Obamacare - practical discussion

Obamacare - practical discussion


Good point. Although I would have preferred a different data set, the UN and WHO numbers seemed more reliable than some of the small sample surveys. If someone finds better sources, it would add to the discussion.

I was trying to compare the relative calorie consumption rates of the US, Canada and France and wasn’t focusing on the gross numbers. If the US wastes more food than Canada and France the relationship will vary.


Is that a sincere question?


I just saw a Dr. on twitter whining that Hospital CEO’s got inflation adjusted pay increases of nearly 100% from 2005 to 2015 versus the 15-25% that Dr’s got and mere 3% that nurses got.

In that 10 year period real household income grew a meager 0.5%.

The 15-25% raises for Doctors added ~$30-60B to national healthcare costs. Thats nearly $500 per household.

Dr raises alone were more than enough to wipe out the median household income growth over a decade.

Doctors are of course integral to our healthcare and they deserve to be compensated well … but… what gives with the 25% raises while we all got diddly squat?

The study in question :


Since you brought it up, yes.

“…expensive, unnecessary end-of-life care”

Who is going to determine what is necessary and what is unnecessary ?


The person paying for it, presumably.


How do we decide now?


How do we decide now?

Why are you asking me ?

“…but I’ll bet a bunch of that spend is from lifestyle diseases already mentioned, and expensive, unnecessary end-of-life care.”

You made the statement indicating that you’re aware of expensive unnecessary EOL care, the removal of which would make healthcare more affordable. So you have decided that some of it is unnecessary. Care to point out those expensive cases ?


I want to know what you think happens now. vs. the fictional death panels.

And for the 2nd bit you’re replying to the wrong person.


I want to know what you think happens now. vs. the fictional death panels.

The same that happens all over the world. Somebody will make a decision that it is time to die.
It will first depend on your insurance coverage (good, bad, none)
and then on your or your family’s will and/or ability to spend.

That’s why the right-wing talk of death panels that will be introduced with healthcare-for-all is so idiotic. They already exist in the US. It starts with politicians that deny people affordable healthcare, they are the first death panel in line.

And for the 2nd bit you’re replying to the wrong person.

Sorry for the wrong attribution.


…expensive, unnecessary end-of-life care

Can you point to some examples for expensive EOL care that you deemed unnecessary ?

And some figures of how they have a large impact on the cost of healthcare in the US ?


Not sure about necessity, but it looks like the last year costs about 10% of the health care spending and last 3 years around 20-25%. If you figure people live 75 years, end of life care is 6-8x more expensive than an average year.


Then again all you could cut is 10% if you knew when to stop wasting money on sick people when they had a year or less left, and since you don’t know such things and many types of care would still be done, any savings would be only a fraction of that.


As overly rhetorical and scare mongery the term “death panel” is, there is unfortunately no escaping the argument about them thanks to the intransigence of the NHS and British courts in the face of public outrage in the cases of Alfie Evans and Charlie Gard.


Yeah so in some way theres someone deciding how we handle end of life care.

But if you call it a “death panel” then you can scare people into thinking that a panel of grim reaper hooded incompetent government bureaucrats will murder your grandma.

We used to just call the people deciding who gets to live and die the “board of directors of a health insurance company”


That’s basically what a Fox viewer I know thought “death panels” were.

Like you said, health insurers already make these kinds of decisions; they just use different terms, like “utilization management.” The conflict of interest with a private insurer is far more concerning to me than with the government. (Even where the insurer is only acting in an administrative capacity, the entity that established the plan and has financial responsibility for claims still has influence in the insurer’s approval criteria.)


As I understood the Charlie Gard case, it didn’t really have anything to do with the NHS per se; it was actually a disagreement between the parents’ wishes and the doctors’ medical judgment as to what was in Charlie’s best interest. In such a situation, UK law is more deferential towards the doctors’ medical judgment and allows doctors to petition a court to overrule the parents, unlike US law which tends to be more deferential to the parents. Those doctors were employed by the NHS, of course, but as far as I can tell, nothing would have stopped the same situation from occurring in a private hospital with private doctors (assuming there was a private hospital in the UK capable of providing the treatment, which there might not have been). But perhaps my understanding is wrong.

I didn’t follow the Alfie Evans case much when it happened, but at first glance, it looks like the same issue.


Do you know of any instance in the UK or the US where private doctors at a private hospital have petitioned the courts for removal of life support in defiance of a patient’s or a patient’s family’s wishes?




Wow. I had no idea these cases existed here. All the coverage of the cases in the UK made it seem like it was a problem there but not here. Thanks for the enlightening articles.


jerosen addressed the US question well. For the UK question, I couldn’t find one. My understanding is that private hospitals in the UK focus on the more planned types of medical services, like surgeries or other procedures. If complications occur, they will call an NHS ambulance and send you to the NHS. So I suspect there isn’t such a case, but that would be because private hospitals are unlikely to handle patients needing life support. I could be wrong though.