Originally Posted by The Rani

I saw a fb post recently by a friend of mine who works for Big Pharma, complaining that his job is so boring because it involves figuring out the economics of how to make the largest possible profit from the latest Miracle Drug.
I really really really had to hold my tongue. Really. Maybe I shouldn't have, but getting into politics on fb is not my thing. Besides, I think you are right; Karma will come back to bite that industry in the ass.

This is why the TPP must be stopped.

Here's some details:

New standards concerning access to key medicines appear to be equally problematic for many nations. The Obama administration is insisting on mandating new intellectual property rules in the treaty that would grant pharmaceutical companies long-term monopolies on new medications. As a result, companies can charge high prices without regard to competition from generic providers. The result, public health experts have warned, would be higher prices around the world, and lack of access to life-saving drugs in poor countries.

Nearly every intellectual property issue in the November chart is opposed by a broad majority of the 12 nations. The December memo describes 119 "outstanding issues" that remain unresolved between the nations on intellectual property matters. The deal would obligate nations to develop many standards similar to those in the United States, where domestic prescription drug prices are much higher than costs in other nations.Also according to the December memo, the U.S. has reintroduced a proposal that would hamper government health services from negotiating lower drug prices with pharmaceutical companies. The proposal appears to have been universally rejected earlier in the talks, according to the memo.

Australia and New Zealand have medical boards that allow the government to reject expensive new drugs for the public health system, or negotiate lower prices with drug companies that own patents on them. If a new drug does not offer sufficient benefits over existing generic drugs, the boards can reject spending taxpayer money on the new medicines. They can also refuse to pay high prices for new drugs. The Obama administration has been pushing to ban these activities by national boards, which would lock in big profits for U.S. drug companies. Obamacare sought to mimic the behavior of these boards to lower domestic health care costs by granting new flexibilities to U.S. state agencies for determining drug prices.

More: http://www.huffingtonpost.com/2013/1...n_4409211.html

This is just a thought and should give you pause before you write me off as lunatic fringe.

But if TPP goes through, already there is NDAA in place along with a plethora of Executive orders that all taken together as a whole give the government unlimited powers. Now let's add the unconstitutional small arms treaty that Kerry signed for the United Nations.

If someone wanted unlimited power to form a dictatorship or something equally horrendous, healthcare and access to meds are but one piece of the puzzle to controlling a population, TPP gives another piece, the NDAA gave a huge piece, the small arms treaty and all the gun regulations so many want to see enacted give yet another piece to the puzzle. The Executive orders fill in one of the few remaining puzzle pieces.

About all that is left to having a complete puzzle is an unarmed populace unable to defend itself, food being in short supply along with clean water. We have the perfect storm being put in place to the government controlling every man, woman and child in this country through these things. Everyone has to have food, water, a good percentage must have medication.

Now imagine how fragile the water supply is in this country. West Virginia just proved that, California where most of the food we all eat is grown is experiencing severe water shortages. Our power grid is also fragile. One either on purpose attack by another country or a madman in power that wants to stay there or just a run of the mill accident could and would give the government the right to invoke any or all of those Executive orders and rule of law and elections as we know it ends.

Life as we know it comes to a screeching halt.

Maybe it's just me, but I see the fact that power is addictive and political power even more so. None of these TPP, NDAA, executive orders, gun regulations, making medicine harder to get or priced out of reach, a faltering economy as a good thing undertaken by a government with peaceful designs on its people. Remember 1918 and Stalin, I'm sure the Russians never would have believed 20 million would be killed by their own government either.

just something to think about.

Originally Posted by princeofcats67

Hey Rani.

You may want to check-out: The Corrupted Blood Plague Incident.


Prince

PS: OK. Back to my self-imposed "quarantine".

Thanks for giving me some horrible flashbacks (that annoying noise you hear is the plague working its way through the crowd). That was a shitty week for everyone.

With sandbox type games though you never know what you are going to get. World of Warcraft has also featured what can only be described as full blown terrorist attacks on capital cities. Bored guilds would occasionally kite powerful world bosses with certain annoying abilities into cities that would potentially kill thousands of players and require a reset of the server. It was bad enough that it was considered a ban-worthy offense.

Of course the trolling can also be rather creative and include behavior less likely to be encountered in reality. A guild named Serenity Now once infamously raided an in-game funeral being held by in-game friends of a person who had actually died in real life. Both abhorrent and hilarious at the same time. Welcome to the internet.

Originally Posted by Copperfield

Thanks for giving me some horrible flashbacks (that annoying noise you hear is the plague working its way through the crowd). That was a shitty week for everyone.

You're welcome, Copper.

Originally Posted by Copper

With sandbox type games though you never know what you are going to get. World of Warcraft has also featured what can only be described as full blown terrorist attacks on capital cities. Bored guilds would occasionally kite powerful world bosses with certain annoying abilities into cities that would potentially kill thousands of players and require a reset of the server. It was bad enough that it was considered a ban-worthy offense.

Of course the trolling can also be rather creative and include behavior less likely to be encountered in reality. A guild named Serenity Now once infamously raided an in-game funeral being held by in-game friends of a person who had actually died in real life. Both abhorrent and hilarious at the same time. Welcome to the internet.

Wow! Some seriously fascinating stuff going-on there!


Prince

PS: Gah, I'm such a "noob"!

Originally Posted by herbal tee

In looking over the mail I gotten this weekend I find that I have to fight with my mothers precription drug plan because they want to charge her more than her meds. cost without help!!!

Obamacare prescription drug plan appears to be a major fail. My story.
1. I tried to get refills in January with my new medical plan. The pharmacy said it didn't go through. However, for some reason, the plan I canceled would go through. Well, I need my meds, so I tell them to just go ahead and fill them using the now defunct old plan. [The hell with insurance companies anyway. If they fuck up to my favor, I'll screw them like they screw everyone else. ]
2. I call up the customer service number and was on hold for 1 hour plus. So I put my cell phone on speaker and play poker online while waiting for an answer.
3. Finally get an answer. They said I didn't pay. WTF? I did pay and pulled up my credit union statement and told them they took out the premium on such and such date.
4. They back off and said, yeah, I paid, but I have to use either Walgreens or CVS because their prescription handling was screwed up. OK, so I know they're idiots and liars now. They also said Walgreens/CVS would fill said prescriptions for free. [ Another lie].
5. I call Walgreens , transfer prescriptions and tell them about my insurance company's stupidity. They said, yes, assorted health insurance companies stuff isn't quite working and they have staff to fix the mess.
6. I transfer prescriptions over and this month, was and was able to get them filled, but not "for free". The cost is what is on the card, not free.
7. So, next problem, no bill came in the mail until the 29th of Jan. [I got impatient and paid by phone on the 20th by credit card, so I can an even better method proof of payment. ] Now, this I shall do for now on. Every 15th of the month, I won't wait for bills. I shall call and pay by credit card because I'm expensive for them and I think they want me gone and since they've proven themselves as incompetent liars. Next up is some lab work I've been saving, since my old plan didn't pay for that. So I'm gonna be even more expensive now. I think now is also a good time to schedule a colonosocpy as well. If I'm gonna make myself a loss leader, I may as well go all in.

Also, all of my nieces and nephews are opting out of Obamacare because of the cost.

Ditto. Mine are all Milles. Excepting the youngest one who is still in middle school, there are some severe Millie issues.
1. I have 2 nephews who work at Macy's in Virginia. They don't even know they're supposed to sign up, so they blew it off. Since they live in the new economy of everyday low wages, yeah, they can't afford it and have no patience for buggy web sites. Now I have 1 nephew who is a convenience store manager so he gets his from his employer. The final nephew has bipolar/ aspergers and is on SSI, so he gets Medicaid. As for the place I work for, part time employees get no health insurance, like me. The Millies and younger Xer's there are blowing it off as well. They have very expensive tablet/cell phone/ whatever plans they pay for with their meager wages. I think gaming has a higher priority than health insurance for the folks at work. I think their junk food bills are sort of high as well. Monster energy drinks and Wendy's stuff ain't cheap. My foodies are cheap stuff like beans, blueberries, avacadoes, and yogurt to mix with the blackberries. I also have onions and dried habaneros as well. Meat is too damn expensive to it's a fairly rare item nowadays.

oOn eextended family may not be a microcossim of the larger trends but I know of others who hva similar delimnas.

I think our political system makes sausage legislation now. A bunch of random stuff is mixed up and ground up to make a bill. I think it was Bismark that said not to look at what actually went into the sausage because it's gross. I think Obamacare went like this. It was supposed to fix mass unisured problem, but once it hit the sausage factory [Congress], Congresses owners [big pharma, health insurance companies, and perhaps an HMO or 2] brought in a bunch of sausage ingredients to prepare the final legislation, known as Obamacare. The ingredients got ground up and mixed together into a 2000+ page piece of legislative sausage. That is why its hard to understand. I know I don't know what the ingredients are. Sometimes I think one of the ingredients is E Coli.

Could it be that the whole system is going to get so complecated and expensive from the complecations that the whole thing is going to implode at some point?

NO! Since Congress's owners get swill from this program, it will be duly bailed out and assorted accounting tricks will be performed. The only problem I see with it is getting 50 somethings to lobby for Obamacare's continuation. Obamacare is Medicare for Jonesers. Jonesers are the largest 10 year cohort there is. Obama is a Joneser. Jonesers need to realize they/we got our own gravy train now and need to keep it rolling. We may not like the company we keep like Big pharma, but if we get swill, don't complain man. I know it takes some work to get swill, but that's OK.

We deserve a break today, at Obamacare from that old McDonalds ad

We deserve a break today, at McDonalds.

This is starting to look like a series of interlocking problems that will need to be addressed further in the 4T.

I think it's 1 problem. Welcome to Gilded Age 2.0 The way stuff is going, Xer's seem destined to push the reset button at some point and set stuff up their way. Please watch Fight Club, written by a 1962 cohort member.

Sometimes it's just about common sense.

Health care: Adverse selection


As any student of insurance of any kind would know, premium revenue and provider cost must on balance produce a profit. Private insurance companies stay in business by managing these two factors, limiting exposure from policyholders likely to cost too much and limiting costs by negotiating low prices from providers.

This formula works well for companies serving manageable groups of potential patients, such as employer groups, and avoiding coverage for people of predictably high risk, like smokers or those with dangerous illnesses.

Years ago under this system, older people more likely to get sick and poor people who could not pay premium costs were being left behind. Government had to step in with Medicare and Medicaid, programs popular with everyone because they dealt with the parts of the health care system the private sector could not manage, but as time passed it has became clear this selective system will not provide adequate health care for everyone at the lowest price.

The Affordable Care Act is a step forward but can't succeed fully until all citizens are in the same risk pool with basic care covered in a national insurance system, usually called single-payer.

http://www.pnhp.org/news/2014/februa...erse-selection

Originally Posted by Deb C

Sometimes it's just about common sense.

Health care: Adverse selection


As any student of insurance of any kind would know, premium revenue and provider cost must on balance produce a profit. Private insurance companies stay in business by managing these two factors, limiting exposure from policyholders likely to cost too much and limiting costs by negotiating low prices from providers.

This formula works well for companies serving manageable groups of potential patients, such as employer groups, and avoiding coverage for people of predictably high risk, like smokers or those with dangerous illnesses.

Years ago under this system, older people more likely to get sick and poor people who could not pay premium costs were being left behind. Government had to step in with Medicare and Medicaid, programs popular with everyone because they dealt with the parts of the health care system the private sector could not manage, but as time passed it has became clear this selective system will not provide adequate health care for everyone at the lowest price.

The Affordable Care Act is a step forward but can't succeed fully until all citizens are in the same risk pool with basic care covered in a national insurance system, usually called single-payer.

http://www.pnhp.org/news/2014/februa...erse-selection

It is essential that all citizens be in a single risk pool. Although I am not yet convinced that we must go to single payer, it is clear that ACA is not the best answer and some are worse off than before. However, we may need to go to single payer to replace the ACA with its problems.

Originally Posted by princeofcats67

Wow! Some seriously fascinating stuff going-on there!


Prince

PS: Gah, I'm such a "noob"!

Oh I forgot to mention the battle of B-R5RB that took place just last week in EVE Online. A complete recap of the battle can be found here. The battle was by far the biggest in the game's 10 year history and involved several thousand players commanding thousands of ships of varying size from fighters on up to super-capital class warships. The 21 hour virtual battle was so remarkable that it made the real-world mainstream news. The cause of the battle? An unpaid bill.

There are some pretty spectacular videos of the battle, including the very beginning of the fight with both sides still jumping warships into the system. (watch it in hi-def)

A complete write-up of the battle and related events leading up to the battle can be found here.

Ah, Eric can occasionally agree with The Rani

Originally Posted by Deb C

To which I responded - first on facebook, now on here:

"We're also the only first world country where working people are afraid of getting robbed, raped, or murdered on their way to or from work, by those who do not work - at least to anywhere near the same degree."

Originally Posted by '58 Flat

To which I responded - first on facebook, now on here:

"We're also the only first world country where working people are afraid of getting robbed, raped, or murdered on their way to or from work, by those who do not work - at least to anywhere near the same degree."

Seriously? According to you, the unemployed are mostly criminal. Do you even understand how absolutely ridiculous that sounds? So I guess all of those rapes that take place in the military are unemployed soldiers?

Rape in the military: exposing the shocking truth

The groundbreaking film The Invisible War exposes the shocking level of sexual abuse against women in the US military. Its concerns about rape are echoed in the UK

http://www.theguardian.com/lifeandst...shocking-truth


Oh, and about those robbers.

Looting the Pension Funds

All across America, Wall Street is grabbing money meant for public workers

Read more: http://www.rollingstone.com/politics...#ixzz2sq8iXFDi

About those murders on the way to work.

Murder in America

2,581
Argument Over Money or Property	2,231
Brawl Due to Influence of Alcohol	1,470
Gangland Killings	1,205
Lover's Triangle	1,168
Burglary	965
Brawl Due to Influence of Narcotics	887
All suspected felony type	802
Arson	540
Rape	440
Child Killed by Babysitter	357
Motor Vehicle Theft	276
Larceny	184
Institutional Killings	149
Other Sex Offense	121
Prostitution and Commercialized Vice	93
Gambling	65
Sniper Attack

http://projects.wsj.com/murderdata/#view=all

Originally Posted by Copperfield

Oh I forgot to mention the battle of B-R5RB that took place just last week in EVE Online. A complete recap of the battle can be found here. The battle was by far the biggest in the game's 10 year history and involved several thousand players commanding thousands of ships of varying size from fighters on up to super-capital class warships. The 21 hour virtual battle was so remarkable that it made the real-world mainstream news. The cause of the battle? An unpaid bill.

There are some pretty spectacular videos of the battle, including the very beginning of the fight with both sides still jumping warships into the system. (watch it in hi-def)

A complete write-up of the battle and related events leading up to the battle can be found here.

Thanks for posting that, Copper. This event has actually become a re-occurring topic
of discussion in my world. Generally speaking, I'm not a big fan of "modeling", per se
(due in-part to what I believe are mistakes related to translations to the "real world"),
but I think this type of stuff is definitely worth looking-at/thinking-about. I do have
to take issue with the "unpaid bill" being "the cause", though. I'd probably label it as
a 'contributing factor', but I'm pretty particular about that sort of thing(ie: "causality").


Prince

PS: Metaphorically speaking, a related topic might be: Hamartia.

Our health care system could be so much better. Someone else here has mentioned the health care system in France. The following is how it works so well.

The French way of cancer treatment

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.

The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.


Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.


That time was priceless.

http://blogs.reuters.com/anya-schiff...cer-treatment/

Originally Posted by The Rani

One of the potential problems with government interference in health care:

http://members.csahq.org/blog/2014/0...9s-malpractice

Saw this article on facebook, along with a comment from a friend of mine that his patients now receive beta-blockers post-op whether he has written an order for them or not. IMO, that's seriously messed up. But maybe it's par for the course in single-payer systems? I really have no idea.

The history of medicine in the U.S. itself leads one to believe that there are very many hidden agendas, and very many opportunities for ego and financial considerations to get in the way of "good medical care." For a good grounding, check out Paul Starr's classic The Social Transformation of American Medicine.

Yeah, "evidence-based medicine" makes sense, I suppose. I'm drawn to that old joke, "What do you call the person who finishes last in his/her medical class?" And of course the answer is "Doctor."

Health-care-provider/patient interactions, over the years, produce healthcare providers with a deep, profound intuitive sense of what's wrong with individual patients, and what has worked with other similar patients, and what needs to be done to/for this particular patient. Sometimes this intuitive sense is called "art." It's not so much based on easily identified symptoms or on what the patient is saying, as it is based on the "art" that has developed.

People often complain about how healthcare providers proceed to the "nutcase" diagnosis too quickly. Well ... that's because there are a plethora of nutcases out there. And even physical/medical problems are often complicated by emotional/mental pathology that contributes and makes the case more difficult.

Medicine is not an exact science at the individual patient level. However, there are indeed some situations in which outmoded ideas need to be discarded and newer ideas/techniques introduced. Older healthcare providers who have not kept up, healthcare providers with substance abuse problems, healthcare providers who perhaps shouldn't be doing this work at all, healthcare providers whose egos have transcended all reason, ... yeah, "something" probably needs to be done. But, "evidence-based medicine?"

Certain "simple" diseases are often included in algorithmic systems. Take for example Type II diabetes. It's practically epidemic. What does "evidence" show us? Well, exercise and weight loss are probably the two things that will virtually cure most cases!! Right? And how often does that happen with the average Type II diabetic? So what happens instead? The patient is sent to an RN who specializes in "Diabetic Education." The patient is put on Metformin or something, and monitors their non-progress by checking the blood glucose every morning, and continues their sedentary life, gaining weight and eventually having to be put on insulin, blah, blah, blah.

It strikes me that we patients fail ourselves as much as the healthcare system fails us. In addition, the various healthcare providers fail each other by failing to police one another. In over forty years hanging around the medical professions, I wish I had $100 for every time I've seen substandard medicine overlooked by others in the field, just because it's uncomfortable to confront.

Even published medical research has come under attack. http://www.theatlantic.com/magazine/...cience/308269/

Which makes one wonder what "evidence" there is that can be leaned on comfortably.

At last ...

Perhaps there are simple things that can be done to improve medical care, to decrease accidental harming of patients, etc. But to have government begin to conclude from the view at 90,000 feet, that something specific needs to be done to a patient by a healthcare provider? I think we need to move slowly and carefully on that.

Meanwhile, there's more than plenty of blame to go around.

P.S. - going back to Deb's example of "good healthcare" in France. I too believe that France has a good system. However, what was described was good hospice care of a terminal patient in the last few days of life. And wouldn't we all like to have that? And yet, there's a whole heck of a lot more to comprehensive, good healthcare than compassionate hospice care.

How many of us are aware of the overpayments to private Medicare Advantage programs? A study published online finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion. These for profit corporations are draining money away from Medicare. Meanwhile we have these "doc fixes" that penalize doctors for not crossing every T and dotting every I.

The ACA will require reductions in these over payments, but there is a bipartisan push to keep payments to these privatized corporations.

Following a few quotes, I give the link to the letter from the lobbying group that is pushing hard for keeping these over payments and the response to that letter from Don McCanne, M.D..

Last year the scheduled reductions were countered by increasing quality rewards to MA plans that had not earned them. This year, the reductions were partially countered by an accounting gimmick assuming a “doc fix” to scheduled reductions in Medicare payments, even though no such fix has been enacted. AHIP wants these “doc fix” increases to continue

Why should we care?

The most obvious reason is that it is our tax funds that are being given to these private health plans, paying them more than it costs us to provide care in the traditional Medicare program. A much more important reason is that enrollment in these plans continues to expand, opening the door to converting Medicare into a “premium support” program (vouchers) for a market of private plans. Traditional Medicare will then be allowed to wither as an underfunded welfare program, and perhaps eventually be abolished. Then the value of the premium support vouchers will be allowed to diminish, shifting more health care costs to the beneficiaries.

Here's the original letter that supports overpayment and Dr. McCanne's response:

Bipartisan support of Medicare Advantage overpayments


http://www.pnhp.org/news/2014/februa...e-overpayments

Originally Posted by The Rani

I'm not sure I'll be participating much in this thread again, because the more I read about this stuff the more it makes me want to throw up. America is the land of making a fast buck, but people whose main goal is to make a fast buck off the illness of others are the lowest forms of scumbags.

I hear you. I often have to take a break from the exposure to
certain information I come in contact with. It's just not a very
healthy environment i/r/t my "state of mind", IMO.

And, I agree about the "fast buck", but even worse IMO is the
"slow bleed" form of parasitic-behavior that I see occuring.

God help the Baby Boom when they start going into "long-term care".

Originally Posted by Rani

And while this one gave me the laugh of the day:

Making big bucks off nutcases is the easiest way of all to do it. If you are convinced that you are "sick," you'll do whatever it takes to get "better." I've seen it happen time and time again. Just plain disgusting.

Too true. It's like a society of freakin' hypocondriacs, IMO.


Prince

PS:

Originally Posted by Rani

End rant.

No way! Rant away, baby!

Originally Posted by princeofcats67

God help the Baby Boom when they start going into "long-term care".

Adult diapers + medical marijuana = problem solved.



[/QUOTE]

Originally Posted by The Rani

I'm not sure I'll be participating much in this thread again, because the more I read about this stuff the more it makes me want to throw up. America is the land of making a fast buck, but people whose main goal is to make a fast buck off the illness of others are the lowest forms of scumbags.

The quick-buck culture will die in a 4T. Politicians aligned with it will either change or be voted out of office. Businesses that fail to adjust will go under. The 3T exults the profit motive as if it were the highest of virtues. In the end such fails because people realize that hustles simply drain their assets.

Service typically pays badly, but it survives.

And while this one gave me the laugh of the day:

Making big bucks off nutcases is the easiest way of all to do it. If you are convinced that you are "sick," you'll do whatever it takes to get "better." I've seen it happen time and time again. Just plain disgusting.

End rant.

Seeing that most physicians are coached to push prescription medications for everything -- my view of medicine isn't what it used to be.

Originally Posted by Ragnarök_62

Adult diapers + medical marijuana = problem solved.

Sounds good to me

let's start the 1t :

Originally Posted by herbal tee

Sounds good to me

let's start the 1t :

Rats. My lungs can't deal with the smoke.

Originally Posted by Bad Dog

Rats. My lungs can't deal with the smoke.

Our lungs may not be able to handle it but we can still eat brownies.

Originally Posted by Deb C

Our lungs may not be able to handle it but we can still eat brownies.

Chocolate to the rescue. Yaaay!

(rant)

Spent another three hours on hold with BCBS this week.

They want five months' premiums (because of billing errors) yesterday or they're canceling our coverage.

So I'm uninsured again. I think. I already paid two months premium but never got a plan booklet or membership cards or access to the provider directory.

Between me and the government, they've already collected as much from me and in my name this year as they did in all of 2013.

I'm pissed.

(/rant)

Originally Posted by JohnMc82

(rant)

Spent another three hours on hold with BCBS this week.

You did? I spent 90 minutes with them after it was getting late. I was expecting my card/brocure in December and I was Dec. 20, and no stuff from BCBS [Blue Crap, Bull Shit]

They want five months' premiums (because of billing errors) yesterday or they're canceling our coverage.

Just wait, you'll get a pharmacy error after that.

So I'm uninsured again. I think. I already paid two months premium but never got a plan booklet or membership cards or access to the provider directory.

3 Hours on hold ? Uh did you bring this up with them?

Between me and the government, they've already collected as much from me and in my name this year as they did in all of 2013.

I'm pissed.

(/rant)

Yes, I would be too. I was pissed 'cause
1. They were late in sending me my card in December for January start date. I insisted they send it to me.
2. Pharmacy shit. I had to xfer stuff to Walgreens 'cause they said they would do something about fuckup and I could get my pills.
3. Payments, still fuckup. They send their bill on the 2nd to last day of the month. I fix this fuckup by just calling billing on the 15th and pay with a credit card so they have to pay the 2% credit card fee. I use discover, so I get the 2% back from them.
4. Of course the ultimate fuckup is the fact we have to deal with health insurance companies in the first place.
Either.
a. Allow medical professions to form coops and you can pay x amount a month to join [with subsidies of course for broke folks]
b. Just set Medicare age to 0.