wizardwatson
Member
- Joined
- Jun 15, 2007
- Messages
- 8,077
How to fix health care (with thoughts on overall movement strategy after)
Stats are from here: http://www.cdc.gov/nchs/fastats/hospital.htm
Hospital inpatient care comes to around 168,480,000 hospital "days" per year. That requires about 462,000 hospital beds per day. America has about 30 beds per 10,000 people so that's around 933,000 so 462,000 is about half that. So half the beds are unoccupied.
Outpatient visits are 100,700,000 per year.
Emergency room visits are 129,800,000 per year.
Now doctors should obviously make at least a $100 an hour why else would they practice? Nurses should make say $20 and receptionists and clerical around $15.
Now clearly many people have no insurance I believe the statistics are around one in four. So let's double all our numbers to make sure everyone is getting to the doctor.
340,000,000 hospital days in bed per year
200,000,000 outpatient visits
260,000,000 emergency room visits
Outpatient visits and emergency room visits essentially require "beds" too. So let's assume that an emergency room visit requires a bed for four hours and an outpatient visit requires a bed for two hours.
So breaking everything down into "bed days per year" let's show our costs using our hourly rates for nurse/doc/clerical above:
340,000,000 inpatient bed days
$96 nurse (1 24 hour nurse for every 5 beds)
$240 doc (1 24 doctor for every 10 beds)
$72 clerical (1 24 clerical for every 5 beds)
$54 depreciation ($100,000 room/equipment at 20% yearly depreciation)
$150 disposable expenses (Food medical waste)
(TOTAL: $636 per bed per day for inpatient care x 340,000,000 = $216,240,000,000 billion dollars)
16,700,000 outpatient bed days
$240 nurse (half time you see nurse half time doc so 12 hours nurse)
$1200 doc (half time you see nurse half time doc so 12 hours doc)
$360 clerical (clerical 24 hours per bed)
$27 depreciation ($50,000 room/equipment at 20% yearly depreciation)
$240 disposable (medical waste $10 per hour)
(TOTAL: $2067 per bed per day for outpatient care x 16,700,000 = $34,518,900,000 billion dollars)
43,400,000 emergency bed days
$720 nurse (3 nurses per bed all day)
$2400 doc (2 docs per bed all day)
$720 clerical (2 clerical per bed all day)
$108 depreciation ($200,000 room/equipment at 20% yearly depreciation)
$600 disposable (medical waste food $25 per hour)
(TOTAL: $4548 per day per bed for emergency care x 43,400,000 = $197,383,200,000 billion dollars)
$216,000,000,000 visits for inpatient care.
$34,518,900,000 billion for outpatient care.
$197,383,200,000 billion for emergency visits.
Anyway, that's about $450 billion per year. Add another $100 billion for dental and vision which is way more than it actually costs and add another $200 billion for drugs which is way more than they should ever cost. In fact let's quadruple the room/bed values that adds another $75 billion. The current value of the healthcare industry is around $1,668 billion and our total is less than half that at $825 billion. Now everyone can't afford healthcare so let's divide this by only 80% of the population since 20% will either not pay or default on their bill. That comes to around $3320 per paying person per year.
Now I've oversimplified but that's why I jacked all the costs through the roof. You don't have a doctor for every person being taken care of in emergency. You have 1 for every 5 or six. You certainly aren't in a $800,000 per room facility. If you were you'd have hdtv and state of the art medical devices in every room.
Now I work for the state of Kansas and am on a blue cross plan. If you combine my premium with what the state chips in and add my out of pocket costs I pay probably $20,000 per year total for 3 people. The health care industry rakes in about $5000 per person so I'm basically paying for an extra person. Under my scenario I'd be paying for 3 other people.
In a sane world that saw medical care as a responsibility to our neighbors instead of a cash cow you could probably easily cut my scenario down to $1000 per person. With some competition, poke some holes in immigration laws to get doctors from other countries, get rid of mandatory insurance, etc. If we did that and cut our Kansas budget by 20% we could pay for universal health coverage in our state and all the money people pay to the health care industry would be freed up.
Now I know many in the movement despise the idea of government paid for health care but what we have now is government co-opted healthcare. We are essentially being taxed via monopolistic legal red tape.
A lot of our strategic end goals involve downsizing. Now we know that ultimately that just means move resources around and that people will find useful jobs but consider what the people really want. I work for the state and I can tell you that the main reason myself and many others don't want to leave is because of health care benefits. So many people stay at jobs they don't particularly like because they don't want their family to be without health care.
One of my tax ideas involves simplifying the tax system to just collecting a fixed percent of land and improvement property values. I work for the department of revenue on the program that processes our state taxes so I am fully aware of the end result of all this tax code chaos. 10's of thousands don't file sales tax. We have a long list of people who owe over 100 thousand in taxes and even though we can legally seize their business and property we don't have the resources to go after them. We have accountants who file fraudulent income tax returns that our system auto-processes refunds for because they are under our threshhold for human supervision. I did some rough calculations on property values and median income and if we simply taxed land and improvements (land and house, or land and business structures) people in the median income range wouldn't see any difference but they wouldn't have to file state taxes. In fact tax "rates" would probably go down since there would likely be more revenue since you can't hide from a property tax so all the cheats would be forced back in the system. Everyone's lying about income but the counties appraise land and structures so there's nowhere to hide. We have records and values for every plot and piece of land in the state.
Anyway, you may disagree with that too but what made me think of the health care thing is that doing this with the tax system would eliminate a large portion of the tax accountant community. If you did this with federal too, it would eliminate it entirely along with most everyone in my department. People would probably love this idea but they would be scared for themselves and others losing their jobs mainly because of health care for their families.
I've been thinking about this stuff for a while now. If we're really going to do something we need to have detailed ideas. I researched the health care and the tax idea for maybe 2 hours, 30 minutes of that spent typing this out. And those ideas need to show clearly to the people we are trying to convince that we aren't going to put them on the street without food shelter or medicine. If our strategy is really going to succeed people in the movement need to start putting together solid plans that have real solutions and stop saying "get rid of these barriers and the market will sort it out". Why not go all the way into it for them? Talk to investors, get things going, do the research, crunch the numbers, show the path to reform instead of result of the current debacle. Obamacare is a joke but it shows who gets the money, etc. Do our ideas do that? Do we have detailed market solutions to offer?
Just felt like posting this today, I just want people around here to start thinking bigger. And I think solving the health care problem in people's mind on paper in detail could be a huge weapon for the liberty movement. Show our plan. Show how we will get our system going. Show what laws are an obstacle to that system. Show the path to overcoming those obstacles. Same with taxes, crime, unemployment and any other end goal we have.
People here want liberty. We disagree only on minor philosophical minutia. We argue and philosophize over wedge issues. But we can certainly get a consensus on real world market solutions that put people at ease even if they involve short term philosophical compromises. This idea would involve some government involvement in health care too but it would be less government involvement than we currently have and it would be a lot cheaper. It's true that people's fears keep them from wanting to change anything. We can overcome that fear by showing them what a better world will look like and how they should really fear not working toward it.
Food for thought. If we're looking for a strategy to move forward I think we need to start hashing out our ideas for market solutions and getting a consensus on those. What laws are preventing those solutions and where the investment will come from. I'm totally against all this political campaigning. I say go straight to the one's in office when we have the people behind the issues. Politicians aren't going to convince the people. We have to convince the people then we all just go straight to the source and call them out when they don't comply because they are bought and paid for. They certainly aren't going to beat our solution because they have none except to give more of our tax money to the system that's already there.
Stats are from here: http://www.cdc.gov/nchs/fastats/hospital.htm
Hospital inpatient care comes to around 168,480,000 hospital "days" per year. That requires about 462,000 hospital beds per day. America has about 30 beds per 10,000 people so that's around 933,000 so 462,000 is about half that. So half the beds are unoccupied.
Outpatient visits are 100,700,000 per year.
Emergency room visits are 129,800,000 per year.
Now doctors should obviously make at least a $100 an hour why else would they practice? Nurses should make say $20 and receptionists and clerical around $15.
Now clearly many people have no insurance I believe the statistics are around one in four. So let's double all our numbers to make sure everyone is getting to the doctor.
340,000,000 hospital days in bed per year
200,000,000 outpatient visits
260,000,000 emergency room visits
Outpatient visits and emergency room visits essentially require "beds" too. So let's assume that an emergency room visit requires a bed for four hours and an outpatient visit requires a bed for two hours.
So breaking everything down into "bed days per year" let's show our costs using our hourly rates for nurse/doc/clerical above:
340,000,000 inpatient bed days
$96 nurse (1 24 hour nurse for every 5 beds)
$240 doc (1 24 doctor for every 10 beds)
$72 clerical (1 24 clerical for every 5 beds)
$54 depreciation ($100,000 room/equipment at 20% yearly depreciation)
$150 disposable expenses (Food medical waste)
(TOTAL: $636 per bed per day for inpatient care x 340,000,000 = $216,240,000,000 billion dollars)
16,700,000 outpatient bed days
$240 nurse (half time you see nurse half time doc so 12 hours nurse)
$1200 doc (half time you see nurse half time doc so 12 hours doc)
$360 clerical (clerical 24 hours per bed)
$27 depreciation ($50,000 room/equipment at 20% yearly depreciation)
$240 disposable (medical waste $10 per hour)
(TOTAL: $2067 per bed per day for outpatient care x 16,700,000 = $34,518,900,000 billion dollars)
43,400,000 emergency bed days
$720 nurse (3 nurses per bed all day)
$2400 doc (2 docs per bed all day)
$720 clerical (2 clerical per bed all day)
$108 depreciation ($200,000 room/equipment at 20% yearly depreciation)
$600 disposable (medical waste food $25 per hour)
(TOTAL: $4548 per day per bed for emergency care x 43,400,000 = $197,383,200,000 billion dollars)
$216,000,000,000 visits for inpatient care.
$34,518,900,000 billion for outpatient care.
$197,383,200,000 billion for emergency visits.
Anyway, that's about $450 billion per year. Add another $100 billion for dental and vision which is way more than it actually costs and add another $200 billion for drugs which is way more than they should ever cost. In fact let's quadruple the room/bed values that adds another $75 billion. The current value of the healthcare industry is around $1,668 billion and our total is less than half that at $825 billion. Now everyone can't afford healthcare so let's divide this by only 80% of the population since 20% will either not pay or default on their bill. That comes to around $3320 per paying person per year.
Now I've oversimplified but that's why I jacked all the costs through the roof. You don't have a doctor for every person being taken care of in emergency. You have 1 for every 5 or six. You certainly aren't in a $800,000 per room facility. If you were you'd have hdtv and state of the art medical devices in every room.
Now I work for the state of Kansas and am on a blue cross plan. If you combine my premium with what the state chips in and add my out of pocket costs I pay probably $20,000 per year total for 3 people. The health care industry rakes in about $5000 per person so I'm basically paying for an extra person. Under my scenario I'd be paying for 3 other people.
In a sane world that saw medical care as a responsibility to our neighbors instead of a cash cow you could probably easily cut my scenario down to $1000 per person. With some competition, poke some holes in immigration laws to get doctors from other countries, get rid of mandatory insurance, etc. If we did that and cut our Kansas budget by 20% we could pay for universal health coverage in our state and all the money people pay to the health care industry would be freed up.
Now I know many in the movement despise the idea of government paid for health care but what we have now is government co-opted healthcare. We are essentially being taxed via monopolistic legal red tape.
A lot of our strategic end goals involve downsizing. Now we know that ultimately that just means move resources around and that people will find useful jobs but consider what the people really want. I work for the state and I can tell you that the main reason myself and many others don't want to leave is because of health care benefits. So many people stay at jobs they don't particularly like because they don't want their family to be without health care.
One of my tax ideas involves simplifying the tax system to just collecting a fixed percent of land and improvement property values. I work for the department of revenue on the program that processes our state taxes so I am fully aware of the end result of all this tax code chaos. 10's of thousands don't file sales tax. We have a long list of people who owe over 100 thousand in taxes and even though we can legally seize their business and property we don't have the resources to go after them. We have accountants who file fraudulent income tax returns that our system auto-processes refunds for because they are under our threshhold for human supervision. I did some rough calculations on property values and median income and if we simply taxed land and improvements (land and house, or land and business structures) people in the median income range wouldn't see any difference but they wouldn't have to file state taxes. In fact tax "rates" would probably go down since there would likely be more revenue since you can't hide from a property tax so all the cheats would be forced back in the system. Everyone's lying about income but the counties appraise land and structures so there's nowhere to hide. We have records and values for every plot and piece of land in the state.
Anyway, you may disagree with that too but what made me think of the health care thing is that doing this with the tax system would eliminate a large portion of the tax accountant community. If you did this with federal too, it would eliminate it entirely along with most everyone in my department. People would probably love this idea but they would be scared for themselves and others losing their jobs mainly because of health care for their families.
I've been thinking about this stuff for a while now. If we're really going to do something we need to have detailed ideas. I researched the health care and the tax idea for maybe 2 hours, 30 minutes of that spent typing this out. And those ideas need to show clearly to the people we are trying to convince that we aren't going to put them on the street without food shelter or medicine. If our strategy is really going to succeed people in the movement need to start putting together solid plans that have real solutions and stop saying "get rid of these barriers and the market will sort it out". Why not go all the way into it for them? Talk to investors, get things going, do the research, crunch the numbers, show the path to reform instead of result of the current debacle. Obamacare is a joke but it shows who gets the money, etc. Do our ideas do that? Do we have detailed market solutions to offer?
Just felt like posting this today, I just want people around here to start thinking bigger. And I think solving the health care problem in people's mind on paper in detail could be a huge weapon for the liberty movement. Show our plan. Show how we will get our system going. Show what laws are an obstacle to that system. Show the path to overcoming those obstacles. Same with taxes, crime, unemployment and any other end goal we have.
People here want liberty. We disagree only on minor philosophical minutia. We argue and philosophize over wedge issues. But we can certainly get a consensus on real world market solutions that put people at ease even if they involve short term philosophical compromises. This idea would involve some government involvement in health care too but it would be less government involvement than we currently have and it would be a lot cheaper. It's true that people's fears keep them from wanting to change anything. We can overcome that fear by showing them what a better world will look like and how they should really fear not working toward it.
Food for thought. If we're looking for a strategy to move forward I think we need to start hashing out our ideas for market solutions and getting a consensus on those. What laws are preventing those solutions and where the investment will come from. I'm totally against all this political campaigning. I say go straight to the one's in office when we have the people behind the issues. Politicians aren't going to convince the people. We have to convince the people then we all just go straight to the source and call them out when they don't comply because they are bought and paid for. They certainly aren't going to beat our solution because they have none except to give more of our tax money to the system that's already there.
