Free market medical care versus the status quo

[LivingAlmostLarge]

You can get subsidies under $150K income? Is that not taxable? I thought it was like $75k.

We did buy it a few years ago and it was $600/month for $13k deductible and no one took it. Basically it as utter crap and just in case of emergency. We also went without dental because we figured for 1 year. Took the kids but skipped ourselves. Luckily we did get a job at exactly 1 year mark. Even better nothing major happened to us so knock on wood. We basically didn't go to the dr because it was so bad for anything.

[corn18]

You can get subsidies under $150K income? Is that not taxable? I thought it was like $75k.

We did buy it a few years ago and it was $600/month for $13k deductible and no one took it. Basically it as utter crap and just in case of emergency. We also went without dental because we figured for 1 year. Took the kids but skipped ourselves. Luckily we did get a job at exactly 1 year mark. Even better nothing major happened to us so knock on wood. We basically didn't go to the dr because it was so bad for anything.

The cutoff for MFJ is $65,840 MAGI. You can easily stay under that if you have the right assets in Roth and taxable accounts. If you need to withdraw $150k, pull it all from Roth. MAGI is $0. Or pull it all from taxable and keep the cap gains under $65,840. Many ways to withdraw money and not produce income.

[TexasHusker]

You can get subsidies under $150K income? Is that not taxable? I thought it was like $75k.

We did buy it a few years ago and it was $600/month for $13k deductible and no one took it. Basically it as utter crap and just in case of emergency. We also went without dental because we figured for 1 year. Took the kids but skipped ourselves. Luckily we did get a job at exactly 1 year mark. Even better nothing major happened to us so knock on wood. We basically didn't go to the dr because it was so bad for anything.

You pretty well summed up ObummerCare. It is priced like a Ferrari. Most people can't afford a Ferrari but they are required by law to buy it anyway. Now it might be some consolation if you actually got the Ferrari, but with ObummerCare, you pay for a Ferrari and you get a bicycle.

Pretty much par for the course when Washington bureaucrats are involved. Playing the peanut/shell game as to who is actually paying for it is a ruse. We are ALL paying for it.

[disneysteve]

Those who would like to have ObummerCare, have never had ObummerCare.

I know you believe this but there are literally millions of Americans who disagree with you. I had hundreds of patients in my former practice who were thrilled to get coverage under the ACA because prior to that, they couldn't afford insurance or they were paying far more for it. I also know a number of people personally who were able to retire early specifically because of the availability of affordable insurance thanks to the ACA. If not for that, they would have needed to work until they were 65 and qualified for Medicare.

[TexasHusker]

I know you believe this but there are literally millions of Americans who disagree with you. I had hundreds of patients in my former practice who were thrilled to get coverage under the ACA because prior to that, they couldn't afford insurance or they were paying far more for it. I also know a number of people personally who were able to retire early specifically because of the availability of affordable insurance thanks to the ACA. If not for that, they would have needed to work until they were 65 and qualified for Medicare.

I'm sure there are millions of Americans who disagree with me - the ones who are getting ObummerCare for free.

[disneysteve]

I'm sure there are millions of Americans who disagree with me - the ones who are getting ObummerCare for free.

No, but I know you won't change your mind so I'll agree to disagree.

[TexasHusker]

No, but I know you won't change your mind so I'll agree to disagree.

...lest you walk in another man’s shoes. A big part of the problem is that people that actually have to pay something for ObummerCare are simultaneously paying for several other people.

Too many riding the cart, not enough left to pull it .

[LivingAlmostLarge]

...lest you walk in another man’s shoes. A big part of the problem is that people that actually have to pay something for ObummerCare are simultaneously paying for several other people.

Too many riding the cart, not enough left to pull it .

then wouldn't the answer be that everyone should pull the cart? So socialized medicine spreads it around? So does free market but I have a suspicion that majority won't be able to afford free market healthcare.

[disneysteve]

then wouldn't the answer be that everyone should pull the cart? So socialized medicine spreads it around? So does free market but I have a suspicion that majority won't be able to afford free market healthcare.

While I agree with you 100%, the opposition will probably say that 45% (or whatever the number is) don't pay any taxes so those who do pay would still be paying for those who don't.

It's pretty interesting but over the past 2-3 decades, the stance of the medical field (doctors, nurses, med students, etc.) has changed dramatically. 25+ years ago, the medical field was staunchly Republican and conservative and strongly opposed to a single payer system. Today, just the opposite is true. The vast majority of medical folks are Democrats and support for a single payer system has grown tremendously. Even the American Medical Association, which had always vehemently opposed single payer, has had to soften their stance because it was so out of touch with the reality of the field.

[TexasHusker]

then wouldn't the answer be that everyone should pull the cart? So socialized medicine spreads it around? So does free market but I have a suspicion that majority won't be able to afford free market healthcare.

Like college costs, free market healthcare would cost a heck-of-a-lot less if the government wasn't entangled in the system.

Example 1: Back when I was in college, I paid for all of my room, board, tuition, and fees each year with a part time job at the university's library and still had money left over. That was 30 years ago. Today, due to massive government fettering with higher education through the whole guaranteed student loans debacle, costs at that same university are about 12X higher than they were when I was in school. You are not paying for it with any part time job, that is for certain.

Example 2: When I began work in hospital administration in 1994, our hospital's average cost per discharge for inpatient stays was $5,400. If you didn't have insurance, that was going to be a large amount to pay off, but it wasn't going to send you to bankruptcy court. Today, according to Medicare, that same hospital now at approximately $52,000 for an inpatient stay. So it's 10X what it was 25 years ago. If you don't have insurance, a $52,000 medical debt could be a life-changer. The government's constant encroachment into healthcare finance has caused huge imbalances which has triggered runaway inflation. OBummerCare has only made it worse.

This is what happens when the government gets involved, and it doesn't matter what sector of the economy it is.

[disneysteve]

Example 2: When I began work in hospital administration in 1994, our hospital's average cost per discharge for inpatient stays was $5,400. If you didn't have insurance, that was going to be a large amount to pay off, but it wasn't going to send you to bankruptcy court. Today, according to Medicare, that same hospital now at approximately $52,000 for an inpatient stay. So it's 10X what it was 25 years ago.

That's not really an apples to apples comparison, though, and not just because of insurance issues. The depth and breadth of care available today is light years ahead of what it was in 1994. Back then, there's a good chance the hospital didn't have an MRI machine (or NMR as it was still called at that point) and that's just one example. There were far fewer invasive tests and advanced treatments. A lot of run of the mill procedures today were in their infancy if they existed at all in 1994. I finished residency in 1993 and hospital care was phenomenally different than it is today so you just can't compare costs side by side.

[disneysteve]

That's not really an apples to apples comparison, though, and not just because of insurance issues. The depth and breadth of care available today is light years ahead of what it was in 1994. Back then, there's a good chance the hospital didn't have an MRI machine (or NMR as it was still called at that point) and that's just one example. There were far fewer invasive tests and advanced treatments. A lot of run of the mill procedures today were in their infancy if they existed at all in 1994. I finished residency in 1993 and hospital care was phenomenally different than it is today so you just can't compare costs side by side.

There's also been a major shift in what warrants hospitalization. Today's inpatients are far sicker than those in 1994. Back then, you could admit someone for relatively minor stuff and insurance would pay. Plus you didn't have all of the outpatient treatment options that exist today. Today, nearly everything is treated as an outpatient and only the sickest most complex patients get admitted, so obviously their average costs are going to be much higher.

[TexasHusker]

That's not really an apples to apples comparison, though, and not just because of insurance issues. The depth and breadth of care available today is light years ahead of what it was in 1994. Back then, there's a good chance the hospital didn't have an MRI machine (or NMR as it was still called at that point) and that's just one example. There were far fewer invasive tests and advanced treatments. A lot of run of the mill procedures today were in their infancy if they existed at all in 1994. I finished residency in 1993 and hospital care was phenomenally different than it is today so you just can't compare costs side by side.

Average length of stay is less than what it was in 1994. That doesn't line up with much sicker patients.

Automobiles are quite a bit more advanced than they were in 1994, and they are only about 2.5 to 3X as much today. Why aren't they 10X higher?

Is college more advanced than it was in 1994? And it's 10X higher?

As a side note, I finally got that "cash price" from the hospital for my son's MRA: $4200. I said "I'm so sorry...we had it done last week for $550."

Healthcare is S-I-C-K. I know. I worked in it playing the peanut/shell game for 23 years.

[disneysteve]

Average length of stay is less than what it was in 1994. That doesn't line up with much sicker patients.

This is just wildly false. In 1994, I could admit a patient with a routine pneumonia and keep them there for 5 days or more and get paid very well for doing so. Today, you will rarely see a patient hospitalized for pneumonia at all. When you do, it's because they are gravely ill, low blood oxygen level, severe dehydration, and likely have other co-morbid conditions like heart disease or something else complicating their condition. Despite all of that, they are unlikely to spend more than 1-2 days in the hospital because there is tremendous pressure to get them out as quickly as possible. Insurance companies won't pay to have someone just occupying a bed unless they are getting a high level of care that simply can't be delivered as an outpatient. Patient needs IV antibiotics? That can be done at home. They need physical therapy? That can be done at home. They need breathing treatments every 4 hours? That can be done at home. And forget getting paid for a patient being hospitalized over the weekend waiting for a test to be performed on Monday. Saturday and Sunday won't be paid for at all. As long as the patient is reasonably stable, they get kicked out on Friday and scheduled to come back on Monday to have the test done as an outpatient.

I don't know how long it has been since you left the hospital field but it has changed dramatically over the past couple of decades. It's a whole different ballgame today than it was 10 or 20 years ago.

[TexasHusker]

This is just wildly false. In 1994, I could admit a patient with a routine pneumonia and keep them there for 5 days or more and get paid very well for doing so. Today, you will rarely see a patient hospitalized for pneumonia at all. When you do, it's because they are gravely ill, low blood oxygen level, severe dehydration, and likely have other co-morbid conditions like heart disease or something else complicating their condition. Despite all of that, they are unlikely to spend more than 1-2 days in the hospital because there is tremendous pressure to get them out as quickly as possible. Insurance companies won't pay to have someone just occupying a bed unless they are getting a high level of care that simply can't be delivered as an outpatient. Patient needs IV antibiotics? That can be done at home. They need physical therapy? That can be done at home. They need breathing treatments every 4 hours? That can be done at home. And forget getting paid for a patient being hospitalized over the weekend waiting for a test to be performed on Monday. Saturday and Sunday won't be paid for at all. As long as the patient is reasonably stable, they get kicked out on Friday and scheduled to come back on Monday to have the test done as an outpatient.

I don't know how long it has been since you left the hospital field but it has changed dramatically over the past couple of decades. It's a whole different ballgame today than it was 10 or 20 years ago.

You can say that again. It's a whole different ball game run off the cliff.

I left 6.5 years ago, and am intimately familiar with it, as I still do consulting work.

The hospital that I left...in 1994 we posted a profit of $6 million. All of our management team got nice bonuses and a fancy dinner. I think the CEO tossed in bottles of fresh honey for all of us from a local bee farm. Last year, the same hospital posted a profit of over $70 million. Almost 12X what it was in 1994.

Any questions?