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Jeb Bush op-ed: My plan to replace Obamacare

Of course you would shop around for the best place to get Chemo. Why the hell would you not?

And so you get a dozen prescription. Why wouldn't you shop around for the best price for each of them. Too hard?

If the surgery is not emergency surgery, but planned in advance, why wouldn't you shop around? I'd want the best center AND the best price, just like I shop around for everything else I purchase in my life.

Do you just go to the grocery store and throw whatever in your cart because comparing the price per ounce is too hard?

Apparently, YOU don't understand it.

You 'shop around' when you are planning for an 'elective' surgery.

But what happens when a biopsy comes back that you have a malignancy and need an emergency followup surgery, an oncologist and radiation therapy and/or chemo? You 'chose' the cheaper hospital for your elective surgery, because you are healthy, and had the time to pick where to go, but it has NONE of those treatments as good options or programs. Now, you have a few days to decide where to go to try to treat a cancer before it spreads, because once it spreads, you are done.

An insurer has the buying power and time to 'find' therapy options which will provide ALL of those types of care for their patient base. And the 'consolidation' of many of the insurers into mega-insurers is lowering the number of plan options to patients. Shutting down completely solvent and cash-flow-positive Co-Ops was a BAD decision, and our Congressional representatives should be ashamed they are allowing that to happen. They were one way to keep the competition against the bigger insurers on a more level field.
 
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The sad thing is this should be common sense to anyone who's ever used the healthcare system or been close to someone who has.

It seems to NOT be apparent to many putting out ACA 'replacements'. :(

Maybe because the Congressional plans they are on are too 'cushy'....we should demand they re-form the successful Co-Ops and every one of them be put on those plans. There is simply no reason that Congress should have 'elite' plans above the typical plan for a middle-class American family.
 
Trusting the government - of either party - to fix healthcare is like asking the drunk who just ran your family off the road to drive you to the hospital. Doesn't seem like a prudent decision. ;)

"Those who cannot remember the past are condemned to repeat it," declared philosopher George Santayana. The U.S. “health care cost crisis” didn’t start until 1965. The government increased demand with the passage of Medicare and Medicaid while restricting the supply of doctors and hospitals. Health care prices responded at twice the rate of inflation (Figure 1). Now, the U.S. is repeating the same mistakes with the unveiling of Obamacare (a.k.a. “Medicare and Medicaid for the middle class”).

holly1.jpg


Figure 1: An Indexed Comparison of Health Care Inflation and Consumer Price Index in US from 1935 to 2009 (Source: US Census 2013) Nobel Prize-winning economist Milton Friedman wrote that medical price inflation since 1965 has been caused by the rising demand for health-care coupled with restricted supply (Friedman 1992). Robert Alford explained the minority view: "The market reformers wish to preserve the control of the individual physician over his practice, over the hospital, and over his fees, and they simply wish to open up the medical schools in order to meet the demand for doctors, to give patients more choice among doctors, clinics, and hospitals, and to make that choice a real one by public subsidies for medical bills" (Alford 1975). The majority of policymakers support either monopolization (e.g. typically Republicans) or nationalization (e.g., typically Democrats).

https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive
I'm not sure I'm seeing causation here. From 1965-1980, there is hardly any difference between the CPI and healthcare costs. So why is there a 15 year delay for rapidly rising healthcare costs if Medicare is to blame?
 
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Trusting the government - of either party - to fix healthcare is like asking the drunk who just ran your family off the road to drive you to the hospital. Doesn't seem like a prudent decision. ;)

"Those who cannot remember the past are condemned to repeat it," declared philosopher George Santayana. The U.S. “health care cost crisis” didn’t start until 1965. The government increased demand with the passage of Medicare and Medicaid while restricting the supply of doctors and hospitals. Health care prices responded at twice the rate of inflation (Figure 1). Now, the U.S. is repeating the same mistakes with the unveiling of Obamacare (a.k.a. “Medicare and Medicaid for the middle class”).

holly1.jpg


Figure 1: An Indexed Comparison of Health Care Inflation and Consumer Price Index in US from 1935 to 2009 (Source: US Census 2013) Nobel Prize-winning economist Milton Friedman wrote that medical price inflation since 1965 has been caused by the rising demand for health-care coupled with restricted supply (Friedman 1992). Robert Alford explained the minority view: "The market reformers wish to preserve the control of the individual physician over his practice, over the hospital, and over his fees, and they simply wish to open up the medical schools in order to meet the demand for doctors, to give patients more choice among doctors, clinics, and hospitals, and to make that choice a real one by public subsidies for medical bills" (Alford 1975). The majority of policymakers support either monopolization (e.g. typically Republicans) or nationalization (e.g., typically Democrats).

https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive


There are actually SOME technological reasons for increases in costs here; imaging technologies (MRI, CT, etc) have exploded in value and cost, providing FAR better care for people than what we had pre-1980s.

So, the chart we SHOULD be looking at is comparable treatments and costs rising where the care is effectively the same. And, MANY treatments today (for certain cancers) will only increase lifespans in 'months', not 'years'. For some, that is fairly important (seeing a grandchild born, graduation, etc). But in many or most cases, when you are talking about a 75 or 80 year old person, 3 months at a 6-figure cost simply makes no sense.
 
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Trusting the government - of either party - to fix healthcare is like asking the drunk who just ran your family off the road to drive you to the hospital. Doesn't seem like a prudent decision. ;)

"Those who cannot remember the past are condemned to repeat it," declared philosopher George Santayana. The U.S. “health care cost crisis” didn’t start until 1965. The government increased demand with the passage of Medicare and Medicaid while restricting the supply of doctors and hospitals. Health care prices responded at twice the rate of inflation (Figure 1). Now, the U.S. is repeating the same mistakes with the unveiling of Obamacare (a.k.a. “Medicare and Medicaid for the middle class”).

holly1.jpg


Figure 1: An Indexed Comparison of Health Care Inflation and Consumer Price Index in US from 1935 to 2009 (Source: US Census 2013) Nobel Prize-winning economist Milton Friedman wrote that medical price inflation since 1965 has been caused by the rising demand for health-care coupled with restricted supply (Friedman 1992). Robert Alford explained the minority view: "The market reformers wish to preserve the control of the individual physician over his practice, over the hospital, and over his fees, and they simply wish to open up the medical schools in order to meet the demand for doctors, to give patients more choice among doctors, clinics, and hospitals, and to make that choice a real one by public subsidies for medical bills" (Alford 1975). The majority of policymakers support either monopolization (e.g. typically Republicans) or nationalization (e.g., typically Democrats).

https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive

One of the best posts I've seen on here since I came back.
 
There are actually SOME technological reasons for increases in costs here; imaging technologies (MRI, CT, etc) have exploded in value and cost, providing FAR better care for people than what we had pre-1980s.

So, the chart we SHOULD be looking at is comparable treatments and costs rising where the care is effectively the same. And, MANY treatments today (for certain cancers) will only increase lifespans in 'months', not 'years'. For some, that is fairly important (seeing a grandchild born, graduation, etc). But in many or most cases, when you are talking about a 75 or 80 year old person, 3 months at a 6-figure cost simply makes no sense.

Why do you think hospital technology differs from every single other technology?
 
I'm not sure I'm seeing causation here. From 1965-1980, there is hardly any difference between the CPI and healthcare costs. So why is there a 15 year delay for rapidly rising healthcare costs if Medicare is to blame?

Because economic decisions are never immediately seen. That's why I laugh when the government passes legislation like the stimulus package. It's nothing but a money grab made to look like they are trying to jump-start the economy, and it does more damage down the road.
 
One of the best posts I've seen on here since I came back.
I don't think so. Shank blames the government for rapidly increasing healthcare costs compared to the CPI. Problem is that this increase doesn't take place until a full 15 years after the government got involved. So why the delay? Why did medical costs stay about the same as CPI from 1965-1980, but the diverge after? It seems dubious to try pegging this on Medicare.
 
I don't think so. Shank blames the government for rapidly increasing healthcare costs compared to the CPI. Problem is that this increase doesn't take place until a full 15 years after the government got involved. So why the delay? Why did medical costs stay about the same as CPI from 1965-1980, but the diverge after? It seems dubious to try pegging this on Medicare.

I just responded to this post while you were writing it.
 
Why do you think hospital technology differs from every single other technology?

Imaging is something that practically didn't exist outside of X-rays pre-1970s.

Today we have MRI, CT, PET-CT and ultrasound; they are increasingly used for more and more procedures, which absolutely have improved quality of life and provided life-saving options. And they are not cheap.

Pre-1970 if you had a malignant cancer, you were dead. Today, they can run a PET-CT and look for where it has spread, allowing cures for many people using the right treatments. Those costs can easily run to $250k per patient. If we are talking about an 80 year old, it probably is not a worthwhile cost. If we are talking about a 30 or 40 year old, there is enormous cost benefit to putting a cancer in remission or curing them.

We need to take a hard look at the 'end of life' costs being incurred by the healthcare system, because much of the cost is being weighted to that end and the cost benefit is fairly low, perhaps even 'negative' if it takes resources away from the care for younger people.
 
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Because economic decisions are never immediately seen. That's why I laugh when the government passes legislation like the stimulus package. It's nothing but a money grab made to look like they are trying to jump-start the economy, and it does more damage down the road.
So your contention is that it took 15 years for consumers to start using Medicare?
 
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Imaging is something that practically didn't exist outside of X-rays pre-1970s.

Today we have MRI, CT, PET-CT and ultrasound; they are increasingly used for more and more procedures, which absolutely have improved quality of life and provided life-saving options. And they are not cheap.

Pre-1970 if you had a malignant cancer, you were dead. Today, they can run a PET-CT and look for where it has spread, allowing cures for many people using the right treatments. Those costs can easily run to $250k per patient. If we are talking about an 80 year old, it probably is not a worthwhile cost. If we are talking about a 30 or 40 year old, there is enormous cost benefit to putting a cancer in remission or curing them.

We need to take a hard look at the 'end of life' costs being incurred by the healthcare system, because much of the cost is being weighted to that end and the cost benefit is fairly low, perhaps even 'negative' if it takes resources away from the care for younger people.

I understand that, but that really doesn't answer my question. Innovation in technology drives down the cost in every industry with the exception of the medical industry. There has to be a reason for that.
 
Apparently, YOU don't understand it.

You 'shop around' when you are planning for an 'elective' surgery.

But what happens when a biopsy comes back that you have a malignancy and need an emergency followup surgery, an oncologist and radiation therapy and/or chemo? You 'chose' the cheaper hospital for your elective surgery, because you are healthy, and had the time to pick where to go, but it has NONE of those treatments as good options or programs. Now, you have a few days to decide where to go to try to treat a cancer before it spreads, because once it spreads, you are done.

An insurer has the buying power and time to 'find' therapy options which will provide ALL of those types of care for their patient base. And the 'consolidation' of many of the insurers into mega-insurers is lowering the number of plan options to patients. Shutting down completely solvent and cash-flow-positive Co-Ops was a BAD decision, and our Congressional representatives should be ashamed they are allowing that to happen. They were one way to keep the competition against the bigger insurers on a more level field.

Already asked and answered. The majority of healthcare costs are not the result of emergencies, but in treating long-term chronic conditions. You obviously can't shop around in an emergency, but you can shop around for all the after care.
 
I'm not sure I'm seeing causation here. From 1965-1980, there is hardly any difference between the CPI and healthcare costs. So why is there a 15 year delay for rapidly rising healthcare costs if Medicare is to blame?
You might have to read the linked article to get the whole picture. That's the thing about exponential increases; they don't seem to be doing much and all of a sudden they explode. :( Now compare the the chart of medical costs to the national debt: notice any similarities???? Not too much to be alarmed about from '65 to '80 was there?

history.gif
 
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Lots of untruths about Obamacare. Kind of weak on specifics beyond tax credits that would be of little use to those most in need:

As gridlock persists in our nation's capital and good legislation continues to die in the Senate, it is clear the next president will play a key role in determining the future of Obamacare. That means candidates' positions on the issue will be among the most important when ballots are cast next year.

Obamacare's "three-legged stool" — the subsidies, guaranteed-issue rules and individual mandate — is already collapsing under its own weight. The failing Obamacare co-ops mean that more than 500,000 Americans have lost their health plans, while individuals face a new wave of premium increases — about $600 a year on average for a silver-level federal exchange plan. The individual mandate is overreaching and ineffective; Obamacare's attempt to stop "pricing out people with preexisting conditions," as a Nov. 2 Post editorial put it, has priced out people who don't have preexisting conditions; and while the subsidies primarily benefit those below 200 percent of the poverty level, the majority of Americans are worse off.

The point is that individuals, instead of insurers, would control more of the health care dollar, via tools such as HSAs. My approach would also make these HSAs work better for those with chronic conditions by offering plans with lower deductibles for certain services related to a given condition and would establish transparent information on the value of services so consumers have the information they need to make informed choices and demand value. If Hillary Clinton or Bernie Sanders wins the White House, the only question will be how much she or he can expand Obamacare, growing our debt and raising taxes in the process.
I know there is a better path. That is why I recently proposed the most substantive conservative plan to repeal and replace Obamacare presented to date. My Obamacare alternative addresses the root causes of high health care costs, offers patients more options and strengthens the safety net for the most vulnerable Americans.

First, my plan would lower costs. Health care is expensive primarily because Washington has long distorted the meaning of "insurance." Health insurers pay the majority of bills and control how most health-care services are delivered.
Under my plan, instead of an insurer directly paying all the bills, consumers would be empowered to make choices that are right for them. For instance, an asthma patient could save money by choosing a treatment costing $8,000 instead of one from a different hospital in the same city costing $34,000.
http://www.chicagotribune.com/news/...ush-obamacare-replacement-20151109-story.html
Additionally, medical entrepreneurs would be given better opportunities to develop new approaches to delivering care. Instead of getting paid every time a diabetic patient came into the office, what if a specialist could manage all of that patient's diabetic care, including the use of remote monitoring technology, for a one-time payment? Such an approach might save money and lead to better outcomes.
But this does not mean patients would be on their own to cover costs; rather, they could choose from a range of innovative coverage options. Patients may spend far less on premiums and be able to save more for out-of-pocket costs with a health savings account (HSA), and they may select a high-deductible plan that offers them a defined amount when they need certain services, so that they can select a specialized physician to provide them. And states could supplement the value of plans for the poor by fully funding HSAs.

Second, my plan promotes innovation. It can take 12 to 15 years and more than $2 billion to develop a new cure for a disease. In a $3.1 trillion system, efficiency and effectiveness are desperately needed; yet under the current system, health care start-ups face costly and complex government overregulation. My plan would overhaul Washington's entire approach to innovation, including modernizing the Food and Drug Administration, investing in the National Institutes of Health and promoting big data solutions in health care. Advances can be led by the creativity of America's scientists, care providers and innovators.

Finally, my plan would strengthen the safety net. The primary goal of the tax credits for the purchase of insurance included in my plan is to finally achieve tax fairness between the employer and individual health insurance markets. A middle class family that needs to purchase health coverage should get a tax break similar to what another middle class family receives through an employer. The tax credit would benefit low-income Americans, and my plan would enable the states to target additional resources to the needy by supplementing the value of the credit.

Furthermore, these changes would complement reforms to Medicaid that replace unnecessary rules with an approach that insists on results. The most exciting improvements we have seen to the safety net have come from the states breaking free from Washington's rules, and we need to build on those successes. With the right tools and accountability in place, states can achieve far better outcomes for the poor.

Unfortunately, Obamacare was built on top of a 1940s- and 1960s-era system. A 21st-century health care system requires innovation and an overhaul of this antiquated structure. Only then will all Americans realize the lower costs, better options and greater possibilities of the future.

http://www.chicagotribune.com/news/...ush-obamacare-replacement-20151110-story.html
Mostly incoherent. Did Donald Trump write this for Jeb? You're going to like my plan. It will lower costs. There will be choice. There will be tax credits. Hillary sucks.
 
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You do realize i have insurance as well (your reading comp is awful) and plan on always carrying ins right??? I don't understand your irrational views towards tax free savings.

I'm sorry jscott for being able to save at a high rate...i am one of those white devils.

Yes, i understood that, but 30,000 bucks in an HSA doesn't cut it for the uninsurable when they need 250,000 in healthcare. That's the thing that the GOP/wingers continue to ignore and its the elephant in the room.
 
Mostly incoherent. Did Donald Trump write this for Jeb? You're going to like my plan. It will lower costs. There will be choice. There will be tax credits. Hillary sucks.
MOSTLY incoherent WWJD?? C'mon; you're being much too kind. The Bushies aren't exactly known for their intelligence.
And Jeb's supposed to be the smart one of the family.:D
 
Yes, i understood that, but 30,000 bucks in an HSA doesn't cut it for the uninsurable when they need 250,000 in healthcare. That's the thing that the GOP/wingers continue to ignore and its the elephant in the room.

Hello, McFly!!!! You don't have a standalone HSA. You pair it with a high-deductible healthcare plan that only pays for financially catastrophic care. The deductible is not $250,000. You'd pay $10,000 and everything beyond that is covered and you still have $20,000 in the HSA.

If you're going to opine about something, try learning about it before sharing. Thank you.
 
Yes, i understood that, but 30,000 bucks in an HSA doesn't cut it for the uninsurable when they need 250,000 in healthcare. That's the thing that the GOP/wingers continue to ignore and its the elephant in the room.
Exactly. There is probably nothing wrong with HSA's per se, but they are not going to provide the same level of coverage for all people. So if that level of coverage is what you are trying to assure with your plan, then HSAs won't get the job done.

It's like privatizing Social Security. Sure, we can do that, but it won't provide the same bedrock level of security for the elderly. So if that minimum level of security is what you are aiming at, privatizing SS won't get the job done.

If we want some people to do well and don't really care if some don't, then by all means throw it to the free market and walk away. And I'm not saying that to disparage the free market. There are plenty of things that it makes sense to handle that way. But some don't. Once we decide that we want to be the kind of society that guarantees a minimum level of something to all - whether it's education, healthcare, mail delivery, clean water, or whatever - then it stops being something we leave up to the free market.
 
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Exactly. There is probably nothing wrong with HSA's per se, but they are not going to provide the same level of coverage for all people. So if that level of coverage is what you are trying to assure with your plan, then HSAs won't get the job done.

It's like privatizing Social Security. Sure, we can do that, but it won't provide the same bedrock level of security for the elderly. So if that minimum level of security is what you are aiming at, privatizing SS won't get the job done.

If we want some people to do well and don't really care if some don't, then by all means throw it to the free market and walk away. And I'm not saying that to disparage the free market. There are plenty of things that it makes sense to handle that way. But some don't. Once we decide that we want to be the kind of society that guarantees a minimum level of something to all - whether it's education, healthcare, mail delivery, clean water, or whatever - then it stops being something we leave up to the free market.

Hello... reality calling....

What part of "high deductible" don't you understand? The deductible isn't $120,000.

This is the problem. Health insurance under Obamacare is like your car insurance covering oil changes, tires, and other maintenance and repairs. That would be ridiculously expensive.

Healthcare should cover the big stuff. An office visit shouldn't be covered at all.
 
Hello, McFly!!!! You don't have a standalone HSA. You pair it with a high-deductible healthcare plan that only pays for financially catastrophic care. The deductible is not $250,000. You'd pay $10,000 and everything beyond that is covered and you still have $20,000 in the HSA.

If you're going to opine about something, try learning about it before sharing. Thank you.

What is it about the word "uninsurable" that you don't understand? Am I supposed to prance right out there into the free market and just buy a HD plan even though no one will issue one to me? Get a clue.
 
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Unfortunately, Obamacare was built on top of a 1940s- and 1960s-era system. A 21st-century health care system requires innovation and an overhaul of this antiquated structure. Only then will all Americans realize the lower costs, better options and greater possibilities of the future.

These are absolutely true words. Obamacare should have been a universal payer from the start. Jeb's plan, like most Republican plans, are notoriously short on details. How is a lower income person supposed to be able to afford a high deductible plan, plus be able to afford contributions to an HSA? If they are simply going to use tax credits, I don't see how that differs from the current program.
 
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What is it about the word "uninsurable" that you don't understand? Am I supposed to prance right out there into the free market and just buy a HD plan even though no one will issue one to me? Get a clue.

Why wouldn't someone sell a policy to you?
 
Let's get serious. No Republican has a plan to replace Obamacare. It took nearly 15 years to craft the ACA. Democrats actually started working on it in the mid 90's after they got their big healthcare push shot down. So the idea that one person, let alone an entire party, can come up with an alternative in just a few months or even a year or two is not realistic.

This entire paragraph is full of stupid.
 
I understand that, but that really doesn't answer my question. Innovation in technology drives down the cost in every industry with the exception of the medical industry. There has to be a reason for that.

If I had to guess I would say it has something to do with reduced need for mass production.

If you invent a better smart phone, everyone wants your smart phone so there is a free market reason for you to try and find ways to lower the costs of your smart phone so that more people can buy the thing. Ford didn't get rich cause he invented the car, because he didn't invent the car at all. Ford got rich because he figured out how to make the car affordable for the the middle class. He expanded the market base and sold his cars to his now much much larger market base while his competitors only sold their cars to an extremely small market base.

If you invent a new cancer treatment only so many people need that cancer treatment. The market base is very limited in size and can't be expanded unless you can find a way to give more people cancer. There isn't much money in trying to make that cancer treatment cheaper. The money is in finding an entirely new cancer treatment that another limited market needs.

Also because if you need that cancer treatment you absolutely have to buy that cancer treatment or you die means that the market for cancer treatments is static. It can not increase or decrease. Those who need it always have to buy it and those who don't need it will not ever be convinced to buy it unless they get that cancer. (Again the only way to significantly expand your market base here is to somehow give more people that specific type of cancer. Something that is both evil, illegal, and unrealistic even if it where not illegal.)

You can convince a person he should get a smartphone by lowering the costs of the smartphone and lowering the costs of the plans to use the smartphone. You can't convince a person they need a cancer treatment when they don't have cancer nor can they realistically choose to forgo said treatments if the price is too high.

This is why the free market doesn't work for healthcare. It's like in negotiations they say you have to be willing to walk away. The free market needs that to work. It needs people to have options in order to walk away. This is accomplished by it either being an unneeded product or a product that is extremely widely produced and provided by multiple firms.

One might not be able to choose not to buy food but so many firms provide food that competition keeps prices low and profit margins in regular grocery business (not specialty stuff like Whole Foods) are razor thin. I think it's pretty safe to say that more firms sell loaves of bread (or make loaves of bread for that matter) then firms that make and sell cancer treatments.

But with cancer treatments especially with a patent. Very few firms provide it and at the same time it is entirely unrealistic for someone who needs that treatment to be able to say no.
 
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What part of "high deductible" don't you understand? The deductible isn't $120,000.

This is the problem. Health insurance under Obamacare is like your car insurance covering oil changes, tires, and other maintenance and repairs. That would be ridiculously expensive.

Healthcare should cover the big stuff. An office visit shouldn't be covered at all.

For some people an office visit is too expensive. You really think the poor have $120+ on hand to see the doctor?

Absolutely. Eventually we may all have individual devices (maybe our iWatch) that could be used for routine diagnosis and prescriptions...which would solve a lot of issues. Unfortunately we here on HROT will probably all be dead by then.
 
Okay, so the poor don't have money for food, so we give them food stamps.

The poor don't have money for healthcare so we give them subsidies.

The poor don't have housing so we give them houses.

Is there anything else the poor are too poor to afford that we should give to them? At what point does it become more attractive to be poor than to work?
 
Absolutely. Eventually we may all have individual devices (maybe our iWatch) that could be used for routine diagnosis and prescriptions...which would solve a lot of issues. Unfortunately we here on HROT will probably all be dead by then.

I had the thought that one thing we could consider, although this wouldn't fix the whole system would be to have lower level people with some of the training of doctors but not all of it at the clinical level.

If a guy just wants to be a family practice doctor he still has to go through all the same schooling as a heart surgeon. The only difference is that a heart surgeon does a longer residency.

Why not just train the guy to treat the cold and the flu, handle little minor surgeries and other minor problems that come up at the clinical level and save all the extra schooling etc for the surgeons? If the family practice doctor doesn't know what's going on he can refer you elsewhere.

Seems like medical training could be a bit more specialized.
 
Okay, so the poor don't have money for food, so we give them food stamps.

The poor don't have money for healthcare so we give them subsidies.

The poor don't have housing so we give them houses.

Is there anything else the poor are too poor to afford that we should give to them? At what point does it become more attractive to be poor than to work?

A lot of the poor are working. They just can't make enough to afford those things without help. So the solution is to make work pay more.
 
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