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posted by martyb on Tuesday June 16 2020, @04:53PM   Printer-friendly
from the first-world-health-care? dept.

COVID-19 hospitalizations could mean significant out-of-pocket medical costs for many Americans:

For their study, the researchers analyzed out-of-pocket costs for pneumonia and other upper respiratory illness hospitalizations from January 2016 through August 2019 as a potential indicator of likely COVID-19 costs. The researchers found that these out-of-pocket costs were particularly high for so-called consumer-directed health plans -- which typically feature lower premiums, compared to standard plans, but higher deductibles that can be paid via tax-advantaged health savings accounts.

[...] Many big-name health insurers have voluntarily waived out-of-pocket cost sharing for COVID-19 treatment. However, employer-sponsored "self-insured" health insurance plans are not required to adhere to such waivers. Thus, tens of millions of Americans have high-deductible insurance plans that, in cases of COVID-19 hospitalization, may expose them to relatively high out-of-pocket costs.

[...] To get a sense of the likely cost burden on patients hospitalized for COVID-19, Eisenberg and colleagues examined de-identified insurance claims for 34,395 unique hospitalizations from January 2016 through August 2019. They looked at out-of-pocket costs incurred by people who had been hospitalized during the 2016-2019 study period with pneumonia, acute bronchitis, lower respiratory infections, and acute respiratory distress syndrome. (Claims data on actual COVID-19 cases were not available in the database at the time of the study.) The cases examined did not include those for people ages 65 and over, who are normally covered by Medicare. The out-of-pocket costs included deductible payments, copayments, and coinsurance payments.

The researchers found that average out-of-pocket spending for the 2016-2019 study period for these respiratory hospitalizations was $1,961 for patients with consumer-directed plans versus $1,653 for patients in traditional, usually smaller-deductible plans.

The out-of-pocket cost gap was lowest for older patients age 56 to 64, and greatest -- $2,237 vs. $1,685 -- for patients 21 and younger. The analysis was not designed to examine why the cost gap varied inversely with patient age, but one possible explanation proposed by the researchers was that, since younger patients are healthier on average, their hospitalizations may reflect more serious and thus more costly illness.

Journal Reference: Matthew D. Eisenberg, Colleen L. Barry, Cameron Schilling, Alene Kennedy-Hendricks. Financial Risk for COVID-19-like Respi- ratory Hospitalizations in Consumer-Directed Health Plans, American Journal of Preventive Medicine (2020), doi: https://doi.org/10.1016/j.amepre.2020.05.008


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  • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @07:08PM (53 children)

    by Anonymous Coward on Tuesday June 16 2020, @07:08PM (#1008804)

    Glad you're liking your Obamacare.

  • (Score: 1, Insightful) by Anonymous Coward on Tuesday June 16 2020, @07:30PM (52 children)

    by Anonymous Coward on Tuesday June 16 2020, @07:30PM (#1008811)

    If I didn't have that, I'd be uninsurable via pre-existing conditions.

    So, while (as I said during the debate over the ACA back in 2010) while the ACA wasn't anywhere near enough, it was Better Than Nothing.

    Your weak attempt at snark just goes to show how fucked up the US healthcare system is. I won't (although I have repeatedly done so in other discussions about the ACA here) get into all the varied reasons why a single-payer plan would be cheaper, with better outcomes for more people, and would eliminate people ending up *homeless* because they can't pay their medical bills, and just all around better for everyone except insurance companies and healthcare conglomerates. A good trade-off, if you ask me.

    Why are you wasting time here anyway? Don't you have some anarcho-capitalist cock to suck?

    • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @08:41PM (48 children)

      by Anonymous Coward on Tuesday June 16 2020, @08:41PM (#1008833)

      When did more federal gov involvement make something cheaper?

      • (Score: 5, Insightful) by PartTimeZombie on Tuesday June 16 2020, @09:10PM (24 children)

        by PartTimeZombie (4827) on Tuesday June 16 2020, @09:10PM (#1008845)

        When did more federal gov involvement make something cheaper?

        When every other country in the world did it. Just because you can't seem to do it, doesn't mean it can't be done.

        • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @09:19PM (23 children)

          by Anonymous Coward on Tuesday June 16 2020, @09:19PM (#1008848)

          So you can't think of a single time the US federal government became more involved in something and it became cheaper? I agree. I don't think this has ever happened.

          • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @09:56PM (14 children)

            by Anonymous Coward on Tuesday June 16 2020, @09:56PM (#1008867)

            On top of that.

            Here is my story.

            "I have a headache can you hand me my purse"
            "oh sure" hands over purse
            reaches in and pulls out a bottle of generic asprin
            nurse scribbles on bit of paper
            2 months later
            400 dollar bill for handing my mom her purse.

            One thing we can do is itemize all bills and put them on the internet. Full transparency. Only one person wants that apparently in our government because the AHCA is perfect and needs no changes.

            Check your bills. Hospitals put extra shit on there all the time. Also never take the helicopter. The hospitals no longer own them. Never take the ambulance if you can help it. Some bright sparks use it as a taxi service so they have to have extras laying around to backup. Which costs lots of extra money.

            • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @10:08PM (1 child)

              by Anonymous Coward on Tuesday June 16 2020, @10:08PM (#1008874)

              Check your bills. Hospitals put extra shit on there all the time.

              They do. I was admitted to the hospital a number of years ago when a doctor (wrongly) thought I might have MRSA [wikipedia.org]. I spent three days getting unnecessary IV antibiotics before the tests came back and, surprise, surprise, no MRSA.

              When I saw the list of charges, I was surprised to find that not only was I in two different beds at the same time, but also I found out that I'd had a pap smear [mayoclinic.org]. Which is quite a trick, since being male, I don't have a cervix.

              • (Score: 2) by c0lo on Wednesday June 17 2020, @01:49AM

                by c0lo (156) Subscriber Badge on Wednesday June 17 2020, @01:49AM (#1008973) Journal

                Which is quite a trick, since being male, I don't have a cervix.

                Don't you want one? It can be arranged for the right money (grin)

                --
                https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
            • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @10:10PM

              by Anonymous Coward on Tuesday June 16 2020, @10:10PM (#1008875)

              One thing we can do is itemize all bills and put them on the internet. Full transparency. Only one person wants that apparently in our government because the AHCA is perfect and needs no changes.

              Who said that? I've never heard *anyone* (except you, just now) say anything even close to that.

            • (Score: 5, Insightful) by PartTimeZombie on Wednesday June 17 2020, @12:02AM (7 children)

              by PartTimeZombie (4827) on Wednesday June 17 2020, @12:02AM (#1008935)

              Here is my story: A couple of years ago I got a call from Mrs PartTimeZombie telling me she'd fallen and broken her ankle.

              By the time I got home the ambulance was there and she was admitted to hospital.

              6 weeks and two operations later, I was still complaining about having to pay $4 an hour for parking to visit her.

              That was my total "out of pocket" and that is how the entire civised world does healthcare, because it is cheaper and works better for everyone except insurance companies.

              I'm sorry you have such dishonest system. Maybe you should consider emigration.

              • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @12:10AM (3 children)

                by Anonymous Coward on Wednesday June 17 2020, @12:10AM (#1008937)

                Seems strange to ignore that you have paid taxes over the years for this service.

                • (Score: 5, Informative) by PartTimeZombie on Wednesday June 17 2020, @01:17AM (1 child)

                  by PartTimeZombie (4827) on Wednesday June 17 2020, @01:17AM (#1008959)

                  Who is ignoring it? That is entirely my point.

                  I don't have to worry about losing my house because of an accident. You do.

                  • (Score: -1, Troll) by Anonymous Coward on Wednesday June 17 2020, @01:36AM

                    by Anonymous Coward on Wednesday June 17 2020, @01:36AM (#1008965)

                    No I dont. People who gave all their money to insurance companies and live in houses they cant afford do.

                • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @02:29PM

                  by Anonymous Coward on Wednesday June 17 2020, @02:29PM (#1009126)

                  And presumably you are not?

              • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @04:53AM (2 children)

                by Anonymous Coward on Wednesday June 17 2020, @04:53AM (#1009030)

                Like most of the 'civilized world' which you mention require you to have specialized skills, a masters degree, or a lot of money in order to give you a working or resident visa. Furthermore, many explicitly state you will have to pay for any medical care you recieve while there (the on-the ground realities may or may not be in line with that.) I don't remember exactly which countries I got that information from, but it was among norway, denmark, belgium, netherlands and a few other of the more prominent european countries.

                Lots of other places have far lower scrutiny of immigrants, but also have fewer opportuntiies, more corruption, and questionable or limited first world medical care available.

                • (Score: 2) by FatPhil on Wednesday June 17 2020, @09:23AM (1 child)

                  by FatPhil (863) <pc-soylentNO@SPAMasdf.fi> on Wednesday June 17 2020, @09:23AM (#1009063) Homepage
                  Marry a local. Sheesh, is your personality so terrible you don't think you can find anyone in the whole of the EU?
                  --
                  Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
                  • (Score: 1, Funny) by Anonymous Coward on Wednesday June 17 2020, @12:24PM

                    by Anonymous Coward on Wednesday June 17 2020, @12:24PM (#1009082)

                    I'm sure it won't be a problem when I tell her I just want to get married so the state will pay for my herpes meds.

            • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @05:11AM (1 child)

              by Anonymous Coward on Wednesday June 17 2020, @05:11AM (#1009036)

              Also never take the helicopter. The hospitals no longer own them. Never take the ambulance if you can help it.

              I'll remember that for the next time I get asked.

              • (Score: 1, Funny) by Anonymous Coward on Wednesday June 17 2020, @02:33PM

                by Anonymous Coward on Wednesday June 17 2020, @02:33PM (#1009129)

                Don't forget to refuse non-generic drugs and bring your own gauze (much cheaper). Also, you should put out a tender and conduct interviews. And for God's sake, take your bleach!

            • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @07:54PM

              by Anonymous Coward on Wednesday June 17 2020, @07:54PM (#1009264)

              So... it's a little more complicated than that.

              Your wife engaged the nurse. The nurse did an assessment of her, determined she was lucid and rational. Nurse probably looked at her skin tone and color, absence of sweat, mental attitude (was not screaming in pain nor experienced it). If nurse was competent she probably asked Mom to describe headache to ensure it wasn't migraine or burst aneurysm, and probably observed and or asked if there was any other symptoms with that. Mom decided to self medicate. Nurse agreed that this was acceptable (would not stop that in any event), but it does likely stop nurse from prescribing anything else at that time (assuming this was an advance practice nurse who can prescribe). Nurse may have also decided that no prescription from the nurse was warranted but the patient can self medicate so you're not charged another $25 for two whatever's. (Pills cost $.25, pharmacist who stocks it $5, nurse salary $3.75, lights and overhead $1.00. $15.00 because every person tries to make darn sure you are getting 50 mg of aspiring and not 30 mg codeine and liability insurance for when the nurse was wrong and you just died of OD and sue.)

              Let's take it from a different profession point of view. You call over a plumber and describe that the pipe underneath your sink is leaking. Plumber looks at it and can see that it is indeed a small leak. You ask plumber to hand you a wrench. Plumber does so and you tighten the joint. Have you not still engaged the time and professional skill of that plumber even though you decided to fix it yourself?

          • (Score: 2) by PartTimeZombie on Tuesday June 16 2020, @11:34PM (7 children)

            by PartTimeZombie (4827) on Tuesday June 16 2020, @11:34PM (#1008916)

            I think we've already established the fact you have to live with the exploitative healthcare system you have because your government is run by and for corporate interests.

            How do you think you wound up in the state you're in?

            • (Score: -1, Troll) by Anonymous Coward on Tuesday June 16 2020, @11:59PM (6 children)

              by Anonymous Coward on Tuesday June 16 2020, @11:59PM (#1008932)

              > you have to live with the exploitative healthcare system you have

              I don't live with it. I stay as far away from it as possible. When there was that obamacare penalty I just paid it rather than take the "free" insurance.

              > How do you think you wound up in the state you're in?

              Idiots who think its a good idea to give the people/organizations who messed it up even more money and power.

              • (Score: 2) by PartTimeZombie on Wednesday June 17 2020, @01:14AM (5 children)

                by PartTimeZombie (4827) on Wednesday June 17 2020, @01:14AM (#1008957)

                That's nice, until you get sick, or have an accident and have to deal with $500,000 invoice.

                • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @01:24AM (4 children)

                  by Anonymous Coward on Wednesday June 17 2020, @01:24AM (#1008960)

                  Look up chargemaster, no one pays those prices. The real price is 50-99% less. Also taxes already pay for emergency care.

                  • (Score: 3, Informative) by PartTimeZombie on Wednesday June 17 2020, @02:20AM (2 children)

                    by PartTimeZombie (4827) on Wednesday June 17 2020, @02:20AM (#1008988)

                    So I looked up Chargemaster, but there was no useful information, so I did another search, and found this: [worldpopulationreview.com]

                    A 2015 study by the Kaiser Family Foundation found that medical bills caused 1 million U.S. adults to declare bankruptcy every year and that 26 percent of Americans age 18 to 64 struggled to pay medical bills.

                    As it turns out, medical bankruptcy is almost unheard of outside of the United States.

                    So why don't you tell me again how those 1 million bankrupt Americans every year are just doing it wrong?

                    • (Score: -1, Redundant) by Anonymous Coward on Wednesday June 17 2020, @05:00AM (1 child)

                      by Anonymous Coward on Wednesday June 17 2020, @05:00AM (#1009032)

                      So I looked up Chargemaster, but there was no useful information,

                      You obviously did not, because the Zero-Click info on DDG would have taken you to the Wikipedia page for Chargemaster.

                      Why don't you just give up your attempts at trolling US politics as a foreigner from the other side of the world?

                      • (Score: 0) by Anonymous Coward on Thursday June 18 2020, @07:30PM

                        by Anonymous Coward on Thursday June 18 2020, @07:30PM (#1009674)

                        Because he or she is right, if you are in the United States. Just because you might be able to negotiate self-pay discounts from a practice's chargemaster does not mean that a catastrophic event still cannot result in over $50,000 of discounted charges you'll be liable for from one hospitalization. Just because you can negotiate prices does not mean that people have to file bankruptcy because of medical conditions [nih.gov] every year. That number is in the hundreds of thousands [cnbc.com]. Per year. Stop thinking you've found some kind of magic bullet.

                  • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @05:37AM

                    by Anonymous Coward on Wednesday June 17 2020, @05:37AM (#1009044)

                    By law, someone literally has to pay those prices within a certain percentage listed on the CDM, so your claim of "no one pays it" is just factually incorrect. In addition, even though the public insures against the loss of emergency care, that covers way less than most people think it does and in no way legally absolves you of having to pay the hospital for your care.

      • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @09:51PM (12 children)

        by Anonymous Coward on Tuesday June 16 2020, @09:51PM (#1008862)

        Plan overhead (~2%) and lower payments to providers makes Medicare (the US version) many times less expensive than private insurance.

        You're just spouting a bunch of bullshit that your anarcho-capitalist corporate masters drill into you while you gargle their jizz. Good times!

        • (Score: -1, Troll) by Anonymous Coward on Tuesday June 16 2020, @10:17PM (8 children)

          by Anonymous Coward on Tuesday June 16 2020, @10:17PM (#1008881)

          > Plan overhead (~2%) and lower payments to providers makes Medicare (the US version) many times less expensive than private insurance.

          Medicare was started in 1966 and now spends $740 billion/year on 60 million people. That is $12k per person per year.

          https://en.wikipedia.org/wiki/Medicare_(United_States)#Financing [wikipedia.org]

          Before medicare the cost was ~$150 per person per year (2010 dollars). So lets say its $300 in 2020 dollars. Then it costs ~40x more with medicare than without.
          https://www.businessinsider.com/healthcare-costs-have-exploded-since-1960-2014-4?op=1 [businessinsider.com]

          So I don't see this decrease in expense that you claim. Do you mean the individual pays less with the taxpayer and debt covering the rest?

          • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:13PM

            by Anonymous Coward on Tuesday June 16 2020, @11:13PM (#1008903)

            But the US is 40x healthier now compared to 1960.

          • (Score: 4, Interesting) by sjames on Tuesday June 16 2020, @11:20PM (1 child)

            by sjames (2882) on Tuesday June 16 2020, @11:20PM (#1008906) Journal

            In order to really decrease the costs, we'll have to socialize the part that keeps jacking up the charges as well, but $12K per person for the group with the highest medical needs on average is actually a savings.

            People in their 20s and 30s (a group with low medical needs on average) pay nearly that much for a great deal less healthcare.

            In countries where they finished the job rather than the half measures in the U.S., costs are less than half those in the U.S.

          • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:49PM (3 children)

            by Anonymous Coward on Tuesday June 16 2020, @11:49PM (#1008927)

            Medicare (the US version) is many times less expensive than private insurance.

            Your blather about increased medical costs (which have increased much faster than inflation), while true, is orthogonal* to that statement.

            You're just parroting back a bunch of talking points because you apparently don't have an original thought in your head.

            More's the pity.

            *If you're having problems with the longer words, try here [dictionary.com]

            • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:55PM (2 children)

              by Anonymous Coward on Tuesday June 16 2020, @11:55PM (#1008931)

              > Your blather about increased medical costs (which have increased much faster than inflation), while true, is orthogonal* to that statement.

              Here is the original statement: "When did more federal gov involvement make something cheaper?"

              So you agree that the comparison of medicare to private is orthogonal to the original topic of discussion (increasing government intervention making something cheaper). Yes, I knew that when I responded, and was sure to respond to the original topic.

              • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @12:14AM (1 child)

                by Anonymous Coward on Wednesday June 17 2020, @12:14AM (#1008938)

                So you agree that the comparison of medicare to private is orthogonal to the original topic of discussion (increasing government intervention making something cheaper). Yes, I knew that when I responded, and was sure to respond to the original topic.

                I'm going to assume you're stupid rather than trolling and explain.

                No. The fact that medical costs have increased faster than inflation over the last fifty years is orthogonal to whether or not something can be done more cheaply by government

                That the Medicare (government) program has overhead many times lower than private insurance, and is, in fact much cheaper is *directly* related to the question of whether or not government can do something less expensively than the private sector, in that the Medicare program does just that.

                It is, in fact, specifically answering the question asked. Much more so than any comparison of current vs. historical medical costs.

                • (Score: -1, Troll) by Anonymous Coward on Wednesday June 17 2020, @01:28AM

                  by Anonymous Coward on Wednesday June 17 2020, @01:28AM (#1008961)

                  No one mentioned whether the government can do something cheaper. Stop bringing up semirelated stuff.

                  Fact is that healthcare is about 40x more expensive now than before medicare. So thats not an example of the gov getting involved then something getting cheaper.

          • (Score: 2) by FatPhil on Wednesday June 17 2020, @09:37AM

            by FatPhil (863) <pc-soylentNO@SPAMasdf.fi> on Wednesday June 17 2020, @09:37AM (#1009064) Homepage
            Wrong. You don't understand the economics of the situation. The start of the explosion in costs was way before medicare, it started with private medical insurance. Increases in costs were 8-9% per year in such times. Medicare was just a cherry on top, a new deep pocket to rifle through, but still costs only increased at 11-12% per year. So in summary, about 3/4 of the increase was because of the combination of privitised healthcare and privitised insurance, the medicare component was relatively minor.

            By the early 70s, even Nixon realised this was unsustainable, so he tried to do something about it, but bizarrely he thought the way to make it sustainable was by trying to sustain it. Everyone since then just followed his lead. Go put your mike next to your speakers - how you liking that feedback?
            --
            Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
        • (Score: 2) by linuxrocks123 on Tuesday June 16 2020, @11:05PM (2 children)

          by linuxrocks123 (2557) on Tuesday June 16 2020, @11:05PM (#1008899) Journal

          There's lower overhead with Medicare, but that private insurance overhead also equals oversight, so I think what's being missed is that more unnecessary testing gets done with Medicare since they know they won't get denied. Private insurance companies have a strong incentive to deny claims for bogus shit. Medicare doesn't.

          • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:22PM

            by Anonymous Coward on Tuesday June 16 2020, @11:22PM (#1008910)

            AFAIK Medicare has strong limits on what treatments can be billed by hospitals for what condition. There are so many customers on Medicare that there are optimized processes in hospitals to deal with it.
            Private insurers on the other hand can deny claims for random stuff, but then the patient is still on the hook to the provider.

          • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:32PM

            by Anonymous Coward on Tuesday June 16 2020, @11:32PM (#1008915)

            Private insurance companies have a strong incentive to deny claims as often as they can get away with, whether they are medically necessary or not, to maximize their profits

            There. FTFY.

      • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:35PM (8 children)

        by Anonymous Coward on Tuesday June 16 2020, @11:35PM (#1008919)

        For any sort of health insurance, the provider has a certain amount of revenue, which can be in the form of premiums, subsidies, and taxes. A portion of that money is then used to pay for treatments received by their customers. There are also operating costs to pay employee salaries, maintenance of facilities, equipment and supplies, and things like that. These costs are incurred regardless of whether health expenses are covered by an HMO or by the government. The ability to pay for treatments depends on the amount of revenue and how much of that is left after paying other expenses.

        For government-provided health care, the sum of operating expenses and treatments that are covered should be equal to the revenue. It should break even. But for an HMO, the goal is not to break even but to make a profit. Some of those profits are taxed. A portion of the profit is retained for future investments and expenses. This can go toward covering operating costs when revenue decreases or to paying for capital improvements, but often is used to finance mergers and acquisitions, which involves paying shareholders. Many companies also pay a portion of the profits as shareholder dividends. Any profit made by an HMO is money that's not going to pay for medical treatments for its customers. Because the government does not expect or need to be profitable, just to break even, more money is inherently available to pay for patients to be treated.

        Simply put, why is it a good thing that some revenue is diverted to pay shareholders when it could be going to pay for medical treatments for customers? This is not an issue with government-provided health coverage.

        It's also worth noting that HMOs aren't the only place where shareholders get paid. Many hospitals have shareholders. Those hospitals purchase drugs and medical equipment from other companies. Pharmaceutical companies have shareholders and many pay dividends. Medical equipment manufacturers also have shareholders. So there are multiple steps at which shareholders get paid. Every time shareholders get paid, either the costs of treatment increase or the portion of treatments that are covered goes down.

        Medical treatment is a necessity. Why should this necessity require paying shareholders at multiple levels?

        • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:42PM (7 children)

          by Anonymous Coward on Tuesday June 16 2020, @11:42PM (#1008920)

          > For government-provided health care, the sum of operating expenses and treatments that are covered should be equal to the revenue. It should break even.

          This isn't how government budgeting works. You get allocated a certain amount for the year and if any is left over you get less the next year. So a successful department/etc is one that manages to spend as much as possible, to show the need for a bigger budget (that comes with increased staff and political power). Ones that don't do this get starved of funding and lose power.

          • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @12:01AM (2 children)

            by Anonymous Coward on Wednesday June 17 2020, @12:01AM (#1008934)

            While government agencies typically do operate in that manner, that isn't actually how medicare operates. I recommend you learn about the medicare trust fund [taxpolicycenter.org] and how it works. There are a certain amount of assets in the medicare trust fund, which can be used to cover expenses and treatments in later years if income drops below expenditures. Operating at a surplus for a year does not automatically decrease the funding for medicare the following year.

            • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @02:02AM (1 child)

              by Anonymous Coward on Wednesday June 17 2020, @02:02AM (#1008981)

              And what is held in this trust fund?

          • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @12:05AM (3 children)

            by Anonymous Coward on Wednesday June 17 2020, @12:05AM (#1008936)

            This isn't how government budgeting works. You get allocated a certain amount for the year and if any is left over you get less the next year. So a successful department/etc is one that manages to spend as much as possible, to show the need for a bigger budget (that comes with increased staff and political power). Ones that don't do this get starved of funding and lose power.

            I guess you've never worked for a large corporation. That's *exactly* how things work in a big company.

            Back in the mid 1990s I was (among other things) a Unix evangelist at the corporate headquarters of a Fortune 50 company. I would work with various business units to implement Unix-based systems to support their analytical functions.

            I would give presentations every couple months and learned very quickly that the term "increased productivity" was a big no no. Why? Because if productivity increased, that means less headcount would be required and, hence a smaller budget. And *every single exec* with their own budget would have none of that.

            Even more egregious, the company had spent ~USD$300 million developing a new customer service platform including ~USD$100 million worth of Unix boxes and peripherals for the project. As they finished the pilot, they realized it would cost them USD$100 million/year to manage and support the new environment, so it was scrapped.

            But we still had ~USD$100 million in equipment sitting in warehouses.

            As such, when planning/implementing new Unix installations for various business units, I always encouraged the business unit to use the already purchased equipment. All they had to do was put the depreciation on their budget lines and the corporation as a whole wouldn't have to spend any more money.

            But the vendor (in this case, IBM) was offering sufficient discounts on new equipment that meant less of a hit on the business unit's budget. What did those execs do Every. Single. Time? They chose to purchase new equipment rather than take the depreciation hit from using already purchased equipment sitting idle in warehouses.

            The upshot was that money was going out of the company rather than maximizing the resources *already paid for* by another business unit.

            Repeat: This was not any government. This was a Fortune 50 company.

            • (Score: -1, Troll) by Anonymous Coward on Wednesday June 17 2020, @12:14AM (2 children)

              by Anonymous Coward on Wednesday June 17 2020, @12:14AM (#1008939)

              > I guess you've never worked for a large corporation. That's *exactly* how things work in a big company.

              I never said it didnt work like that in all large organizations. The larger they are, the worse it gets. US government is the largest and worst offender.

              • (Score: 2, Informative) by Anonymous Coward on Wednesday June 17 2020, @12:25AM (1 child)

                by Anonymous Coward on Wednesday June 17 2020, @12:25AM (#1008944)

                I never said it didnt work like that in all large organizations. The larger they are, the worse it gets. US government is the largest and worst offender.

                I hate to break it to you, but the insurance companies and healthcare conglomerates are all large organizations. The difference is that the government doesn't need to show a profit.

                That profit takes funds *directly* away from treating patients.

                Which is why other nations that have private insurance (Germany is a notable example) systems have laws forbidding insurance companies from making a profit.

                Oops.

                • (Score: -1, Troll) by Anonymous Coward on Wednesday June 17 2020, @01:33AM

                  by Anonymous Coward on Wednesday June 17 2020, @01:33AM (#1008963)

                  Yes, those large organizations are also bad and inefficient. I want nothing to do with any of them.

      • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @06:49PM

        by Anonymous Coward on Wednesday June 17 2020, @06:49PM (#1009237)

        Defense of my home from invasion by China or Russia. Pretty sure the costs of the standing armed forces are a little more expensive than my taxes are.

        Ability for me to go to four hundred square miles of forest and go walking. Pretty sure the cost of that is more than my taxes pay.

        Ability for me to travel from here at my work to home. Pretty sure the three miles of paved and pretty well-maintained asphalt would be more expensive than the taxes I pay.

        You can't convince me (vouchers or no) that privatizing all education would result in cheaper costs of education, sorry. Public schools are cheaper.

        I have access to a library of several thousand printed books and many more ebooks, much more than I can ever read or afford.

        I have clean and potable water on tap, and my sewage wastes are taken away without my worrying about them past my property line. (That despite everything Trump is trying to do...)

        If I do end up without insurance and homeless and somebody cracks me over the head with a baseball bat I don't have to worry that the emergency room is going to wait until I prove I have the ability to pay them.

        So honestly, you sound a lot like the protestors in Monty Python's Life of Brian. "But apart from better sanitation and medicine and education and irrigation and public health and roads and a freshwater system and baths and public order... what have the Romans done for us?"

        There's a long way to go, to. But let's first look at what we have.

    • (Score: 0) by Anonymous Coward on Tuesday June 16 2020, @11:11PM (2 children)

      by Anonymous Coward on Tuesday June 16 2020, @11:11PM (#1008901)

      "Don't you have some anarcho-capitalist cock to suck?"

      They never stop, that is why they can only communicate via text.

      • (Score: -1, Spam) by Anonymous Coward on Tuesday June 16 2020, @11:34PM

        by Anonymous Coward on Tuesday June 16 2020, @11:34PM (#1008917)

        Gargle gargle! Your corporate masters' jizz is tasty, huh?

      • (Score: 0) by Anonymous Coward on Wednesday June 17 2020, @06:05PM

        by Anonymous Coward on Wednesday June 17 2020, @06:05PM (#1009224)

        why they can only communicate via text.

        Just curious, who is "they" and *how else* might one communicate on a text-based discussion site?

        This ought to be amusing.