[lexapro]

eBuddy, you do read into things and make many good points. bstone and I talk every day and he has described his willingness to answer your questions.

He says that he soon will qualify for Medicare and is greatly looking forward to that. He said something about also paying for a "supplemental" policy, but I am not too sure what that means.

Regarding fraudulent cases, I am sure that happens. However the process bstone went through was a combination of his own doctors testimony and being twice examined by Social Security's doctors. He had to send in every test, every dr appt date (he has a blog and has been documenting all of this, every appt, etc) and then sign 11 different forms. It seems that the SS process was serious, in depth and most fraud cases would not pass. Most, not all.

WRT the co-pays, etc....he only advocates that for people who are disabled and in the 2 year waiting period between being approved for monthly payments and Medicare. So in reality this is a tiny period of time for a tiny group of people. It would have less than minimal impact on the private insurance companies, at most.

[lexapro]

bstone just checked. He qualifies for Medicare Part A and Part B in March 2010.

[besson3c]

Originally Posted by CharlesS 

The problem is that Obama went into this with great ideals — reach across the aisle, work on bipartisan solutions that the Republicans can get on board with — hence the rather conservative health care plan. Unfortunately, the Republicans aren’t the conservative party lately — they’re now the “fiercely oppose everything the Democrats do, no matter what it is” party. Reaching across the aisle doesn’t work too well when the people on the other side of the aisle have decided to be this Borg-like entity that you can’t reason with.

Frankly, I think that if this health care plan manages not to pass, they should just go all the way and bring out a single-payer plan. At least then, the left wing would get excited about it — right now, a lot of them aren’t, because of how conservative it is — and as for the right wing, as long as they’re going to be screaming “socialist” even at a plan as conservative as this one, then what difference does it make, really?

Good point. On the other hand, *if* this plan succeeds to some measurable extent, this might be enough to make Conservatives STFU for good, at least as far as all of this socialist fear nonsense et all goes? Perhaps it's a gamble? Perhaps a more conservative (as in, small "c", the opposite of bold) plan has a greater probability of making some sort of difference as opposed to something more bold in scope? Perhaps the justification here is to simply get the ball rolling... Regardless of what happens, it's not like we would be able to say "okay health care, all good now... Next!" This is something that will always need to be examined and re-examined, and not ignored like we have for so many years.

[shiff]

My insurance covered all my pre-existing conditions. I had my new insurance for 2 days and then got a $67,000 dollar surgery approved. I paid $300.00 total since that was my deductible.

[lexapro]

For the praying types, bstone is going back into the hospital Monday morning at 9am to have an infusion of a corticosteroid. For the good thoughts type, please keep him in mind.

It's an on-label use of the medication and prescribed by his neurologist (who is the chief of neurology at the hospital). The insurance keeps denying to pay for it.

[ebuddy]

Originally Posted by besson3c 

Good point. On the other hand, *if* this plan succeeds to some measurable extent, this might be enough to make Conservatives STFU for good, at least as far as all of this socialist fear nonsense et all goes?

Based on the above, I have a hunch your definition of "succeeds to some measurable extent" becomes pretty loose in the hopes that it'll shut some conservatives up. As if the many examples of government policy failure have shut any liberals the f*** up.

[ebuddy]

Originally Posted by CharlesS

Well, in a country that is always claiming that your most fundamental rights are life, liberty, and the pursuit of happiness, denying treatment for a life-threatening tumor pretty obviously violates the first of those as far as I see it, and for something like what bstone is going through, it pretty clearly violates the other two.

Statistically, you're much better off in the US for cancer care than anywhere else on the globe. Cancer is one of those buzz-phrases for folks because we all know someone struggling with it, but it makes no sense to bring this up within the context of an argument for a nationalized system without acknowledging our incredible successes in this regard under the status quo.

The problem is that Obama went into this with great ideals — reach across the aisle, work on bipartisan solutions that the Republicans can get on board with

He went into this with a great deal of rhetoric and has since engaged in partisan derision the likes of which I would've thought impossible for the office of the President. Republicans have been trying to get healthcare proposals into the President's office since March of this year and have been all, but shut out of the process entirely. This is no surprise in light of a massive stimulus measure passed without a single Republican vote. He's reached across the aisle by repeatedly reminding us who the last President was and who won this election. He's sicking cronies on news organizations he doesn't like and Administration officials are characterizing political opposition as astro-turf, nazis, and partisan attack dogs. I suppose a definition of "bipartisan" is in order.

— hence the rather conservative health care plan.

Your definition of "conservative" is a $1.2 trillion proposal that includes an option for a government-run health plan? If there is any concession at all in these bills it is because of declining public support. It's kind of difficult to administer a plan from an office you no longer hold. Republicans aren't the ones delaying this legislation CharlesS.

Unfortunately, the Republicans aren’t the conservative party lately — they’re now the “fiercely oppose everything the Democrats do, no matter what it is” party. Reaching across the aisle doesn’t work too well when the people on the other side of the aisle have decided to be this Borg-like entity that you can’t reason with.

I agree with you that Republicans aren't the conservative party lately (though decidedly more conservative than when they held the majority that's for sure), but I'd fully expect them to "fiercely oppose everything the Democrats do" when Democrats themselves are in complete disarray. This Administration seems to be playing a game of "beat the clock" with little regard for the merits of the legislation for the sake of passing something, anything. I have no problem buying a car, but if the salesman is standing over my shoulder; "C'mon, you know you want it! You gotta do it now! You'll never have another opportunity to do it! C'mon! Now! You're stupid if you don't do it!" I'm likely going to walk. That's what is happening right now.

Frankly, I think that if this health care plan manages not to pass, they should just go all the way and bring out a single-payer plan. At least then, the left wing would get excited about it — right now, a lot of them aren’t, because of how conservative it is — and as for the right wing, as long as they’re going to be screaming “socialist” even at a plan as conservative as this one, then what difference does it make, really?

I agree with your distaste for the cries of "socialism!". They should be crying "communism!".

IMO, your definition of "conservative" is as specious as your definition of "bipartisan". There is little by way of a Congressional healthcare bill that is "conservative" and it's a long stretch to define the current environment in Washington as "bipartisan". The buck starts and stops at the President and he's been anything, but the bipartisan pragmatist he campaigned as.

[CharlesS]

The bill does the absolute bare minimum needed to address the issue. It works with the existing private health insurance industry (unfortunately). It simply adds regulations to stop the abuses that are documented to have been happening. Even the public option is run as a private company, it gets its funding through premiums like any other insurance company, and it can’t be bailed out. All it does is provide competition. Private industry, competition, pays for itself. Man, that sure sounds like “communism” to me.

A “liberal” plan would be a single-payer system. And even that’s not as far left as you think — most of the rest of the free world uses one; it’s not that exotic. The fact that even Doofy has come out in favor of a national health care service should illustrate how utterly bizarre it is for people here to be headless chickens over the idea.

What are those Republican health care proposals you’re talking about, anyway? Eliminating state-wide monopolies? Well, that’ll help. What’re you gonna do if you’re like bstone, you’re sick and your crappy insurance company keeps weaseling out of paying the claims? Switch providers? Even if another provide would actually provide decent service (which is doubtful), they wouldn’t take you anyway because you have a pre-existing condition!

[moonmonkey]

Originally Posted by Paco500 

It's got it's issues. Big issues. But sometimes I like the NHS.

Generally Brits don't know how lucky they are.

[rickey939]

Please tell bstone I said hello and that I give my best.

[ebuddy]

Originally Posted by CharlesS 

The bill does the absolute bare minimum needed to address the issue.

A 1,990 page bill that includes over 110 new boards, agencies and programs and an unfunded Federal mandate for little gems like nutrition labeling at chain restaurants and vending machines is the absolute bare minimum? I get that you generally appreciate the move, but there's no reason to make it something it is not.

It works with the existing private health insurance industry (unfortunately). It simply adds regulations to stop the abuses that are documented to have been happening.

Right, abuses like 2.2% profit-taking. Tell me, until very recently Blue Cross Blue Shield was entirely non-profit and what has that done for cost containment historically?

Otherwise, it sounds like you're conflating the "exchange" with the public option offered on the exchange. (little more than a massive expansion of Medicaid) It doesn't work with the existing private health insurance industry, it works around it when possible and modifies it where it pleases (unfortunately). Unless of course you could indicate which private insurers it will be working with. Not unlike how the State-run property insurance has worked with private property insurers in Florida for example. (by chasing them out)

Even the public option is run as a private company, it gets its funding through premiums like any other insurance company, and it can’t be bailed out. All it does is provide competition. Private industry, competition, pays for itself. Man, that sure sounds like “communism” to me.

It's run as a private industry alright and with CBO projection that premiums would actually be higher than under comparable private insurance. To make sure I have this straight though... the public insurer will not be initially seeded with taxpayer funds then? They'll be paying property taxes as well I suppose?

A “liberal” plan would be a single-payer system. And even that’s not as far left as you think — most of the rest of the free world uses one; it’s not that exotic.

I don't think anyone's claimed how exotic the notion is as much as citing the historical failure of the ideal such as the desire to cut burgeoning costs by moving towards privatization in Sweden since the early 90's. A "liberal" plan such as the single-payer system is not the panacea "y'all" seem to think.

The fact that even Doofy has come out in favor of a national health care service should illustrate how utterly bizarre it is for people here to be headless chickens over the idea.

I'm not entirely sure you and he are talking about the same thing with regard to "national healthcare service", but if he'd like to clarify, I'll listen. BTW, is there a reason Doofy should be an appeal to authority in this anyway CharlesS?

What are those Republican health care proposals you’re talking about, anyway?

HR3400 among approximately 34 other Republican proposals.

• Republican Health Care Solutions Group
• Empowering Patients First Act
• Improving Health Care for all Americans Act
• Patients Choice Act
• Medical Rights and Reform Act
• (HEALTH) Help Efficient, Accessible, Low-cost, Timely Healthcare Act
• Small Business Health Fairness Act
• They tried to work with the prevailing Democratic bills by offering amendments such as 31 Common Sense Changes
• They even tried to express solidarity with Obama in a letter addressed to him in May indicating their desire to work with him on what they referred to as a mutual agreement on the need for reform citing common ground for bipartisan measures. republicanleader.house.gov

The fact that these proposals aren't given any press by your favorite Daily reading doesn't mean they don't exist CharlesS.

Eliminating state-wide monopolies? Well, that’ll help.

Hell yeah it'll help. It's a necessary foundation of "competition". Why add "just one more insurer that acts just like a private insurer" when you've already got some 1300 insurers in the marketplace ready to compete? If competition is the silver bullet for accessability, why not spur competition with simple, cost-free legislation? You already have a Securities and Exchange Commission, anti-trust legislation, COBRA, Commerce Clause, etc.; why not employ the powers already granted the Federal government instead of creating over 110 new ones?

A: because then you can't create over 110 new ones.

What’re you gonna do if you’re like bstone, you’re sick and your crappy insurance company keeps weaseling out of paying the claims? Switch providers? Even if another provide would actually provide decent service (which is doubtful), they wouldn’t take you anyway because you have a pre-existing condition!

I feel for bstone's situation and it is situations like this that make the need for government reform more apparent. Adding "one more insurer" is not going to help bstone until at least 2013 (3 years after he'd already be eligible for Medicare) and the fact of the matter is that the 46% already managed by the Federal government were among those who let him down. Remember, he's disabled. What about the crappy government using your tax dollars to stall someone like bstone already established by the government as in need, but providing zero by way of medical assistance for three years?

What are you going to do if you're one of the over 80% currently happy with your coverage being moved onto a crappy government program as unresponsive as this?

[CharlesS]

I’m not falling into the “essay-length posts” trap again. Not this time.

All I’ll say is that it doesn’t matter whether there are 1, 1000, or 1,000,000 insurance options out there. If you can’t even switch from one to another without risking getting screwed by some “pre-existing condition” nonsense, then there’s effectively only one provider — the one you’re on.

[Chuckit]

Originally Posted by CharlesS 

I’m not falling into the “essay-length posts” trap again. Not this time.

All I’ll say is that it doesn’t matter whether there are 1, 1000, or 1,000,000 insurance options out there. If you can’t even switch from one to another without risking getting screwed by some “pre-existing condition” nonsense, then there’s effectively only one provider — the one you’re on.

Well, yeah, that shouldn't be allowed. But stopping that doesn't require creating a federally run insurance program.

[CharlesS]

Driving down costs, though, does.

[Chuckit]

Originally Posted by CharlesS 

Driving down costs, though, does.

You feel confident saying that without even trying out competition as a means to lower costs?

[CharlesS]

Well, my expectation is that as long as all the insurance companies were focusing on making a profit and making money for the shareholders, executives, etc., then the costs would either stay high or they’d find new ways to screw you over and not pay out claims. Health insurance isn’t as profitable if you’re providing actual health care instead of just taking your customers’ money and then not giving anything back when they need it, and CEOs want to have their mansions, yachts, and solid gold toilets. The public option would at least be run as a non-profit and wouldn’t be beholden to such considerations, so the private companies would actually have to provide a superior service in order to compete. I’d rather have that than a choice of 1,000 different scams.

[downinflames68]

That's a pretty interesting outlook, Charles. Would certain drugs/operations only be available through private sectors though? Because if I invented "drug A" which cured something important, how would a non profit pay for it, when I can get a lot of scratch for it through the private healthcare industry?

[CharlesS]

A non-profit would still be taking in money in the form of premiums, it’s just that it would use that money to pay for health care, drugs, etc. The idea is that it wouldn’t have to have a ton of money left over afterwards to enrich the shareholders.

[ShortcutToMoncton]

Originally Posted by CharlesS 

A non-profit would still be taking in money in the form of premiums, it’s just that it would use that money to pay for health care, drugs, etc. The idea is that it wouldn’t have to have a ton of money left over afterwards to enrich the shareholders.

Sounds kinda like how the Canadian system works. Uh oh.

[Uncle Skeleton]

Originally Posted by CharlesS 

Well, my expectation is that as long as all the insurance companies were focusing on making a profit and making money for the shareholders, executives, etc., then the costs would either stay high or they’d find new ways to screw you over and not pay out claims.

My solution takes care of that. If patients are responsible for a proportional payment to the cost of their treatment, then normal market forces will push down costs. If a treatment's cost is wildly out of proportion to its benefit, it will no longer be chosen. Right now, on the other hand, there is no market pressure on costs whatsoever, because the only people who are in a position to choose one treatment or another, have no interest nor even access to the knowledge of what treatments cost.

After that, you just have to enforce existing fraud laws; if a company promises coverage and then refuses it, they get a hefty punitive fine. It won't be long before they are honoring the contracts they signed. There's your place for government intervention, enforcement of contracts. No conservative would ever object to that.

[ghporter]

Originally Posted by Uncle Skeleton 

My solution takes care of that. If patients are responsible for a proportional payment to the cost of their treatment, then normal market forces will push down costs. If a treatment's cost is wildly out of proportion to its benefit, it will no longer be chosen. Right now, on the other hand, there is no market pressure on costs whatsoever, because the only people who are in a position to choose one treatment or another, have no interest nor even access to the knowledge of what treatments cost.

After that, you just have to enforce existing fraud laws; if a company promises coverage and then refuses it, they get a hefty punitive fine. It won't be long before they are honoring the contracts they signed. There's your place for government intervention, enforcement of contracts. No conservative would ever object to that.

Tell the cancer cells about "market forces." Chemo is very expensive; you really don't have a "choice" in whether or not to choose this treatment-unless death is a valid alternate choice. Hereditary liver disorders don't care about market forces either; if your liver decides to quit on you-through no fault of your own-then your "market-oriented choices" are either pony up for a $100k+ transplant or lay back and die slowly...

There are many elective procedures that eat up insurance money that your idea would work with, but the overall system also must deal with the non-elective side of care, which is where most of the problem lies.

The better way to enlist market forces to fight medical cost inflation is to force insurance companies to be far more transparent, including publicly posting their processes (like ISO 9000 compliant companies must do) and forcing them to abide by them. If Blue Cross has a process that says "this particular malady is always covered, but this one is not," then consumers could be better informed about whether Blue Cross is likely to screw them over. But since this sort of information is actually treated like trade secrets, the consumer is SOL. I personally think that many (not a majority, but far too many) health insurance decision makers are interested in denying more claims so as to maximize stockholder return, rather than fulfilling the mission of the organization in the first place, which is paying for valid medical costs for their clients. With transparency, this sort of practice would be exposed and quickly eliminated-through lawsuits and customer protests at the very least.

[turtle777]

Originally Posted by CharlesS 

Well, my expectation is that as long as all the insurance companies were focusing on making a profit and making money for the shareholders, executives, etc., then the costs would either stay high or they’d find new ways to screw you over and not pay out claims. Health insurance isn’t as profitable if you’re providing actual health care instead of just taking your customers’ money and then not giving anything back when they need it, and CEOs want to have their mansions, yachts, and solid gold toilets. The public option would at least be run as a non-profit and wouldn’t be beholden to such considerations, so the private companies would actually have to provide a superior service in order to compete. I’d rather have that than a choice of 1,000 different scams.

No, in reality, it doesn't work out like that.

Even though for-profit companies will have high salaries etc, their spending spree will be kept in check if there are other players allowed in the same field. The companies will be forced to find a balance between profit maximization and maintaining a market share / viable business.

If you go for the public option, and all for-profit companies go away, then the remaining non-profit organization has no incentives at all to keep cost under control and run an efficient operation. Cost will spiral out of control, funded by tax payers. It;s a nightmare that has proven to not work with Medicare and Medicaid.

-t

[besson3c]

Pulease Turtle... Medicare and Medicaid have worked just fine for a number of years. The increase in costs is affecting the entire industry, not just Medicare and Medicaid.

This whole debate is so damn circular and repetitive it's pretty much pointless at this point.

[turtle777]

Originally Posted by besson3c 

Pulease Turtle... Medicare and Medicaid have worked just fine for a number of years. The increase in costs is affecting the entire industry, not just Medicare and Medicaid.

What are you talking about ? You mean the first 5 years, until the cost started to spiral out of control ?

The cost of Medicare is a good place to begin. At its start, in 1966, Medicare cost $3 billion.

The House Ways and Means Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly "conservative" estimate.

But in 1990 Medicare actually cost $107 billion.

The Medicare Monster - Reason Magazine

You know how good the dimwits in Washington are with numbers.
They tell us the Health Care Bill will cost $1,000B. We can be assured that it will cost a multiple of that down the road.

Government budget and cost forecasts NEVER EVER come in on plan or lower.

-t

[CharlesS]

Originally Posted by turtle777 

If you go for the public option, and all for-profit companies go away

Why would they go away? Even in countries like the UK, France, and Canada that have universal coverage, there still exist private health insurance companies that provide enhanced coverage over and above what the national service provides. If health insurance companies can survive when everyone has access to a free public health service, then I think they can survive alongside a public option that’s run like a private company. Maybe the CEOs will have to install solid silver toilets in their restrooms instead of solid gold ones, but somehow I’m not too broken up over that.

[turtle777]

Originally Posted by CharlesS 

Why would they go away? Even in countries like the UK, France, and Canada that have universal coverage, there still exist private health insurance companies that provide enhanced coverage over and above what the national service provides. If health insurance companies can survive when everyone has access to a free public health service, then I think they can survive alongside a public option that’s run like a private company. Maybe the CEOs will have to install solid silver toilets in their restrooms instead of solid gold ones, but somehow I’m not too broken up over that.

That depends entirely on the parameters that the politicians set.

If you limit the public option to catastrophic insurance coverage, and don't push onerous regulation and coverage mandates on the private insurance companies, then yes, they can co-exist.

Unfortunately, the current health care bill subsidizes a host of insurance options so that private companies can not compete. What's more, they impose onerous rules (like rules on preexisting conditions, price ceiling etc) on the ins cos, so that they have no way to compete.

-t

[CharlesS]

The rules on preexisting conditions are “onerous”?

So basically, you’re saying that stuff like what happened to bstone should be allowed, and welcomed?

[lexapro]

Originally Posted by rickey939 

Please tell bstone I said hello and that I give my best.

I'll let him know when I talk to him later tonight.

He told me he's thinking of writing something additional to what he wrote in the first post, but might wait until he gets Medicare. He did tell me he got a SECOND insurance policy on November 1. As a resident of Massachusetts he was able to qualify through Commonwealth Care for membership in an HMO. They seem to have his primary care physician and the hospitals he's treated at in their "network". However they don't cover out-of-state care, and his neurologist is in Miami and his neuroradiologist is in North Carolina. His BCBS PPO does, but the Network Health HMO does not.

This is his neuroradiologist at Duke Univ Medical Center in North Carolina and this is his neurologist at the Univ of Miami. These are, literally, the only doctors on the East Coast who have any knowledge of his condition and know how to treat him.

So, while he now has two insurance companies, he really only has one for the direct care of his condition. And that's where 99% of his medical costs come from.

[turtle777]

Originally Posted by CharlesS 

The rules on preexisting conditions are “onerous”?

It's onerous if private insurance companies are forced to insure every member for the same premium, even if one member is 25 years old and in perfect health, and another one is 55 with diabetes, cancer and other issues.

Since private companies can not tap tax money to pay for budget overruns, they need to charge premiums that cover their cost.

-t

[ebuddy]

I'll say this in closing;

• Again, if you have cancer your absolute best chances of survival are in the US. You don't have to tell a cancer cell anything in the market place. This is not an opinion, it is fact. If we must use an anecdote to make the case for a public option, please use another one. I'm just trying to help here.
• Again, Blue Cross Blue Shield is a non-profit and while they've managed to monopolize certain regions, they've done absolutely nothing to contain healthcare costs. Y'all are trying to address a broken ankle with a band-aid. There is no profit motive, but there is still a healthcare crisis.
• If you trust the government more than you trust private industry, you're not considering the wealth of history to show how mistaken this is. Simply nothing anyone tells you will suffice. All things being equal- I personally trust the profit motive under a system opened up on a national basis than I do a government that claims to care for me, but can't tell me how.
• you can get competition for free.
• you can increase accessibility for free.
• you can lower premiums for free.
• you can eliminate "pre-existing" condition clauses for free.

If you want a public option to have a public option just say it. No matter how many threads have been authored on this piece, I've yet to see a compelling argument for a public option that can't be resolved with a lot less tax money and contention.

Until the next healthcare thread then...

[turtle777]

The problem is that the Democrats are not really interested in lowering the cost of health care.
There are many things that could be done, but none of them are considered.
They really want to EXPAND government into healthcare, more than fixing what's broken.

The already high cost of insurance is often increased by excessive state regulations. States have passed more than 1,800 benefit mandates, requiring insurance companies to cover services from hair prostheses (wigs) to infertility treatments to acupuncturists to massage therapists. These state mandates raise the cost of insurance, which, in turn, increases the number of Americans who are priced out of the health-insurance market.

Problem #1: adding in sh!t that blows up cost but is only "nice to have"

You may be thinking, what if I don't need a hair prosthesis or infertility treatments? Tough luck. Instead of having a choice in coverage you do need, you'll likely be paying for health insurance at an exorbitant cost to cover things you may never use or desire.

Problem #2: People pay for stuff they don't need / utilize, so they try to find ways to "maximize their return" by doing "unnecessary" procedures for which they would never pay for out-of-pocket. Result: cost overruns

Americans should also be able to purchase their health insurance on the same tax-advantaged basis as their employers. If your employer purchased health insurance on your behalf today, he would be able to do so with pre-tax dollars. However, in today's market, if you go it alone, you won't get any tax incentive to purchase your own health care. This would be a simple remedy to our still antiquated tax code, which favors big government and punishes individuals.

Problem #3: current tax codes discourages shopping around and wise spending of health-care $.

Does anyone believe the billions in new taxes as well as hundreds of pages of new rules and regulations being proposed will lower the cost of health care in America?

Problem #4: Obama tries to cut cost by spending more. Does nobody seems to realize the obvious idiocy of this strategy ?

John Shadegg: There is a No-Cost Path to Cheaper Health Care - WSJ.com

-t

[ebuddy]

Originally Posted by CharlesS 

I’m not falling into the “essay-length posts” trap again. Not this time.

I'm sorry to hear that. I would've looked forward to a response; particularly to the answers I gave your questions.

All I’ll say is that it doesn’t matter whether there are 1, 1000, or 1,000,000 insurance options out there. If you can’t even switch from one to another without risking getting screwed by some “pre-existing condition” nonsense, then there’s effectively only one provider — the one you’re on.

It'd be much easier to switch from one to the other when you have 1300 options to choose from instead of the current 5 or by 2013; one more. The legislation to curb "pre-existing conditions" abuses would be simple and cheap. You might think this is important, but it's at the bottom of the Federal Government's list of interests my friend. Trust me.

[CharlesS]

If the government’s so terrible at providing a service cheaper than the private health insurance companies, then how come our health care system ends up costing twice as much on average as in countries that have single-payer systems?

[turtle777]

Originally Posted by CharlesS 

If the government’s so terrible at providing a service cheaper than the private health insurance companies, then how come our health care system ends up costing twice as much on average as in countries that have single-payer systems?

Many reasons.

First, the "great" single payer systems severely ration access to health care through wait lists and limited treatment options.

Secondly, the current system is not perfect, it needs more competition in the form of people being 100% in charge of their health-care spendings.
Read the link I posted above, it explains why the current system is not as cost- efficient as it could be.

Problem is, the current health-care bill will NOT fix the cost issues at all.

-t

[CharlesS]

You think our system doesn’t severely ration health care towards those who have 5-digit sums of money to throw around?

[turtle777]

Originally Posted by CharlesS 

You think our system doesn’t severely ration health care towards those who have 5-digit sums of money to throw around?

That's not the point.

Just because people with a lot of money get better treatment now doesn't mean we have to make the system WORSE so nobody gets good treatment.

-t

[besson3c]

Originally Posted by CharlesS 

If the government’s so terrible at providing a service cheaper than the private health insurance companies, then how come our health care system ends up costing twice as much on average as in countries that have single-payer systems?

That's the question of the day, as well as why the private insurance companies have to worry if the public option will be no threat to them in terms of providing cheaper services. The Conservatives in here seem to go all over the place, that the public option competition will be so great that it will be the end of private insurance, and this. Perhaps the former sentiment was sort of quelled when it became clear that those making enough money won't be eligible for the public option?

[Uncle Skeleton]

Originally Posted by ghporter 

Tell the cancer cells about "market forces." Chemo is very expensive; you really don't have a "choice" in whether or not to choose this treatment-unless death is a valid alternate choice.

Death is not only a valid alternate choice, it is an INEVITABLE choice. What's that saying about "death and taxes" again?
If your primary objection to my solution is that it includes accepting that death happens, well, let's just say that tells me I'm right.

Hereditary liver disorders don't care about market forces either; if your liver decides to quit on you-through no fault of your own-then your "market-oriented choices" are either pony up for a $100k+ transplant or lay back and die slowly...

And if the patient has to pay 3% of that cost in return for a truly life-saving procedure, well that's the bargain of the F'ing century. However, if the patient has to pay 3% of several extra unnecessary CT scans, when an ultrasound would have been sufficient (as per the anecdote in my first post), s/he is going to raise hell until the hospital reverses its brain-dead policy to always do extra scans.

The point is that someone is going to have to pay that $100k+ cost, and I don't think we should be handing them out like candy unless the patient truly needs it. If the patient is willing to pay their (still small!) share, they must think it's worth it.

We need to encourage the development of cheaper options, because right now there is no incentive (actually, negative incentive) to make the same outcome cheaper through new technology (or off-label use).

The better way to enlist market forces to fight medical cost inflation is to force insurance companies to be far more transparent, including publicly posting their processes (like ISO 9000 compliant companies must do) and forcing them to abide by them. If Blue Cross has a process that says "this particular malady is always covered, but this one is not," then consumers could be better informed about whether Blue Cross is likely to screw them over. But since this sort of information is actually treated like trade secrets, the consumer is SOL.

I don't follow... suppose your proposed procedure is a "not always covered" one, what does that get you? And why wouldn't the insurer list every procedure as "not always covered" or "it depends," to allow themselves more flexibility?

I personally think that many (not a majority, but far too many) health insurance decision makers are interested in denying more claims so as to maximize stockholder return, rather than fulfilling the mission of the organization in the first place, which is paying for valid medical costs for their clients. With transparency, this sort of practice would be exposed and quickly eliminated-through lawsuits and customer protests at the very least.

I personally think that far too many medical costs are ones where no one at all ever considers whether they are valid (the costs) before they are incurred, and if they were considered then they would have been declined. I don't see how transparency addresses this problem. If you know that your procedure is covered, that doesn't make you question whether it's necessary. If it's unclear whether your procedure is covered, that doesn't give you any information at all.

[turtle777]

Originally Posted by besson3c 

That's the question of the day, as well as why the private insurance companies have to worry if the public option will be no threat to them in terms of providing cheaper services. The Conservatives in here seem to go all over the place, that the public option competition will be so great that it will be the end of private insurance, and this. Perhaps the former sentiment was sort of quelled when it became clear that those making enough money won't be eligible for the public option?

Dude, KNOW YOUR GOVERNMENT.

Public Option will not be a threat because it's cost efficient, it will be a threat to sound businesses because its losses will be heavily subsidized.

And "cheaper" services isn't really cheaper if your premiums go 10% down, but your taxes go 50% up and your currency loses purchasing power due to debt-inflicted inflation.

-t

[turtle777]

Originally Posted by Uncle Skeleton 

I personally think that far too many medical costs are ones where no one at all ever considers whether they are valid (the costs) before they are incurred, and if they were considered then they would have been declined. I don't see how transparency addresses this problem. If you know that your procedure is covered, that doesn't make you question whether it's necessary.

People make the best (and most efficient) choices when they have to pay with their own money.

As soon the cost is paid for (unlimited) by an insurance company or government, spending spirals up dramatically.

Example: ask yourself - when do people spend more money for food when on business travel ?
When they have an expense account, or when they have a per diem ?

I'm not saying that the government shouldn't provide a safety net for those who have no money at all.
But there is a HUGE (speak: 1 trillion USD) difference between a safety net that provides emergency and catastrophic care, and full blown health insurance with all bells and whistles.

-t

[lexapro]

http://www.nytimes.com/2009/11/08/he...health.html?hp

Perhaps this is the relief bstone needs. However, this is only for health care. His other issue is he is now poor and will be permanently so. His only income is Social Security Disability, which barely pays for anything.

Is a man who worked full-time for so many years really now relegated to being poor for the rest of his life?

[ShortcutToMoncton]

Originally Posted by lexapro 

http://www.nytimes.com/2009/11/08/he...health.html?hp

Perhaps this is the relief bstone needs. However, this is only for health care. His other issue is he is now poor and will be permanently so. His only income is Social Security Disability, which barely pays for anything.

Is a man who worked full-time for so many years really now relegated to being poor for the rest of his life?

To be fair, I do take some issue with the concept that society should help him be not poor for the rest of his life.

It's a terrible and unfortunate accident/situation, and I think most (and probably all) here are in agreement that bstone should be supported by society. But I tend to feel that society should be responsible for a "basic safety net" - some decent combination of food, water, shelter, etc. etc. That means, yes, he'll be poor. I have a hard time thinking that we should be paying for a new 40" flat screen (which is the sort of luxury that comes to mind when I think of "not poor").

Above and beyond that, I think it's a responsibility of a caring society - friends, family, non-profit/donation services - to provide the other elements of a prosperous and/or fulfilling life....

(Feel free to point out any errors in that logic however )

greg

[Laminar]

Originally Posted by ShortcutToMoncton 

To be fair, I do take some issue with the concept that society should help him be not poor for the rest of his life.

It's a terrible and unfortunate accident/situation, and I think most (and probably all) here are in agreement that bstone should be supported by society. But I tend to feel that society should be responsible for a "basic safety net" - some decent combination of food, water, shelter, etc. etc. That means, yes, he'll be poor. I have a hard time thinking that we should be paying for a new 40" flat screen (which is the sort of luxury that comes to mind when I think of "not poor").

Above and beyond that, I think it's a responsibility of a caring society - friends, family, non-profit/donation services - to provide the other elements of a prosperous and/or fulfilling life....

(Feel free to point out any errors in that logic however )

greg

This was also my gut reaction to lexapro's post.

It's not society's responsibility to provide any more than the basics for survival (and I'm sure some would believe even that much is pushing it).

[lexapro]

Greg,

Surely a 40" flat screen TV is out of the question. So is Caribbean vacations every 6 months. The issue is that he is so financially strapped right now it's just ridiculous. When I advocate for society to not let him be poor what I mean is to allow him a basic quality of life and dignity within that.

He ought to be given rental assistance, food assistance and utility assistance. I don't think this is considered over the top.

And society needs to do away with the 2 year Medicare wait. That's just obscene.

[ShortcutToMoncton]

Makes sense.

greg

[turtle777]

Originally Posted by lexapro 

And society needs to do away with the 2 year Medicare wait. That's just obscene.

Then you should be voting AGAINST the Health Care bill.

Waiting periods and rationing are the ONLY way to control spending in a government controlled health care system. Look at the prime examples of Canada and the UK, it's all controlled via rationing.

To be honest, I do think that's ok for Medicare, since it's a "free" service.

But PLEASE don't f*ck up the good health care that many American's have, just to make it more "fair".

It's like imposing a 500% tax on luxury vehicles, so that everyone could only drive a Chrysler.

-t

[besson3c]

Turtle: stop spinning the **** out of this stuff, please.

Firstly, the health care bill on the table now is not a single payer system like Canada's. It is not tax payer funded, it is not a government takeover, and it is not even universal health care, AFAIK.

Secondly, we have rationing now, the insurance companies decide what they will and will not cover. Rationing is going to happen in any system. However, the health care bill is targeted at providing a basic safety net ala Medicare. You cannot get the most bleeding edge treatments under such a system today, this will not change.

Thirdly, if waiting periods are so out of control in these other countries, why aren't people displeased as a whole with their system? Waiting periods are a problem of resource allocation, not some sort of given with a public health care system. You cannot tell me that waiting periods are a universal problem with all single payer systems, and even if you could, this would still be an apples/oranges comparison since what is being proposed is nothing like the single payer systems in these countries.

Finally, you are being very Abe like. You repeat and repeat and repeat your same old lectures and diatribes over and over again and fail to acknowledge the legitimacy to any other arguments, concerns, issues, tradeoffs, etc. There are always tradeoffs, what neither of us would want in an ideal situation is perfect.

I'm coming from this from the angle of a small business person, and also somebody that is connected to a lot of musicians. You work for a large company doing finance. Our vantage points are much different. A basic safety net as Greg described is quite desirable, it is no fun to live in fear of getting sick.

I purchase health insurance for myself that has a very high deductible. The reason I have this plan is to cover the most catastrophic sorts of accidents. I'm doing pretty well financially, but I realize that paying this deductible alone in the event of a catastrophe would hurt me a great deal, although even there are other people that would be far worse off. This plan basically just allows an event like this to be pretty bad, rather than bad of epic proportions.

We get it, you don't think that we should have safety nets, that the government would be bad at running this, blah blah blah. You don't have to repeat your arguments, I'm just trying to get you to see this through the lens of somebody else. I'm all for what ebuddy wants to do in getting private insurance companies to compete against each other, I just don't think that it will be enough or terribly effective at this point for a host of reasons which I won't bother repeating either.

If you really want to have this discussion, I would suggest demonstrating a slightly more open mind and preaching less. I'm pretty much tuning you and the others out at this point. I know your response, about how I'm a hypocrite, etc. Spare me, I don't care. I probably am.

[turtle777]

Originally Posted by besson3c 

Turtle: stop spinning the **** out of this stuff, please.

Since I'm talking to a broken record, I got nothing else to respond.

Everyone else will recognize the merit of my points.

-t

[besson3c]

You must find everyone else to be complete morons then, given your repetition.

[turtle777]

Originally Posted by besson3c 

You must find everyone else to be complete morons then, given your repetition.

Does everyone share your opinion ?

-t