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About Elysium

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    I work as an internal consultant to the Dept of Health and Human Services. I'm passionate about saving tax payer money and reducing government waste. I'm part of the solution because I'm saving you money and part of the problem because your tax dollars are paying my salary. :P

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  1. You are right that insurance pricing includes the costs of those other factors you described, such as medicine, hospital infrastructure, doctors' salaries. However, those are on a contractual basis between whatever insurance company they have in the private sector with the respective drug manufacturers, hospitals, doctors, etc. That information is essentially fed to insurance companies and negotiated over; those services are not rendered by the insurance company unless you're in an HMO (or similar construct where delivery of healthcare and insurance for it are under 1 roof). Insurance ultimately just boils down to what price you pay for what service when. In that sense, the only thing that changes from a private industry -> my version of public one is the prices you're paying (lower) and who you're paying it to (the government acting as a private entity), and thus all those other elements such as what hospitals, what drugs, what doctors, (except for pricing) stay the same (excluding HMOs of course). I re-read what you said and realized that you and I were saying the same thing. Insurance IS about pricing. Either you choose to pay for treatment upfront (or take out a loan for it) or you get insurance to pay for it. Which insurance you pick comes down to pricing. If your concern is around how certain HMOs, PPOs, etc, have their own exclusive network of doctors / hospitals that are its members, my answer is that those are part of the "hook up" process by which my ideal insurance system is established. Payments to the doctors, pricing on drugs, etc remain the same. All that would change is how much you would pay and who you would pay to. In preserving the payment structures to those drug companies, hospitals, and doctors, changes to which ones you would get to see would be minimized, because those entities would not be incentivized to turn you down if they get paid the same in the end. I thought I... did? To me, insurance = healthcare = being healthy = life. Life is granted to us, we can all agree. And if the means by which we can continue that health is an opt-out system, that does not infringe on others' right to life. I feel like I'm repeating myself. As for why it's a proper function of government, I thought I... did too. I see it in the same vein as national defense, and payment being voluntary. Only in this case, it's more enforceable that if you opted out, you don't get access to the care, whereas in a voluntary payment military, the military will still pay for your protection (unless you wear a big flashing sign saying that you didn't donate or something). In respect of this, I didn't elect to illustrate my point above by walking through the US healthcare supply cycle step by step. Do let me know if you want me to though.
  2. Richard, do you do government contracts? I didn't see in your services human resources calls. Do you guys do that?
  3. Lastly, I'd just like to say that in this topic I feel like Dagny. Everyone else: "YOU'RE STUPID YOU'RE STUPID NEENER NEENER" Dagny: "NO THE WORLD IS STILL WORTH SAVING I WILL DO IT JUST BELIEEEEEEVE IN LIFE AFTER LOOOOOOOVE" Let my... optimism run its course. Either I'll wise up and realize the US isn't worth saving, or I'll fix it. In either case, you win.
  4. Size, influence, and accessibility. Like I said earlier, I think insurance companies by design in the US are fundamentally broken. Their business model is to take your money and not pay for your care. That's what drives up their profits. And they are for profit companies, and their upper management gets paid a lot more than government workers. Take away all those factors and put in place a rock solid SOP for healthcare payment issuance and you have a cheaper system overall. Similar models exist in the private sector; local individuals like NJ Motor Corp (I think was the name) form non-profit insurance organizations (it's a car insurance company, not a health insurance one, but work with me here). They're fewer and farther between, they have a very rigorous review process of who gets in based on driving history, and their premiums are substantially lower than Geico, etc. The challenge is that you don't always have them in your local area. You don't always get in. And even if you get in, you have limitations of where you're covered. I fully recognize the faults of the US government; it's no secret that we have a lot of problems. I could tell you about the barriers upon barriers that prevent us from firing underperforming employees quickly, but I'm preaching to the choir. But yeah, I intend to spend time working for fed govt and learn its ins and outs to see how I can change it for the better. USPS and Amtrak I agree with. Public schools? Nope. There were just as many public school students in my home town who went to ivy league schools as those from private high schools. I'm one of the former. Statistically their performance may be lower than private schools, but there's also a number of reasons for that: contracts between private high schools and ivy league universities, harder to attract talented teachers (speaks to government's lax incentive structure), and underfunding for developmental programs for the students (again, a money management issue).
  5. ^ Selective reading? Naw... I wrote earlier: To summarize again what I said above: nothing changes except insurance. Not medicine, not medical research, not doctors, not hospitals / facilities, etc. That all stays the same. I'm not sure how much clearer I can make it. Not everyone is happy with their healthcare right now. If you think all the rich people are, you clearly haven't seen the numbers: http://www.commonwealthfund.org/Content/Ne...19-Percent.aspx Are you happy paying paying more than double what you paid a year ago (after accounting for inflation)? Ya looking forward to paying double again in 10 years? I'm not, and I'm not even rich! By incentivizing them to a cheaper annual insurance premium? DING DING DING WE HAVE A WINNER. Yes, because it will choose to differentiate itself. And it loves to do that! And all the rich people will be unhappy with the government and will opt out! For my next act, I have a gut feeling I need to explain how the US healthcare system works.
  6. For NYC, I dunno man. I always thought the piles of garbage late at night on all the residential streets, the constant litter and flyers on the ground, and the puddles of garbage water to be unattractive. And don't get me started on its subways. As for Chinese cities (not going to discuss whether HK and Taiwan are part of China), they're all so polluted and disgusting, they make NYC seem cleaner in comparison. :/
  7. Let's define everything! "Opt out" to me means you can choose to not go with the government program, and can elect to pursue whatever other insurance methods you want. The government program covers only those who did not opt out, and is funded only by those who do not opt out. You are essentially choosing to buy a government bond or not, only your annuities throughout are in the form of healthcare. Of course this is all in "Ely's Fantasy America" where I get exactly what I want. I also want a unicorn but I probably won't get that in real life America either.
  8. So there are 2 thoughts: principle and action/result. In principle, it is wrong. In action/result using that example, it is illustrated to also be wrong. I find it's easier to just make my case using the latter. Clearly, I don't need to make it so easy on this board.
  9. Ahh, New York, Hong Kong, and most heavily industrialized cities: incredibly beautiful by night, digustingly disgusting by day.
  10. The simple answer, guys, to the "$1 vs. $1 million" question is cost of living. If we're using extreme examples, consider this: The penniless man gains $1. He is able to buy food and live another day. The rich man loses $1. He earns $1 million a month and his mortgage is $1 million a month (work with me here). He is not able to make his mortgage payment that month. In that extreme example, the penniless man has violated the rich man's right to live and use his money to do so.
  11. Hey man I think I was editing my post while you posted yours. I said: From a practical perspective, I would prefer an automatic enrollment system at the national level, and you have to specifically choose to opt out. Upon enrollment, you're locked in for a 5 year period, and if you chose to opt out, you can't get yourself back in for the full 5 years. Would I prefer a mandatory system? Yes, because I know there's going to be more administrative headache with allowing people to opt out and back in, which would drive up the overall program costs. However, to acknowledge the full definition of a "right" as not impinging 100% at all on any other person's right, I will have to acknowledge that you must on principle have the right to opt out. I guess also the word "mandatory" around here hits some nerves, so I'll avoid it in the future.
  12. Medicine =/= healthcare. See below. We have the right to life, meaning that when we are born, we have the unfettered right to live our lives and not impinge on other people's rights to do the same. The question for me comes down to does "healthcare" get bundled into the same category as "life," and I say yes. With the option to opt out. Now, does that right to "life" impinge on other people's rights to do the same? I say no, to the same extent that law enforcement; it is a preservation of life. As for whether taxation should be mandatory or voluntary to do that (e.g. the vehicle of funding), that's a separate discussion. I completely agree innovation + new technologies are only paved in a capitalist system, and I'm glad for those components. It's the insurance industry specifically I disagree with... OH HEY thanks for the article, and it just validates what I've lived and breathed for the last 3 years. I'm all for innovations; I think that the US is by far the best in its ability to create new solutions to people's problems. I don't mind patent exclusivity for new drugs to make huge profits, because that directly feeds in principle to new pipelines in R&D, and hence more innovator drugs (btw patent law is a government construct, but besides the point). Again, my issue with US healthcare is the reimbursement nature of our care and the pencil pusher decision makers at an insurance company. You and your doctor are waiting on insurance to release money before you can get an operation, or you choose to pay it out of pocket, or the hospital does the procedure, and then tries to chase down payments. In the above 3 cases, the first is one that slows the delivery of healthcare (which was the purpose of buying insurance to begin with), the 2nd negates insurance altogether, and the 3rd just adds to your operating costs because you're paying a doctor's salary to file papers and fill out forms (hospitals can afford to hire assistants, but I hope you get my point). I understand that Canada and other countries have issues with their healthcare systems. However, the source of the problem isn't the public healthcare itself; the source of the problem is that they don't have the innovation dollars incentivizing growth as they do in the US. Imagine a US with the same incentive structure, but with less overhead cost, fewer pencil pushers, and faster delivery of care. That's the healthcare system I want. Hahaha I wonder what else I'm misconstrued as, but that's off topic.
  13. Hey, thanks for correcting some of my posts guys. I will apologize that I was tired and wasn't forming the words correctly. Since it looks like I can't edit stuff after people have posted, so I'll repost some of what I said earlier here. I will say that people should have the right to opt out of the above system, but that they should sign a waiver when they opt out that they will not try to check into the public plan hospitals. Wow, that's something retardedly expensive. Thanks for making my goal of saving $20 million in taxes / year look inconsequential in comparison. But in all seriousness, I think that Obama is trying to control the cost. I will concede this point though, because the numbers (assuming they are valid) speak the truth. I think that there is a differentiation that needs to be made. There are two separate groups of thoughts: 1. What is a fundamental consideration about healthcare 2. What is a practical consideration about healthcare For #1, questions like is healthcare a right? Should we have Medicaid / Medicare? Who deserves to be covered? should be considered. For #2, questions like what makes sense to save money on the program but keeping it the same? What can we streamline to get the same results while keeping the overall configuration the same? should be considered. And I will apologize that I kinda mashed the two together. For #1 above, I think that healthcare is a right (I think the risks of not having a public option are too great), but that people should also have the right to opt out. For #2, I think the means to get to whatever end healthcare result want to land on will reduce the overall costs in the long run. My feelings noooooooo! ;( I tried to go the whole "not having to explain what my background is and for people to judge me based on the content of my message" route but I guess I didn't do a good enough job. I'm still a fervent believer in O'ism for the large majority of life, societal structure, and public policy. Of recent though I have noticed that healthcare is one area in which I just can't apply O'ism. I worked in management consulting for pharma manufacturers, worked with drug wholesalers, learned the product life cycles, supply chains, etc, of the industry, and government's involvement. I agree that a lot of the programs the government runs need fixing or removal altogether. However, I still stand firm on the need for a single, streamlined, public insurance program that people can opt out of. I say this because I'd like to keep all the configurations for the product suppliers (drugs, equipment) and healthcare providers (hospitals, doctors, etc) unchanged (which, upon removal of some ill-conceived government pricing would actually increase overall revenue for those companies), but just replace the middleman with government insurance. Thing to keep in mind is I have no problems with people making a ton of money. I'm convinced that the insurance industry is just a predatory industry writ large. Yup, sorry, thanks for pointing it up. Yeah man, we gotta all work hard to get what we want in life. *EDIT* I just got a notice that I'm veering off topic from the purpose of the Philosophy forum. For the sake of continuing this, let's limit scope of discussion away from "what's the deal with Ely?" to back on topic please.
  14. We're all in agreement on an individual level - no one has the right to make you do something you don't want to do. That said, insurance is one area that I would make a strong case for that everyone should have for a number of reasons: - You can get other people sick if you choose to not go to a hospital when you're sick. You're directly contributing to other people's lack of productivity in doing so. From an individual perspective, people should individually make judgments on whether they'll get other people sick if they are sick, but many times people don't make the right judgments. I can't tell you how many times I've gotten sick because of other people who didn't choose to withdraw from society during their recovery. - Insurance is on principle a vehicle to control costs over time. In a perfect world, you keep paying money to an insurance company, and you get sick / cash out the insurance at some points so that you are able to exactly equate out to what you put in. In practice, it's a lot more back and forth to actually achieve that goal, and a lot of slow down before you are physically able to get care, if at all. Having a universal healthcare system that's designed correctly and avoids a lot of the administrative issues will greatly alleviate that. The trick, as always, is to design and implement that big system correctly. - You drive down overall healthcare costs by increasing the population pool, and mandatory insurance when you're young and healthy will contribute to lower healthcare costs overall because of economies of scale and cost sharing. You... you serious? Look at the post right above yours. *EDIT* Hey, new stuff from freestyle! I'll respond to that after some meetings.
  15. You are right about my not having a right to make them give me that info. This is going to be fun! I never said that, buddy. Yawn. Okay, how much does an MRI scan cost you at Kaiser Permanente in New York? Call your HMO and ask them how much it will cost. Try to get them to send you a price list and you'll get laughed at. They will answer with "it depends on your copay, the specific Kaiser office you're going to, etc." Ask them if you will actually get the MRI scan if you request it to be paid under your insurance program. They will answer "it depends on your past claim history, an approval process, etc." You have a chance of not even receiving this procedure, even if your doctor requests it. What about a PPO? What about under Medicaid? What about under Medicare? One reason that Government Pricing (Average Manufacturer's Price, Average Sales Price, Non-Federal Average Manufacturer's Price, etc) has been mandated by the Centers for Medicaid and Medicare Services is the lack of price transparency that has been created by drug manufacturers. The easiest way to have perfect price visibility is to have no insurance and a great relationship with a doctor who is willing to give you a published price list for his procedures. Most people don't get that luxury. So they're left to deal with the above. Do you know the profits of a drug company? Their ROI on an R&D'd drug is like 400%. Now, things like increased generic pricing competition, class action law suits, regulatory changes, etc, erode those profits, but ultimately drug companies are crazy profitable. I'm not going to cite statistics here, but the external consultant to full time employee ratios within drug companies speaks to their bank roll. The insurance industry is a separate animal. Their margins are thinner than drug manufactuers', but their entire business model fundamentally rests on taking you money and not paying you for care. That's how they make money. In most cases, their policies grant people the care they need, but by design their purpose is to take in money and not pay it out. And before you throw in the card about "competition will stop them," ask yourself - can you really switch between an Aetna or a Cigna or a Kaiser or a Bravo Health? What about if you're unemployed? What if you're on COBRA? First of all, there are few options to choose from in a geographical location. You have a choice to move to a place with an insurance provider you like, but you don't have the ability to invoke other insurance providers to become available. But one of the above discussion matters anyway, because the fact that there exist insurance brokers that connect individual beneficiaries with actual insurance providers to navigate through all the paperwork proves the lack of visibility. Needless conjecture and non-sequiturs.
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