Why Is Health Care In America So Fucked Up?

Rambo

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Rambo Rambo , I think this is your solution (of course you are going to have to change your ways a tiny bit). It is always on satellite radio when I am driving. I'll find you an evangelical dental plan too.

Medi-Share

You and a bunch or hardcore, old school Christians pay for each other's medical care. What could be greater than that? Use the handy, dandy share calculator to determine your costs.


https://mychristiancare.org/medi-share/


Wonder what that lovely Christian couple will think the first time someone gets the clap
 

Rambo

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I've personally had the pleasure of running into this shit more than once

Four Things To Know About One Of The Largest Emergency Room Staffing Companies & Surprise Medical Bills

Opening your mailbox to a surprise bill of any kind isn’t typically a welcome experience. But when that bill is for thousands of dollars in medical care you once paid significantly less for, it’s even worse. Yet, that’s a scenario happening to more consumers as hospitals continue to contract out emergency room staffing, and one company appears to be driving the majority of costs.

The New York Times, citing recent research from Yale University, reports that hospitals turning to emergency room staffing company EmCare have are seeing a significant increase in patients’ medical bills.

Often these patients were seeking medical care at an in-network hospital where their insurance was accepted. But instead of having their costs covered, the doctors who saw them were out-of-network, resulting in surprise medical bills.

Related: Why Emergency Rooms Are A Hotbed For Surprise Medical Bills

To make matters worse, the Times reports that much of the care these patients received was considered an expensive level, driving up costs.

While the Times report and the Yale study provide a wealth of information not only on EmCare, but surprise medical billing, here are four things we learned.

1. A Significant Increase
Shortly after a Spokane, WA, hospital switched to EmCare last year in order to fill vacancies on its emergency room staff, the facility began receiving calls from patients about their medical bills.

While the hospital’s most expensive level of care once cost patients $467, under EmCare the price increased dramatically to $1,649, the Times reports.

Overall, the hospital found that after EmCare brought in doctors and took over staffing and billing, the percentage of patients receiving the highest-level billing code — which is the most expensive — rose from 6% to 28%. The facility says it has since taken back control of billing.

“The billing scenario, that was the real fiasco and caught us off guard,” Tom Wilbur, the chief executive of Newport Hospital, tells the Times. “Hindsight being 20/20, we never would have done that.”

2. Not An Isolated Incident
Research released by Yale University Monday suggests that the experience of the Washington state hospital is much like that of other facilities using EmCare.

The study, which examined out-of-network doctor’s bills for one large, unnamed insurance company, found that out-of-network rates for customers of the insurer jumped to nearly 100% after EmCare came on board at their hospitals.

Of the 16 hospitals that EmCare began working in between 2011 and 2015, the researchers found that eight saw out-of-network billing rise quickly.

Likewise, when the researchers looked at a larger sample of 194 hospitals using EmCare the average out-of-network billing rate was 62%.

The researchers’ analysis found that while the average out-of-network billing for a hospital increased from just above 0% prior to EmCare’s entrance, after the number of such bills increased to nearly 80%. At the same time, however, the study found that admissions and highest-level billing codes saw minimal increases.

3. A Small Number Of Contributors
The significant increase in out-of-network billing costs suggest that unlike other emergency room staffing companies, EmCare did not sign contracts with the insurance company dictating prices. If this is the case, doctors are free to bill customers what they want.

While the issue of out-of-network billing is nothing new, the Yale report found that most of these surprise bills were connected to just a few hospitals, not evenly dispersed around the U.S., the Times reports.

Additionally, the report found that most hospitals of the hospitals contributing to out-of-network bills were staffed by EmCare.

For its part, EmCare tells the Times that the Yale study is “fundamentally flawed and dated,” adding that when the company begins work for a hospital, it allows the facility to treat skier patients, which contributes to increases in costs and billing.

The company also notes that it is working to reach agreements with insurers for most of its doctors, a move that could decrease some out-of-network costs.

4. Costs Vs. Patients
The Times reports that EmCare isn’t the only staffing company tied to a rise in out-of-network billing.

When competitor TeamHealth took over the emergency room departments at hospitals, researchers found an increase in out-of-network billing, albeit smaller than the increases tied to EmCare.

Not all of the out-of-network billing blame can be passed on to EmCare and companies like it, the Times reports, as analysts note that many hospitals are benefiting from such arrangements.

The Yale study found that facilities most commonly benefiting from using EmCare and the increase in billing were for-profit organizations.

Additionally, many hospitals contend that by contracting with companies like EmCare they are able to avoid the headaches of billing and scheduling, and can concentrate on other matters.
 

Rambo

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here's the NYT article. the comments are worth a read. graphs are at link:

The Company Behind Many Surprise Emergency Room Bills


By JULIE CRESWELL, REED ABELSON and MARGOT SANGER-KATZ JULY 24, 2017
  • A small, rural hospital in Washington State, Newport Hospital and Health Services, outsourced its emergency room, as many hospitals have. Soon it started hearing from patients confused by getting large bills from the E.R. doctors. CreditRajah Bose for The New York Times
    On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

    “The billing scenario, that was the real fiasco and caught us off guard,” said Tom Wilbur, the chief executive of Newport Hospital. “Hindsight being 20/20, we never would have done that.” Faced with angry patients, the hospital took back control of its coding and billing.

    Newport’s experience with EmCare, now one of the nation’s largest physician-staffing companies for emergency rooms, is part of a pattern. A study released Monday by researchers at Yale found that the rate of out-of-network doctor’s bills for customers of one large insurer jumped when EmCare entered a hospital. The rates of tests ordered and patients admitted from the E.R. into a hospital also rose, though not as much. The use of the highest billing code increased.
“It almost looked like a light switch was being flipped on,” said Zack Cooper, a health economist at Yale who is one of the study’s authors.

‘Like a Light Switch’
In several hospital emergency rooms, out-of-network rates for customers of one large insurer jumped to nearly 100 percent after EmCare took over. Below, the year before and the year after a switch.


In a statement, EmCare described the study as “fundamentally flawed and dated.” But it acknowledged that surprise billing, as the billing is called when the doctor is unexpectedly not part of an insurance network, is “a source of dissatisfaction for all payors, providers and patients in our current health care system.” It said that the issue was not specific to any one company, and that it had already publicly committed to reaching agreements with insurers for the majority of its doctors within the next two years. This study, and others, have found that EmCare is not alone in the practice of sending out-of-network bills.

EmCare said that it allowed hospitals to treat sicker patients when it takes over, and that an increase in such patients explained the higher billing in Newport.

In the study, the researchers examined nearly nine million visits made to emergency rooms run by a variety of companies between 2011 and 2015, using data from a single insurance company that does business in every state. In exchange for access, the researchers agreed not to identify the insurer. Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to, and the national trends in surprise billing detected by the Yale team are consistent with a broader study by government researchers.

The new data suggests that EmCare, part of publicly traded Envision Healthcare, did not sign contracts with the insurance company and was able to charge higher prices.

Fiona Scott Morton, a professor at the Yale School of Management and a co-author of the paper, described the strategy as a “kind of ambushing of patients.” A patient who goes to the emergency room can look for a hospital that takes her insurance, but she almost never gets to choose the doctor who treats her.

Sometimes, insurers simply pay higher out-of-network bills, but the cost is often passed on directly to patients.

After slipping on some wet leaves outside her house in Crescent City, Calif., in February, Debra Brown, a 60-year-old county accounting clerk, wound up at Sutter Coast Hospital. She is paying off her deductible, but her insurer covered most of her remaining hospital bill. She was shocked to get an additional bill from a doctor who she said never identified himself and only briefly touched her broken ankle. That physician worked for EmCare. Her portion of the bill is more than $500.

“Now I’m going to have to pay this bill off, and I can’t afford to see a doctor about my high blood pressure medication,” Ms. Brown said. “This is insane, and it’s greedy.”

Nationwide, more than one in five visits to an in-network emergency room results in an out-of-network doctor’s bill, previous studies found. But the new Yale research, released by the National Bureau of Economic Research, found those bills aren’t randomly sprinkled throughout the nation’s hospitals. They come mostly from a select group of E.R. doctors at particular hospitals. At about 15 percent of the hospitals, out-of-network rates were over 80 percent, the study found. Many of the emergency rooms in that fraction of hospitals were run by EmCare.

A Few Hospitals Are the Source of Most Surprise E.R. Bills
About 22 percent of emergency room visits at in-network hospitals resulted in out-of-network bills in 2015, according to data from one insurer. But most hospitals had few such bills.

When emergency room doctors work for a company that has not made a deal with an insurer, they are free to bill whatever they want, insurers say. “The more they bill, the more they get paid,” said Shara McClure, an executive with Blue Cross of Texas.

E.R. doctors say out-of-network billing isn’t their fault. Sometimes, insurance companies will offer only low payments, leaving physicians no choice, said William Jaquis, an executive with the American College of Emergency Physicians, who is also an E.R. physician employed by EmCare. Doctors would “prefer that we had better payment and better negotiation with the insurers, and the patients would be covered,” he said.

The researchers focused on 16 hospitals that EmCare entered between 2011 and 2015. In eight of those hospitals, out-of-network billing rose quickly and precipitously. (In the others, the out-of-network rate was already above 97 percent, and it did not go down.) They also looked at a larger sample of 194 hospitals where EmCare worked and found an average out-of-network billing rate of 62 percent, far higher than the national average.

More Surprise Bills, Hospital Admissions and High Codes
In the year after EmCare took over an E.R., customers of one large insurer who were served by it were more likely to receive out-of-network bills, be admitted to the hospital and be billed for the most complex types of care, according to a handful of examples identified by researchers at Yale.

The before-and-after analysis was limited to the small number of hospitals where the researchers could find public records of EmCare’s entrance, and it was based on claims from only one large insurance company. While the nationwide patterns are consistent with studies that have looked at other insurance companies, the single insurer in the study may not be typical in all cases: EmCare does participate in some insurers’ networks, such as Blue Cross of Texas. EmCare also says it has reached agreements with more insurers in Texas, Arizona, Florida and Virginia since 2015.

Researchers also examined what happened when one of EmCare’s top competitors — TeamHealth — took over a handful of mostly nonprofit emergency departments. There, they found a smaller increase in out-of-network billing and virtually no change in hospital admissions, testing or coding.

Analysts point out that hospitals, despite any patient complaints, can benefit financially from the increased testing and admissions EmCare has delivered. In the study, surprise bills were more common at for-profit hospitals than at their nonprofit competitors.


“They’d have to have their heads in the sand to be totally unaware” about the out-of-network billing, said Leemore Dafny, a professor at Harvard Business School, who reviewed the research.

EmCare’s emergency room management has come under scrutiny before. The company was named in a 2011 whistle-blower lawsuit against Health Management Associates, a for-profit hospital chain. The suit alleges that both EmCare and the hospitals pressured E.R. doctors to increase admissions and tests, even when the physicians believed they were not medically necessary. The company “repeatedly terminated physicians and E.R. medical directors” who pushed back, the suit says. The case, which was brought by a hospital chief executive and a former EmCare executive, is still pending. Envision said it does not comment on pending litigation.

Hospital emergency departments, which must take all comers regardless of their health insurance, were once viewed as financial drains. Then hospital leaders started to see the E.R. as the front door, critical to attracting paying patients. In the early 1990s, emergency departments accounted for a third of admissions to hospitals; today, they account for half, according to a RAND study.

As in so many other parts of the modern economy, turning operations over to large outside contractors has been a big part of the transition. Nearly a quarter of all emergency room doctors now work for a national staffing firm, according to a 2013 Deutsche Bank report.

EmCare in particular has thrived. Founded in the 1970s, it has grown rapidly in recent years.

Its sales pitch to hospitals is that it can find high-quality doctors and run emergency rooms more efficiently. It offers a software program called RAP & GO (short for Rapid Admission Process and Gap Orders) that it says speeds admissions and potentially produces “significant new hospital revenue.”

Some doctors say the staffing companies save them from the administrative headaches of billing and scheduling.

In addition to its work in emergency rooms, EmCare has been buying up groups of anesthesiologists and radiologists. In these hospital specialties, it is hard for patients to shop, and out-of-network billing is common.

EmCare’s size and reach have made some doctors wary of criticizing its practices. According to Dr. Carol Cunningham, an emergency room physician in Ohio, that is especially true in places where there is little alternative to working for a large staffing company. “You may have trouble finding something in the area,” she said.

But some doctors outside the E.R. have been less reticent. Dr. Gregory Duncan, chief of surgery at Sutter Coast Hospital in Crescent City, Calif., said patients started complaining about bills they received after EmCare took over the emergency room in 2015.

“I discovered a pattern of inflated bills and out-of-network bills,” he said. “What they are doing is egregious billing.”

Dr. Duncan, who also sits on the county health care district board, has joined with other elected officials in asking Sutter Coast to terminate its contract with EmCare.

In an emailed response, Mitch Hanna, the chief executive of Sutter Coast, said the hospital chose EmCare because of its ability to fully staff its emergency department. He added that he understood EmCare was working to bring two large commercial insurers into its network by the end of the year.

EmCare said in early February that it planned to reach agreements with insurers for most of its doctors. The company also said it was working with insurers, hospitals, lawmakers and others to make sure patients get appropriate care “without creating undue financial burden.” The American College of Emergency Physicians favors an approach in which out-of-network emergency room doctors are paid a standard rate.

California recently passed a law setting a maximum amount that out-of-network doctors can charge patients. Other states, including Florida and New York, have also passed laws to limit surprise bills.

But many state efforts to reduce surprise billing have been met by fierce lobbying from doctors who oppose efforts to weaken their bargaining position, said Chuck Bell, the programs director at the consumer advocacy group Consumers Union.

“The whole thing is really a mess,” he said. “Progress is really slow.”
 

Monkeyface

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So one shouldn't just to check whether a particular hospital is in network, but also whether a particular doctor in that hospital is in network, while having a heart attack? This is exactly why healthcare isn't a free market and should never be regulated as a free market.
 

Rambo

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So one shouldn't just to check whether a particular hospital is in network, but also whether a particular doctor in that hospital is in network, while having a heart attack? This is exactly why healthcare isn't a free market and should never be regulated as a free market.
the better question is, what happens when you go to an emergency room where no one is in your network, while you're having an actual emergency?
 

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Lessons for the United States
Comparing countries’ health care system performance using standardized performance data can offer benchmarks and other useful insights about how to improve care. Among the 11 countries we studied, the U.S. was ranked last in overall health system performance, while spending the most per capita on health care. The insurance, payment, and delivery system of the ACA have improved some aspects of health care system performance, but the U.S. still greatly lags countries with universal health insurance coverage. The top performing countries—the U.K., Australia, and the Netherlands—could offer important lessons to the U.S. and other countries.

THE HEALTH SYSTEMS ACHIEVING TOP MARKS DO SO IN DIVERSE WAYS
The three countries with the best overall health system performance scores have strikingly different health care systems. All three provide universal coverage and access, but do so in different ways, suggesting that high performance can be achieved through a variety of payment and organizational approaches.

Experts generally group universal coverage systems into three categories: Beveridge systems, single-payer systems, and multipayer systems. These three systems are represented among our highest performers.

THE U.K.’S NATIONAL HEALTH SERVICE
The Beveridge model takes its name from the creator of Britain’s modern welfare state, William Beveridge. In the NHS, initiated by Aneurin Bevan in 1948, health services are paid for through general tax revenue, as opposed to insurance premiums. Furthermore, the government plays a significant role in organizing and operating the delivery of health care. For example, most hospitals are publicly owned, and the specialists who work in them are often government employees. This is not true of all providers. Most general practitioner practices are privately owned. Health care in the U.K. and other Beveridge countries is centrally directed and has more direct management accountability to the government than in other health systems.

AUSTRALIA’S SINGLE-PAYER INSURANCE PROGRAM
In Australia, everyone is covered under the public insurance plan, Medicare. Much like the NHS, Australia’s Medicare is funded through tax revenue. Medicare is distinguished, though, by lesser public involvement in care delivery. Many Australian hospitals are private, and roughly half the population purchases private health insurance to access care outside the public system. To put into an American context, Australia’s Medicare resembles Medicare in the U.S.

NETHERLAND’S COMPETING PRIVATE INSURERS
Unlike Australia and the U.K., the Dutch health system relies on private insurers to fund health services for its population. Dutch insurers are mainly financed through community-rated premiums and payroll taxes, which are pooled and then distributed to insurers based on the risk profile of their enrollees. All plans include a standard basic benefit package; subsidies are available for people with low incomes; adults are required to enroll in a plan or must pay a fine. Dutch health care providers are predominantly private. This multipayer system—partly inspired by the managed competition model—shares many similarities with the insurance marketplaces created under the Affordable Care Act. 10

http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/
 

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Americans Are Dying Younger, Saving Corporations Billions
Life expectancy gains have stalled. The grim silver lining? Lower pension costs

Absent a war or an epidemic, it's unusual and alarming for life expectancies in developed countries to stop improving, let alone to worsen. “Mortality is sort of the tip of the iceberg,” says Laudan Aron, a demographer and senior fellow at the Urban Institute. “It really is a reflection of a lot of underlying conditions of life.” The falling trajectory of American life expectancies, especially when compared to those in some other wealthy countries, should be “as urgent a national issue as any other that’s on our national agenda,” she says.

https://www.bloomberg.com/news/arti...re-dying-younger-saving-corporations-billions
 

Monkeyface

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There was an interesting article today about Houston (in furriner language). The thesis was that Americans prefer the individual freedom over the collective good, no matter how much it hurts the collective.

For example, Houston is a proud no-zoning city, allowing its population to build wherever they want, especially on the cheap flood prone land. It also argued how this individual freedom uber alles mentality favors rebuilding over prevention. Houstonians weren't forced to do deal with the floods, they chose to. Why force everyone to pay more taxes upfront to build preventive measures, when people can individually decide afterwards whether to rebuild or not?

The fact that the collective costs of rebuilding are greater than the costs of prevention isn't really important, they simply consider it the cost of individual freedom, or don't consider it all. It's why New Orleans still shows signs of the destruction Katrina caused over a decade later, as people simply exercised their freedom by choosing not to rebuild (or rather, couldn't afford to).

One could extrapolate this same reasoning towards healthcare in the US. The government can't possibly force people to pay more taxes to cover healthcare and lower the collective cost, as it encroaches on the all-important individual freedom.

Combine this with the free market being a solution to everything, politicians being influenced by pharma/healthcare donations and colleges overcharging for a medical degree and you have a recipe for healthcare distaster. The healthcare situation won't be changed until Americans are prepared to give up some freedom in exchange for better collective outcomes, and I suppose they would only do that if they approve of and trust in their government...and we all know how that is going.
 

Thruth

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There is a lot to be said for this.

I'm always fond of comparing the American ethos to the Canadian one as a reason why one has affordable universal healthcare and the other doesn't.

Life, liberty & the pursuit of happiness
suggests the individual choice/success outweighs the collective wellbeing.

Peace, order & good government puts the collective first.
 

Monkeyface

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There is a lot to be said for this.

I'm always fond of comparing the American ethos to the Canadian one as a reason why one has affordable universal healthcare and the other doesn't.

Life, liberty & the pursuit of happiness
suggests the individual choice/success outweighs the collective wellbeing.

Peace, order & good government puts the collective first.
Exactly
 

fxh

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We,tend to be heading that USA way. It might slow down or even reverse as a reaction to USA failures in health and welfare. We still fight to keep free,health care universal and not let it fracture into ghettos and elites. That is it's important to kept the middle classes in the same free health care system as the poor. In order to prevent ghettoisation , slipping standards of service and passsive acceptance of those things for lack of a middle class voice defending it.
 

Lord Buckley

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There was an interesting article today about Houston (in furriner language). The thesis was that Americans prefer the individual freedom over the collective good, no matter how much it hurts the collective.

For example, Houston is a proud no-zoning city, allowing its population to build wherever they want, especially on the cheap flood prone land. It also argued how this individual freedom uber alles mentality favors rebuilding over prevention. Houstonians weren't forced to do deal with the floods, they chose to. Why force everyone to pay more taxes upfront to build preventive measures, when people can individually decide afterwards whether to rebuild or not?

The fact that the collective costs of rebuilding are greater than the costs of prevention isn't really important, they simply consider it the cost of individual freedom, or don't consider it all. It's why New Orleans still shows signs of the destruction Katrina caused over a decade later, as people simply exercised their freedom by choosing not to rebuild (or rather, couldn't afford to).

One could extrapolate this same reasoning towards healthcare in the US. The government can't possibly force people to pay more taxes to cover healthcare and lower the collective cost, as it encroaches on the all-important individual freedom.

Combine this with the free market being a solution to everything, politicians being influenced by pharma/healthcare donations and colleges overcharging for a medical degree and you have a recipe for healthcare distaster. The healthcare situation won't be changed until Americans are prepared to give up some freedom in exchange for better collective outcomes, and I suppose they would only do that if they approve of and trust in their government...and we all know how that is going.
Some interesting thoughts gestating there, but your conclusions are premature and the connections tenuous.

Prevention: difficult to legislate against the raw power of tropical storms. It's easy from temperate climes to forget how powerful these events are. Whilst the Dutch are masters in water management, it came at a great price with the nearly 2000 deaths in 1953. And over 300 people were killed in England during the same natural disaster and measures were taken both sides of the North Sea.

It's very easy in both The Netherlands and England where our nature is a pastoral idyll by comparison to forget that our hedgerows and rolling countryside is a product of moderate climate and conditions. And even that couldn't save us in 1953.

New Orleans still shows sign of Katrina as likely people have moved away from below sea level residencies and many have moved away for good. Only a fool would rebuild on the land that had proven to be a flood plane. Much of The Netherlands is well below sea level, you can't really blame the Texans can you, a similar event here would be greeted with ''Who in their right mind would build whole towns and cities 6' below sea level?''

Collectivization of health care at an insurance level, I quite agree with, as we have it here and it works. The risk is shared and paid for by all insurance payers. But your argument to give up your own individual health care outcome to benefit the collectivized whole is a deceit and is the reason for the NHS disaster. Accept an inferior service and outcome to benefit equal outcomes across the whole spectrum? No thanks.


We,tend to be heading that USA way. It might slow down or even reverse as a reaction to USA failures in health and welfare. We still fight to keep free,health care universal and not let it fracture into ghettos and elites. That is it's important to kept the middle classes in the same free health care system as the poor. In order to prevent ghettoisation , slipping standards of service and passsive acceptance of those things for lack of a middle class voice defending it.
But it's not really free, is it? The middle class is increasingly pissed off everywhere, as we bare a bigger burden and weight than other classes.

We have to accept hard truths. A case in point: Denmark has just passed some seemingly draconian laws limiting health care to refugees. The reality is their generous welfare state is collapsing as 79% of the government revenue is being spent on servicing the needs of the refugees. Unsustainable.
 

Monkeyface

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Some interesting thoughts gestating there, but your conclusions are premature and the connections tenuous.

Prevention: difficult to legislate against the raw power of tropical storms. It's easy from temperate climes to forget how powerful these events are. Whilst the Dutch are masters in water management, it came at a great price with the nearly 2000 deaths in 1953. And over 300 people were killed in England during the same natural disaster and measures were taken both sides of the North Sea.

It's very easy in both The Netherlands and England where our nature is a pastoral idyll by comparison to forget that our hedgerows and rolling countryside is a product of moderate climate and conditions. And even that couldn't save us in 1953.

New Orleans still shows sign of Katrina as likely people have moved away from below sea level residencies and many have moved away for good. Only a fool would rebuild on the land that had proven to be a flood plane. Much of The Netherlands is well below sea level, you can't really blame the Texans can you, a similar event here would be greeted with ''Who in their right mind would build whole towns and cities 6' below sea level?''

Collectivization of health care at an insurance level, I quite agree with, as we have it here and it works. The risk is shared and paid for by all insurance payers. But your argument to give up your own individual health care outcome to benefit the collectivized whole is a deceit and is the reason for the NHS disaster. Accept an inferior service and outcome to benefit equal outcomes across the whole spectrum? No thanks.




But it's not really free, is it? The middle class is increasingly pissed off everywhere, as we bare a bigger burden and weight than other classes.

We have to accept hard truths. A case in point: Denmark has just passed some seemingly draconian laws limiting health care to refugees. The reality is their generous welfare state is collapsing as 79% of the government revenue is being spent on servicing the needs of the refugees. Unsustainable.
It's by no means a conclusion, just a hypothesis. I do believe experts (those pesky fellas, who needs them?) say the floods could definitely be managed to limit the damages, even with a hurricane. I won't be suprised if the damages hit the $100bn mark (already at $90bn!!), and a flood management program would have cost an order of magnitude less. For example, the Dutch program cost about €5bn in today's money. So, one could argue that the individual freedom cost the collective Houstonians $95bn in this case.

As an aside, here's a friendly reminder that the US healthcare system costs twice as much and delivers worse results than many other Western nations.
 

Journeyman

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A case in point: Denmark has just passed some seemingly draconian laws limiting health care to refugees. The reality is their generous welfare state is collapsing as 79% of the government revenue is being spent on servicing the needs of the refugees. Unsustainable.
Really? I haven't bothered to research this statement but it sounds like utter rubbish to me.
 

Lord Buckley

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So, one could argue that the individual freedom cost the collective Houstonians $95bn in this case.

As an aside, here's a friendly reminder that the US healthcare system costs twice as much and delivers worse results than many other Western nations.
A strange argument that: a little less freedom for the collective good would have saved the citizens of Houston. Not really. Proscribing building on flood plains is a planning issue. Not one of individual freedom.

Americans already pay a lot of taxes and the question then is likely, where does this money go? The answer to everything is not to increase taxes and collectivise for the good of the collective.


Hahahahaha.

Oh wait, you're serious.



P.S. *bear
Perhaps I should have explained better: what Americans call middle class, we would call working class. The middle class I am talking about is around 30-35% of the population.

Really? I haven't bothered to research this statement but it sounds like utter rubbish to me.
Approximately 50% of Swedish GDP went to social security payments before the immigrant crisis. I got the figure from a MSM article from a Swedish politician, but I can't remember which one, but that figure was used as justification for the current actions. I'll try and see if I can find the article again.
 

Monkeyface

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A strange argument that: a little less freedom for the collective good would have saved the citizens of Houston. Not really. Proscribing building on flood plains is a planning issue. Not one of individual freedom.

Americans already pay a lot of taxes and the question then is likely, where does this money go? The answer to everything is not to increase taxes and collectivise for the good of the collective.




Perhaps I should have explained better: what Americans call middle class, we would call working class. The middle class I am talking about is around 30-35% of the population.



Approximately 50% of Swedish GDP went to social security payments before the immigrant crisis. I got the figure from a MSM article from a Swedish politician, but I can't remember which one, but that figure was used as justification for the current actions. I'll try and see if I can find the article again.
You're wrong. Planning is also an individual freedom issue. Houston is a no-zoning city, meaning they maximize personal choice. Can't you see how asinine it is to prefer a $100bn loss over a $5bn preventative measure?
 

Monkeyface

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Guess who agrees with me?

How Harvey Will Change Texas
The storm’s most lasting legacy might be the end of the Lone Star State’s rugged individualism.

http://www.politico.com/magazine/story/2017/08/30/how-harvey-will-change-texas-215558?lo=ap_b1

Also, this sentence is hilarious:

"Most recently, Abbott led the failed effort to nullify local tree ordinances—regulations limiting tree removal—because these posed, Abbott argued, a threat to individual freedom."
 
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güero

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Really? I haven't bothered to research this statement but it sounds like utter rubbish to me.
Of course it is, fake news from failing Lord Cuckley. Couple of weeks ago:

In Denmark for instance, the government now pays out 59% of available tax receipts to dole money to asylum seekers.
Now:

Denmark has just passed some seemingly draconian laws limiting health care to refugees. The reality is their generous welfare state is collapsing as 79% of the government revenue is being spent on servicing the needs of the refugees. Unsustainable.
I guess it has increased to 79% over the last weeks due to the unhindered migrant flood sweeping over Lord Cuckley.

But turns out it is completely different:

Approximately 50% of Swedish GDP went to social security payments before the immigrant crisis.
This by itself is an entirely random factoid. And it says nothing to support your original argument, because they are only connected by the %. Literally no connection, you compare:
Denmark vs. Sweden
Tax receipts vs. GDP
Payments to "refugees" vs. Payments to everyone
After "crisis" vs. before "crisis"

Of course both 59% and the 79% are complete and utter tosh:
his claim is so obviously absurd, I had to look that up. Turns out it is less than 7%. Which might still be too much, BUT HOW FUCKING DUMB MUST ONE BE TO BELIEVE IT IS 59%.
He bought that bullshit from some "citizen journalist" conspiracy website, which misunderstood/-interpreted some obscure table in a government study referenced in a Danish newspaper article about something comletely different. Then his paranoia kicked it up a few more notches. I spent at least 5-10 minutes collecting the actual data and while its not 100% perfectly available, it can't be more than 7% for 2016. I am still puzzled how someone can ACTUALLY BELIEVE more than 50% of government income/budget going to "refugees". It takes a rare combination of magnificent stupidity and brainwashed misinformation, it is so far out of the real world.
 

Lord Buckley

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Of course it is, fake news from failing Lord Cuckley. Couple of weeks ago:



Now:



I guess it has increased to 79% over the last weeks due to the unhindered migrant flood sweeping over Lord Cuckley.

But turns out it is completely different:



This by itself is an entirely random factoid. And it says nothing to support your original argument, because they are only connected by the %. Literally no connection, you compare:
Denmark vs. Sweden
Tax receipts vs. GDP
Payments to "refugees" vs. Payments to everyone
After "crisis" vs. before "crisis"

Of course both 59% and the 79% are complete and utter tosh:

He bought that bullshit from some "citizen journalist" conspiracy website, which misunderstood/-interpreted some obscure table in a government study referenced in a Danish newspaper article about something comletely different. Then his paranoia kicked it up a few more notches. I spent at least 5-10 minutes collecting the actual data and while its not 100% perfectly available, it can't be more than 7% for 2016. I am still puzzled how someone can ACTUALLY BELIEVE more than 50% of government income/budget going to "refugees". It takes a rare combination of magnificent stupidity and brainwashed misinformation, it is so far out of the real world.
I stand corrected on the second stats but I'm no Cuck, the reality fits the narrative: the Danes are moving to make refugees uncomfortable and unwelcome. Those are cold hard facts. The 50% was verified from Danish official government stats yesterday. And the 59% from here:

http://www.dailywire.com/news/16816/non-western-immigrants-consume-59-denmarks-tax-joseph-curl

The figures come from this official Danish government agency report:

https://www.fm.dk/publikationer/2017/finanslov-for-2017

So you can scweam and scweam fake news all you like....reality bites!
 
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güero

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I stand corrected on the second stats but I'm no Cuck, the reality fits the narrative: the Danes are moving to make refugees uncomfortable and unwelcome. Those are cold hard facts. The 50% was verified from Danish official government stats yesterday. And the 59% from here:

http://www.dailywire.com/news/16816/non-western-immigrants-consume-59-denmarks-tax-joseph-curl

The figures come from this official Danish government agency report:

https://www.fm.dk/publikationer/2017/finanslov-for-2017

So you can scweam and scweam fake news all you like....reality bites!
Since this post perfectly confirms your mental handicap, I'll try to keep it as simple as possible. I know there are a lot of big words in the article and to make things worse they are even combined with numbers, but have a look at your statement:

"In Denmark for instance, the government now pays out 59% of available tax receipts to dole money to asylum seekers."

Now compare this to the fake news article you linked, which quotes the following from another fake news outlet:

"59% of the tax surplus collected from native Danes is spent on ethnic minorities"

You see the difference? The article you link does not at all say what you say it does. Because you are stupid, because you have only read the headline (which does not correspond to what is in the quoted article), because you don't give a shit about facts, I don't know and I don't care. But what you refer to as a fact is complete and utter bullshit backed up by nothing at all. Not even the completely idiotic article you referenced.

I'm not going to explain to you why the government study you linked does not say what the fake news article quoted in the other fake news article says it does. Mostly because you don't care and I don't want to look into it again. But if your are interested, have a look at it yourself. If you know basic math (you know plus and minus and shit like that) and have an understanding of goverment budgeting comparable to an average teenager, you'll easily figure it out in a couple of minutes.


e. Sorry for more offtopic but that is such a great example of the upcoming idiocracy I had to mention it. Probably has been posted here before, but at least it is on topic. Treatment for a rattlesnake bite:

 
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Rambo

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http://thefreethoughtproject.com/no...tment-us-taxpayers-paid-200-million-discover/

Novartis to Charge $475,000 for Cancer Treatment US Taxpayers Paid $200 Million to Discover
After the federal government paid over $200 million to research this breakthrough cancer treatment, Novartis swept up the rights to it.

By
Matt Agorist
-
September 1, 2017
A first of its kind revolutionary cancer treatment was approved by the FDA this week which boasts cure rates for childhood leukemia upwards of 70-80 percent. The innovative nature of the treatment lies in how it genetically re-engineers a patient’s own immune system to find and destroy tumors.

While this is certainly noteworthy news, a major controversy is being overlooked by the mainstream media. As Novartis announced their $450,000 price tag, the media failed to report on who actually paid for the development of this breakthrough treatment. The answer, according to a patient advocacy group, is—you.

As MIT’s Technology Review notes, the therapy, which will be marketed as Kymriah, is a customized treatment that uses a patient’s own T cells, a type of immune cell. A patient’s T cells are extracted and cryogenically frozen so that they can be transported to Novartis’s manufacturing center in New Jersey. There, the cells are genetically altered to have a new gene that codes for a protein—called a chimeric antigen receptor, or CAR. This protein directs the T cells to target and kill leukemia cells with a specific antigen on their surface. The genetically modified cells are then infused back into the patient.

In clinical trials, involving 63 children with a type of acute lymphoblastic leukemia, 83 percent of patients that received the CAR-T therapy had their cancers go into remission within three months. At six months, 89 percent of patients who received the therapy were still living, and at 12 months, 79 percent had survived, according to MIT.

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These results are nothing short of staggering. Given the fact that thousands of children and young adults are diagnosed every year in the US—making it the most common childhood cancer—the opportunity to save lives is overwhelming.

READ MORE: Leaked Memos Show U.S. Threaten Continued Violence if Colombia Challenges Big Pharma Monopoly
However, like all opportunity, Kymriah comes with a price.

Novartis announced the price this week of $475,000 per treatment. This was sold to the public as an ostensible win since the drug was predicted to be priced at $600,000 to $750,000 per treatment. If Novartis had solely financed and conducted their own research, of course, they could certainly charge whatever they wanted to charge. But this is not the case, according to the advocacy group Patients for Affordable Drugs.


According to David Mitchell, the founder of the group, $475,000 per treatment is excessive because the federal government threw more than $200 million of your tax dollars into researching CAR-T therapy. According to Mitchell, Novartis simply purchased the rights to the treatment and failed to disclose what amount, if any, they invested in the research.

On Thursday, Mitchell released the following statement praising the FDA’s decision to approve the drug, but decrying the monopoly granted to Novartis.

“As a cancer patient, the potential of CAR-T is exciting and I applaud FDA’s approval. It means hope for hundreds of children and their families, and we’re all excited at the potential for cancer patients.

“But let’s remember, American taxpayers invested over $200 million in CAR-T’s discovery. To date, Novartis has not acknowledged the significance of taxpayers’ investment, and the company declined to detail its own investment.

“While Novartis’ decision to set a price at $475,000 per treatment may be seen by some as restraint, we believe it is excessive. Novartis should not get credit for bringing a $475,000 drug to market and claiming they could have charged people a lot more.

The drug pricing system in America is completely broken. Until policy in this country changes, the vicious cycle of patients struggling under high drug prices will continue.”

Patients for Affordable Drugs isn’t pulling this number out of anywhere either. They conducted an extensive review of CAR-T funding and completed a report on it last month.


READ MORE: Scientists Warn Chemotherapy Could Spread Cancer, Trigger More Aggressive Tumors
A whopping $204,288,340.00 in taxpayer dollars was given to various universities and research groups who contributed to the findings related to chimeric antigen receptor research.

To those paying attention, this should come as no surprise. As TFTP reported last year, the Journal of the American Medical Association officially recognized why drug prices skyrocket in America. Big pharma is granted a monopoly by the state which effectively eliminates their competition and allows them to charge any price they want — so they do.

The paper, published on August 23, 2016, The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform, set out to “review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs.”

What the paper’s authors, Harvard Medical School doctors Aaron Kesselheim and Jerry Avorn, and jurist Ameet Sarpatwari, found and subsequently admitted, shattered the very assertion that government regulation in the market is needed to keep medical care costs low. In fact, their findings were quite to the contrary.

According to the paper:

The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents.
This time, however, not only did the government grant Novartis a monopoly on the treatment but they also used your money to fund it.
 
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