taxes - election after election after election. You would think that they would get the message after a while but I guess they can't see past the end of their noses. - jb
 
jeb said:
Knight, the problem with VA has been the lack of funds - like every other part of Government - and the unbelievable increase to VA from older vets and those returning from the middle east. How do you handle that with no or only slight increases in their budget?

Seems a lot of people will fall all over themselves to vote for someone that says they will cut their taxes without giving a thought to how we pay for services we want and need. And on top of that, those "tax cuts" are going to the riches people in the world, not to the average tax payer, but they still keep voting for the same people that told them they would cut their taxes - election after election after election. You would think that they would get the message after a while but I guess they can't see past the end of their noses. - jb
Click to expand...

and guess who voted to cut those funds...

http://usuncut.com/politics/happy-veterans-day-5-times-republicans-in-congress-screwed-veterans/
 
Yup, Jackie - I never understand how any vet could ever vote for someone that wants to go to war or how people say they want change and then vote for the very people that screwed things up. I guess there is at least one thing I can agree on with Trump - his supporters are poorly educated.
 
Ref why Republicans do what they do - besides being paid to do so - is that they want to privatize all of government - including the VA, SS and Medicare. Guess why? They get the money sitting in these agencies and then take these "private" companies and declare bankruptcy. Then all those that voted for them will be up in arms - but too late.
 
jeb said:
Ref why Republicans do what they do - besides being paid to do so - is that they want to privatize all of government - including the VA, SS and Medicare. Guess why? They get the money sitting in these agencies and then take these "private" companies and declare bankruptcy. Then all those that voted for them will be up in arms - but too late.
Click to expand...

Exactly.....their plan.....starve all the government agencies, then they can spread it to all that the agencies are failing and it is Obama/Democrat's fault ...Republicans swallow this hook. line and sinker....they then vote on more Republicans that will vote in Privatization.

They are counting on the average Joe not checking facts to see who votes to under fund and cut services.....and so it goes.
 


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