Let’s see how prescient Let’s see how prescient Piggington readers are.
I’m predicting that John Robert and Anthony Kennedy still will side with the liberal wing of the Court. Perhaps Scalia will too.
Time will tell…
Allan from Fallbrook
March 25, 2012 @
10:00 PM
Brian: Who’s SOCTUS? Brian: Who’s SOCTUS?
briansd1
March 25, 2012 @
11:11 PM
Opps… my fingers type Opps… my fingers type faster than I can read.
Coronita
March 26, 2012 @
7:18 AM
It doesn’t really matter. It doesn’t really matter.
Insurance companies have already used obamacare as an excuse for why insurance premiums need to rise for everyone.
And as a result, employers have already used obamacare and the increase in insurance premiums as an excuse for why employees must now pay more for insurance…
Even if they did reverse obamacare in whole or part, the insurance companies aren’t going to be lowering premiums and even if insurance companies lower premiums, employers aren’t going to be start picking up the tab more like it was before….
The damage has already been done… No point in undoing it.
“But where the White House puts the burden for providing health care on employers, the Republican plan places it on individuals, who would be required to purchase health insurance in the same manner that most states require motorists to carry automobile insurance.”
Obamacare is essentially the Senate GOP plan from 20 years ago. But when implemented by a Kenyan Muslim, of course it is under attack.
The best thing to do is to get the plan repealed, elect Romney, have him implement the same plan again, the whole country will now be for the plan, and the country can heal.
ninaprincess
March 26, 2012 @
7:54 AM
I like parts of the law, I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.
briansd1
March 26, 2012 @
9:17 AM
BTW, you should answer this BTW, you should answer this survey objectively based on what you think the Supreme Court will decide, not what you want it to do.
I have no idea what they’ll I have no idea what they’ll do. But I really impressed my mom with my ability to recall wickard v filburn from law school. Sh heard about it on NPR …
sreeb
March 26, 2012 @
8:16 PM
ninaprincess wrote:I like [quote=ninaprincess]I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.[/quote]
There are plenty of young people who do have an IPhone but don’t have insurance. If you are young, single, and healthy you can probably afford the insurance if you pass on the IPhone.
My read:
Requiring you to purchase health insurance or anything else – not constitutional
Refusing care if you didn’t buy coverage and don’t have the money – constitutional
Reality
April 4, 2012 @
8:48 PM
sreeb wrote:
Refusing care if [quote=sreeb]
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This “opt out” idea for health insurance doesn’t fly because even if it was known that the patient couldn’t pay our society doesn’t have the stomach for denying care. And the uninsured know it.
The fact is that everyone is covered in some way (insurance or safety net) and should contribute.
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This “opt out” idea for health insurance doesn’t fly because even if it was known that the patient couldn’t pay our society doesn’t have the stomach for denying care. And the uninsured know it.
The fact is that everyone is covered in some way (insurance or safety net) and should contribute.[/quote]
Insurance isn’t the only way to pay for medial coverage. They could actually pay for the service. Why would it be OK to force them to pay for insurance but not OK to make someone pay the medical bill for services rendered to an uninsured trauma victim?
It isn’t a tax. It’s a fee for someone saving your ass.
The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.
UCGal
April 5, 2012 @
8:37 AM
sdduuuude wrote:
The supreme [quote=sdduuuude]
The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.[/quote]
Poor people were considered in the law. There is a sliding scale of subsidy for the coverage – up to household incomes 4x the poverty level.
People below 133% of the poverty level get medicaid.
no_such_reality
April 5, 2012 @
8:45 AM
Healthcare is broken in the Healthcare is broken in the US.
My wife recently spent a evening in the ER being checked for internal injuries after a vehicle accident. Of the five people in the ER that night, she was the only one with insurance. Determined by listening to the people telling the ER nurses they didn’t have insurance.
After determining no injuries beyond bruising, the bill arrived at over $10,000. She was there 4 hours.
poorgradstudent
April 5, 2012 @
10:03 AM
I honestly think the Supreme I honestly think the Supreme Court could go any of the three listed directions when they rule. It sounded like Kennedy wasn’t very sympathetic to the mandate. Roberts is a conservative but also has ties to the insurance companies who LOVE the mandate. A 4-3-2 split of opinions is possible, and who knows how they might resolve that kind of split?
[quote=no_such_reality]Healthcare is broken in the US.[/quote]
It really is. I’m not convinced the ACA is anything more than minor first aid on a deep, festering wound. It might help a little bit, but unfortunately real, better options like single payer were stripped out in order to compromise with moderates.
That said, what alternatives are Republicans and conservatives really offering? Their message seems to be “Let’s repeal Obamacare and go back to the way it was before!” The trouble is, that system doesn’t work. Privatizing Medicare isn’t a real solution for anything other than cutting rich people’s taxes. I’d be a lot more open to “Repeal and Replace” if they had any real plan for “Replace”.
Anonymous
April 5, 2012 @
8:54 AM
sdduuuude wrote:The supreme [quote=sdduuuude]The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ?[/quote]
It is the right question. And there is a clear answer.
The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.
(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)
The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the “system” in some way at some point.
It’s not a “slippery-slope” when there is a clear boundary defining one side and the other.
sdduuuude
April 5, 2012 @
10:10 AM
pri_dk wrote:sdduuuude [quote=pri_dk][quote=sdduuuude]The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ?[/quote]
It is the right question. And there is a clear answer.
The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.
(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)
The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the “system” in some way at some point.
It’s not a “slippery-slope” when there is a clear boundary defining one side and the other.[/quote]
The clear boundary is “any area of commerce in which everyone participates” ?
That isn’t a slippery slope. That is the bottom of the hill.
Anonymous
April 5, 2012 @
11:49 AM
sdduuuude wrote:If the [quote=sdduuuude]If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates […][/quote]
Um…a bit circular in your logic there?
What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?
Only one.
Now I suppose we could change that number to zero.
Would that be a step forward?
sdduuuude
April 5, 2012 @
7:16 PM
pri_dk wrote:What industry is [quote=pri_dk]What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?
Only one.
[/quote]
Well, maybe that’s the problem.
sdduuuude
April 5, 2012 @
10:19 AM
pri_dk wrote:The government [quote=pri_dk]The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.[/quote]
Let me get this straight. If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates, then they can force anyone to do anything at any time and control everything? Sounds like a great vision for America.
This is such a disasterous abuse of power, I can hardly find the words to describe how stupid it is. There are so many things wrong with this concept, I can’t believe anyone could support it.
Justifying this kind of control because “the healthcare system is broken” shows how much you all believe that you have the right to tell basically everyone in the country how to live their lives, as long as Congress says its OK.
The government needs to stay the hell out of people’s personal decisions. Period.
Lets let people how make the right decisions for themselves. If you need the government to make this decision for you, you might as well just give them your whole paycheck and let them decide which house you should buy, where to live, what food to eat, and on and on and on.
enron_by_the_sea
April 5, 2012 @
9:37 AM
sreeb wrote:
Requiring you to [quote=sreeb]
Requiring you to purchase health insurance or anything else – not constitutional
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
Charge anything (i.e. Rip off) to the person seeking healthcare in the name of free market – also constitutional!
blahblahblah
April 5, 2012 @
10:31 AM
ninaprincess wrote:I like [quote=ninaprincess]I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.[/quote]
Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc…) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don’t have a choice because the country is run by the people, not the corporations.
In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.
bearishgurl
April 5, 2012 @
11:00 AM
CONCHO wrote: . . . In the US [quote=CONCHO] . . . In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.[/quote]
CONCHO, I agree with this post except the first sentence. “Reputable” insurance companies DO pay and have $5M or unlimited life caps if the worst happens. One needs to be careful in their selection of a plan. If it looks too cheap or you’ve never heard of it, leave it alone.
I agree that MUCH more copay/coinsurance will be put on the consumer in the future. There is nothing wrong with this. MANY people currently abuse the $10/$15 co-pay system and see medical professionals several times per month over problems and “over-testing” that I would visit Rite Aid for an OTC remedy because I have an individual HDHP and they have a “comprehensive plan” (mostly or all paid for by the government or an employer). They do it because they never see the bill. All these visits are for naught when the patient is finally “prescribed” ibuprofen, “rest” or a common antibiotic cream.
dumbrenter
April 5, 2012 @
11:39 AM
CONCHO wrote: Switzerland [quote=CONCHO] Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc…) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don’t have a choice because the country is run by the people, not the corporations.
In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.[/quote]
Among the partisan crap that swirls around the healthcare discussion, it is nuggets of information like these that make reading this page worthwhile.
Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor’s interest to make this clear in the contract. And patients have no idea what their best interest is…most of them anyway.
Anonymous
April 5, 2012 @
11:57 AM
dumbrenter wrote:Those of you [quote=dumbrenter]Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway.[/quote]
Yup.
I find it hilarious that all these folks with private insurance cry “I was able to get health insurance, what’s the problem?”
They have no idea if the company will ever pay any claims.
If the insurance company doesn’t pay for your car accident injuries, go ahead and sue them. Good luck!
There’s the ol’ saying: “You don’t need insurance until you need it.”
Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.
an
April 5, 2012 @
12:04 PM
pri_dk wrote:Regardless of [quote=pri_dk]Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.[/quote]
If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?
Anonymous
April 5, 2012 @
12:41 PM
AN wrote:If the ultimate goal [quote=AN]If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?[/quote]
There are lots of alternatives. That may be a good one.
Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.
Saying “NO!” to every proposal in between temper-tantrums about “socialism” does not qualify as adult conversation.
an
April 5, 2012 @
1:40 PM
pri_dk wrote:[There are lots [quote=pri_dk][There are lots of alternatives. That may be a good one.
Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.
Saying “NO!” to every proposal in between temper-tantrums about “socialism” does not qualify as adult conversation.[/quote]
Sorry, but I put blame on both side. Why can’t both side come up with a solution that is bipartisan (i.e. both side would be OK w/ the solution). It’s not an adult conversation when one side say, we’re in control, we don’t care what you say because your vote doesn’t matter, so we’ll do whatever we want. Then whine about it when the other side gain back some of the control and want to repeal it. This is more of a general statement than just healthcare. You can’t possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.
Anonymous
April 5, 2012 @
2:08 PM
AN wrote:Why can’t both side [quote=AN]Why can’t both side come up with a solution that is bipartisan […][/quote]
You must not have been following the same debate I was.
I was a Republican all my life, but the healthcare debate ended any loyalty I had.
“Socialism, death-panels, government takeover of health care…”
There was no sincere effort on the part of the Republicans to debate. They had no proposal then, and still have no plan now. They never attempted even the most modest compromise, they went “all in” hoping it would fail in order to score political points against Obama. And they are still playing that desperate hand.
[quote]You can’t possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.[/quote]
No I’m not surprised at all that the Republicans would want to do something out of spite and as an attempt to seize political power. That’s all they are about these days. They don’t even bother to propose ideas – all they do is attack the other side. “Repeal and replace” is not a solution – it’s another term for “go back to square one.”
The fact that much of the current legislation they brand as an abomination is basically the same as historical Republican plans (going all the way back to Nixon) is proof that the Republicans have no interest in progressing any agenda that will fix healthcare. All they care about is hurting Obama. It’s a destructive fixation.
The Republican agenda is as transparent as it gets. It is obvious that has nothing to do with the health of the American people.
an
April 5, 2012 @
3:04 PM
pri_dk, funny, because I’m pri_dk, funny, because I’m actually coming from the other side. I was a registered Democrat for most of my life until recently. Now, I’m an independent. I see both the D & R’s agenda as transparent and neither side are really willing to talk about the real solution. They all are saying, it’s my way or the highway.
an
April 5, 2012 @
3:05 PM
dup. dup.
livinincali
April 5, 2012 @
12:51 PM
The fundamental problem with The fundamental problem with Healthcare is there’s a virtual unlimited amount of demand for services especially if people don’t have to pay for them. In essence America had the best treatments available and you don’t have to wait to access them. Because of this the cost is incredibly high.
A single payer system lowers the cost but the effect is waiting for treatment. The reason it costs less is you have fewer doctors and hospitals providing that treatment so the cost is lower.
In pay to get treatment countries (Mexico, China, India, etc.) you have world class services available but you have to be wealthy enough to pay for them. You limit the demand for world class services through the cost. Low quality services are available for a lowered cost.
What system does America really want. Do you want to tax everybody at an incredibly high rate to provide world class services to everybody? Do you want to ration care with a waiting line? Do you want to determine available of services through success/wealth? Do you want to try something different like access determined by future contribution to society (i.e. otherwise health young 25 year old gets treatment before 80 year grandpa)?
Our current path bankrupts us so we have to determine the best way to balance cost, availability of services, and who has access to them. This isn’t about what we wish we could do it’s about what we can do.
Anonymous
April 5, 2012 @
1:08 PM
livinincali,
Good post. You livinincali,
Good post. You are asking the right questions and it’s a horrible shame that our government cannot have a mature debate around these questions.
As far as what system we want, I would say America in general would be very happy with a hybrid system where the general public has access to basic healthcare, and premium services are available to those that want to pay more.
With this system Dick Cheney can still pay for his “Cadillac” insurance that gives him a $700K heart transplant but a poor kid who breaks his leg is not faced with the choice of bankrupting his family or walking with a limp for life.
Of course the tricky part comes into play is when someone in the single-payer system needs the $700K heart transplant, but extremely costly cases can be rationed by age and other humanitarian factors (yes I said rationed because, like you point out, allocation is an inescapable aspect of economics.)
lookingagain
April 5, 2012 @
1:36 PM
AN wrote:If the ultimate goal [quote=AN]If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?[/quote]
Because Obama and congress do not have the stomach to raise the medicare taxes that would be required to do this. Since almost everyone pays into the medicare system, and all at the same percentage of earned income, I would love to hear them explain to the country that regressive taxation as “their fair share.”
The system is indeed broken, and it cannot be fixed until everyone is aware of the true cost of healthcare. As long as someone else is paying, everyone involved has had every incentive to maximize benefits. Patients, doctors, hospitals, lawyers, pharmaceutical and device companies as well as the insurance companies, they all have spent the last 50 years milking the system.
Personally, I think that the only way out is to make the consumer aware of the true cost of care, and to regulate the providers (the industrial players, not just the doctors) much like we regulate utilities.
bearishgurl
April 5, 2012 @
3:12 PM
dumbrenter wrote:…Those of [quote=dumbrenter]…Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor’s interest to make this clear in the contract. And patients have no idea what their best interest is…most of them anyway.[/quote]
dumbrenter, I’ve been on HDHP for 8 years. It IS spelled out what they cover and what will be applied to your (large) deductible when you sign up – that is – ALL x-rays, lab, special procedures and testing ordered by a doctor will be applied to your deductible UNLESS the carrier deems those x-rays, lab, special procedures or testing “preventative health.” The term “preventative health” means different things depending on age and gender (and whether they have already paid for same or a similar procedure in the recent past.
Vison care is an add-on with most HDHP’s. I have vision and discount dental thru other organizations so don’t have them with my medical carrier.
EVERYTHING is spelled out in the plan from the beginning, the copays (PCP, specialist, urgent care, emergency room, generic drugs, brand-name drugs, etc). When your application is accepted and your policy is issued for an agreed-upon monthly premium, a formulary is sent with that policy showing what drugs they cover and don’t cover. The policy also explains the procedure for signing up for clinical trials, getting surgery approved in advance, etc. The staffs of the vast majority of the GREAT doctors in SD who take the reputable HDHPs ALREADY KNOW exactly what these plans cover and how to go about getting advance approvals for surgery, lab work, special procedures and tests. In addition, they know how to bill appropriate “preventative care” properly so it will be covered 100% by the plan.
Most of the HDHPs cover at least $400 of “preventative care” per year without applying any of it to the patient’s deductible. Some cover MUCH MORE, depending on the patient’s age, gender and utilization.
HDHP medical bills are usually processed within one week and the patient can see the EOB’s online and print them out if they wish. I’m very happy with the huge choice of providers and service of the carrier.
I like healthcare the way it is set up now but this could change in March 2014 when I feel that myself and many more thousands of the “healthiest” HDHP subscribers in CA will be subject to much larger rate hikes. At that time, the HCRA provision allowing carriers to charge premiums based upon initial underwriting and utilization will end and the relatively “healthy” subscribers will no doubt be charged enough premium to subsidize the HDHP premiums of our vast brethren “contemporaries” who didn’t take such stellar care of themselves over the years.
If I didn’t have access to a HDHP, I could NOT afford the monthly premiums and I am not alone. A comprehensive individual HMO or PPO plan can be VERY costly between the ages of 50 and 65.
Hopefully, I won’t be priced out of coverage before I become eligible for Medicare (IF it’s still available) :={
jwizzle
April 6, 2012 @
9:14 AM
bearishgurl wrote:
EVERYTHING [quote=bearishgurl]
EVERYTHING is spelled out in the plan from the beginning, the copays (PCP, specialist, urgent care, emergency room, generic drugs, brand-name drugs, etc). [/quote]
I think the problem with your logic is that it isn’t spelled out in a way most people can understand. I have a HDHP. I am pregnant, and was trying to figure out how much my delivery is going to cost. I had to call up the broker to get them to explain it to me (with certainty, I had an idea) because there were so many conditions/caveats… and I am a lawyer. I read/write complicated things for a living. I can’t imagine what it is like for “normal people” who don’t read complex contracts on a regular basis, and who are sick and trying to decide what path to take under a HDHP. And therein lies the problem with those plans – people can legitimately not know what they are getting themselves into and/or not know if they should fight denials, because the interplay between what is and isn’t covered can be so complex.
jstoesz
April 4, 2012 @
10:04 PM
sounds like you are making an sounds like you are making an argument for taxing poor people…
no_such_reality
April 5, 2012 @
9:49 AM
Well when you all get don’t Well when you all get don’t arguing the constitution we can talk about the real issue
Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.
bearishgurl
April 5, 2012 @
10:13 AM
no_such_reality wrote:Well [quote=no_such_reality]Well when you all get don’t arguing the constitution we can talk about the real issue
Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.[/quote]
Mr Cheney was no doubt insured and his “deep-pocketed” carrier paid most or all of his transplant bill (over and above the pittance paid by Medicare). It was probably a “Cadillac Plan” that he retained from his former cabinet position. I’m not as concerned about this as I am undocumented immigrants and border-crossers receiving care (incl “emergency” maternity) that clog the hospital emergency rooms in this county. These are the cases that affect ALL of our rates as the money to keep these ER’s open has to come from somewhere.
bearishgurl
April 5, 2012 @
10:01 AM
Part of the reason for having Part of the reason for having health insurance is having negotiated rates for care. A self-pay would have to negotiate their own bill (I was successful in doing this once for a bill which encompassed a large deductible). I got it down from about a $2750 copay to <$800 by negotiating out frivolous charges. But to do this, I had to show up at a meeting at the billing office with my portion of the bill that I was responsible for and set up a payment plan for six months. If I fell off the plan, my bill would go back up to $2750 and be referred to collections.
I ended up paying it in full in four months.
Lots of self-payors just ignore the bills or give fake addresses to the ER when they're being seen. They don't care if their bills are reported to collections because they don't have any assets and some are homeless or don't even live in the US.
I don't see how paying for health insurance coverage is going to be successfully enforced on anyone. It's like auto insurance. In some parts of the county (San Ysidro, for one), 73% of drivers are “uninsured” and the common limit of liability in Mexico (for those that are insured there) is $3K per vehicle. Yet they still drive and still sue the insured for injuries. Thankfully, the uninsured in a motor vehicle accident within CA can now only get their actual medical bills covered (paid directly) and property damage paid for (as part of tort reform). They CANNOT recover any punitive damages, so it’s not worth it anymore for them to “set up” an “accident” with a (presumed) insured driver.
sdduuuude
April 5, 2012 @
10:31 AM
Hey – I know. Lets force Hey – I know. Lets force people to do it my way.
That always works.
Welcome to China.
sdduuuude
April 5, 2012 @
7:41 PM
I just wish we could separate I just wish we could separate the market from the charity.
In other words, let the health-care market work like a market, with competing providers, prices set based on costs, demand, competition, etc. Let 1000 different people try 1000 different business plans and let the best rise to the top.
Then, if it turns out everyone can’t afford it, you provide money from a charity/welfare pool to give assistance to those who need the services and can’t afford it. Limit the distribution of those funds so that costs don’t go through the roof and you will find some sense of reasonability in the system.
Problem is, everyone tries to manipulate the market to include the charity within the market, which ruins the market, really for everyone, because you end up with no competition, individuals within government making decisions for millions of people and artificially high prices.
sdduuuude
April 5, 2012 @
7:49 PM
oops oops
sdduuuude
April 5, 2012 @
7:49 PM
Kind of like food stamps.
The Kind of like food stamps.
The government doesn’t force bread-makers and farmers to make a certain kind of bread or to price the bread at certain levels, or to sell bread to anyone who wants it – even if they can’t afford it.
And I think I can say, without fear of contradiction that EVERYONE participates in the food industry. Maybe we should make everyone buy only health food. Yeah. That’s the way I want it, so lets just force everyone to do it. That works every time, says the government official.
Anonymous
April 5, 2012 @
8:37 PM
sdduuuude wrote:And I think I [quote=sdduuuude]And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.[/quote]
Sorry, but you keep forcing an equivalence that just isn’t there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That’s the distinction. If you don’t understand this key point you are being disingenuous.
Your suggestion that we eliminate this distinction by removing the requirement to provide care to all does have practical advantages. And it is consistent with everything else – if you can’t afford it tough luck. But it would be hard to implement even if somehow we decided it was a good alternative. First, it’s not just the law, doctors have ethical codes that are similar. Also, we often simply don’t know if someone has the capacity to pay when they go to the hospital. They may be unconscious and, even if they have insurance, hospitals don’t know all the details of coverage.
The reality is that healthcare is a very complicated economic problem. It is by far the most complicated product there is. Attempts to dumb it down and compare it to other goods and services just don’t work.
Just a few characteristics that make healthcare unique (in addition to what I pointed out above):
– There are huge cost differences between applying preventative care early and treating problems later (save $80 and skip that checkup and you may end up with a $100,000 problem.)
– The benefits of the same treatment applied to two people can be drastically different (e.g. giving an 8 year old vs. an 80 year old a new heart.)
– The massive variability and unpredictability in costs (I myself haven’t been to the doctor except for a checkup in over five years, but may get into a car accident tomorrow.)
– The influence of personal choices (e.g. smoking or skydiving) on risks.
– Our ethical obligation as a society to provide basic needs, especially for children who cannot provide for themselves. (Like you said, it’s a combination of product and a charity some ways.)
This list could go on much longer. The point is that healthcare needs a comprehensive solution.
People working at corporations with insurance coverage think it’s easy (I used to think it was easy too). It is not. Try starting a business when you have a family and you will quickly learn what a mess our healthcare system is. The idea that the cost and ability to access healthcare is primarily a function of who you work for is ridiculous. Yet, that’s what we have in America today.
ocrenter
April 5, 2012 @
9:54 PM
I was talking to someone who I was talking to someone who I consider to be very level headed and reasonable the other day. He said he was not in favor of the health care bill. I assumed it was the mandate. And he said no, in fact he thought it was quite logical. But then he mentioned there’s a clause in which all Muslims will be exempt from the bill! I asked him did he actually read the bill?
Of course not, turned out theres been a lot of chain e-mails making the rounds. if you are registered Republican chances are you received one of these.
Here’s what factcheck.org has to say about this one:
pri_dk wrote:sdduuuude [quote=pri_dk][quote=sdduuuude]And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.[/quote]
Sorry, but you keep forcing an equivalence that just isn’t there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That’s the distinction. If you don’t understand this key point you are being disingenuous.
[/quote]
I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can’t afford to pay for it?
So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can’t afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers’ rights.
My point is this: That providers are forced to provide, even for free, is a major part of the problem. My comments about separating the charity from the market itself apply here – the gov gives food stamps so they don’t have to interfere in the bread market. Beaurocrats don’t have to create recipes, bake, ship, and distribute bread, thank god.
Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.
Also note – it eliminates all the political discussions of providers, price, service, etc. It takes the gov out of the market. We would be left with the tax burden of providing for the free-riders, but it would be explicit, not hidden in a complete beaurocratic bastardization of a market.
His “let it be” comment rings true with me – as in, let the market be a market.
sdduuuude
April 5, 2012 @
11:54 PM
I can simplify all this:
If I can simplify all this:
If you put together a plan and at some point you decide or realize that, due to the plan, it is necessary to force everyone in the country to buy something that they might otherwise not choose to buy, then there’s probably something wrong with the plan.
livinincali
April 6, 2012 @
6:56 AM
I understand your point. That
I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can’t take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don’t treat patient regardless of their ability to pay.
It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.
ocrenter
April 6, 2012 @
7:16 AM
livinincali wrote:
I [quote=livinincali]
I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can’t take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don’t treat patient regardless of their ability to pay.
It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.[/quote]
Very good point on the role of Medicare in “making” hospitals take the uninsured.
The bottom line here is we as a society have already gone half way. And going half way is costing us dearly. Either we roll back to a China equivalent, which means getting rid of Medicare as well as EMTALA, or we take the next step, which is the mandate.
The fear with the repeal is we then do nothing for another couple more decades when the problem goes from bad to worse.
Anonymous
April 6, 2012 @
7:16 AM
sdduuuude wrote:I understand [quote=sdduuuude]I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can’t afford to pay for it?[/quote]
Both government and the medical industry have a requirement to provide care – it’s part of their ethical standards. I can’t say I know all the specifics, but I think it is not easy to separate the laws from the ethical codes.
Personally, I wouldn’t so quickly dismiss this as a “bad decision” although there are no doubts limits to the feasibility.
[quote]So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can’t afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers’ rights.[/quote]
Sorry but you are arguing the slippery slope again and there just isn’t one. Plus there is no “providers rights” issue here at all. There are no healthcare providers that feel that their rights are being violated. They want to provide care – to everybody. It’s what they do. Of course they need to do it in an economically feasible way. The healthcare industry is a mix of for profit and non-profit businesses (yet another reason it is different…)
[quote][…] the gov gives food stamps so they don’t have to interfere in the bread market. Beaurocrats don’t have to create recipes, bake, ship, and distribute bread, thank god.[/quote]
Again, I think you are overreaching with your analogy. The new legislation does not tell providers how to provide care. It does nothing analogous to “create recipes, bake, ship, and distribute bread.”
[quote]Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.[/quote]
Well, that’s basically what we have now and it doesn’t work for many reasons.
His “let it be” comment rings true with me – as in, let the market be a market.[/quote]
Sorry but that article is very flawed. The the most glaring issue is that he is comparing the US system with countries that are heavily government subsidized and he doesn’t even realize it.
He’s right that costs have to come down but “allowing consumers to purchase insurance across state lines” – although a good idea – is hardly going to solve the cost problem alone.
I think your goal of “taking government out of the market” is honestly a bit naive. Healthcare is incredibly complicated. Because of the risks and variability there have to be shared risk pools (i.e. insurance) and there is no way that 300 million people can manage it all themselves as individuals.
Like I said before, you can’t “dumb down” healthcare economics to the level of grocery shopping. (In economics parlance it is a market with a massive amount of Information Asymmetry: http://en.wikipedia.org/wiki/Information_asymmetry) One side (insurance companies) has all the information. They write the contracts, they know the costs, the treatments, etc. The other side (the consumer) cannot possibly keep up.
Markets with information asymmetry need government to referee. There are lots of examples where this works well (mortgages, insurance, stock market, …)
Many people who are healthy or have decent employer-provided insurance have no idea how complicated it is. You go to the doctor, the bill gets paid. Anybody who has to get their own insurance quickly learns that it’s a mess: You have no idea what you are really buying, no idea if the insurance company will honor claims, no idea how to dispute it if they don’t…
I suppose one can just not get insurance and live in fear of bankruptcy. And if you have a spouse and a few kids, your risk of bankruptcy is five times higher…
Although the individual mandate may turn out to be technically unconstitutional (I really have no guess either way), I don’t understand why people have such an issue with being required to buy something they’d be fools not to buy anyway.
ocrenter
April 6, 2012 @
7:49 AM
Agree with pri-dk. +1
As for Agree with pri-dk. +1
As for the republicans, after the last few years, this year I will take the extra effort to change to independent after being a republican since I started voting 2 decades ago.
no_such_reality
April 6, 2012 @
9:38 AM
Just extend medicare to all Just extend medicare to all and fund it with a flat income tax (on all AGI) and national sales tax. People will try it’s not fair to the poor, BS, one trip to the doctor costs them, and us, more than they’ll pay in taxes.
People can keep private insurance if they want for their cadillac plan or have the medicare for everything else.
Your company, if they are funding a health plan can then choose to stop and pocket the money, stop and provide you a stipend, or keep offering the plan.
It’ll get the people without insurance out of the most expensive point of treatment and into regular care.
It is that simple.
Want to complain about it not controlling costs? You must be stupid. If you can’t figure out that your medical bill is twice if not five times as much as it should be because they are covering for all the non-pays that are there. My recent ER visit is a prime example.
briansd1
April 6, 2012 @
10:14 AM
ocrenter wrote:
As for the [quote=ocrenter]
As for the republicans, after the last few years, this year I will take the extra effort to change to independent after being a republican since I started voting 2 decades ago.[/quote]
The Republicans have become the party of riled up pitchfork peasants. The have abandoned any pretense of intellectual honesty. ACA was the republican answer to health care reform all along. But when Obama too it on as his own, the Republicans choose to cut off their noses to spite their faces.
As to health care in general, as a developed nation, we tried the free-market method and it failed miserably based on what we spend as a portion of GDP.
sdduuuude
April 6, 2012 @
10:13 AM
pri_dk wrote:Quote:Similarly, [quote=pri_dk][quote]Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.[/quote]
Well, that’s basically what we have now and it doesn’t work for many reasons.[/quote]
No, that isn’t even close to what we have now.
Anonymous
April 6, 2012 @
1:06 PM
sdduuuude wrote:No, that [quote=sdduuuude]No, that isn’t even close to what we have now.[/quote]
Ok duuuude, c’mon.
We have a private healthcare market for insurance. It’s the only market for insurance.
We offer assistance to the needy through medicare, medicaid, various state programs, etc. (which are basically medical insurance programs.)
Not excatly what you described, but pretty damn close.
One could say that the new laws actually make it more like you described, by making more people participate in the private market.
One of the biggest problems is that the private “market” is so tied to employers. It’s a a very strange market – what you can buy, who you can buy it from, and what you actually get is mostly a function of who you work for.
That’s why we have medicare (because old people don’t have employers), that’s why some people don’t think there’s a problem (because they have no clue how much their employers pay for insurance), and that’s why we have self-employed people who have to prepare for a lawsuit with their insurance company every time they go to the doctor.
sdduuuude
April 6, 2012 @
11:01 PM
pri_dk wrote:One could say [quote=pri_dk]One could say that the new laws actually make it more like you described, by making more people participate in the private market.
.
.
.
That’s why we have medicare (because old people don’t have employers), that’s why some people don’t think there’s a problem (because they have no clue how much their employers pay for insurance), and that’s why we have self-employed people who have to prepare for a lawsuit with their insurance company every time they go to the doctor.[/quote]
Only comment I have about your post is this – you said the new laws make the market more of a free market, like I describe, because it forces more people to participate in the market. But, forcing people into the market, by definition, makes it not a free market – with 100% certainty.
Second, I agree with your comment about the wierdness of the market, which is really my point. It is such a convoluted system of “you must do this” and “you can’t do this” and price-fixing and welfare, it is soooooo not a free market.
That there are laws regarding what employers must provide makes it even less a free market – or, as you put, ‘wierd’
My thoughts on the medical profession are, admittedly, way out there. Would make Ron Paul look mainstream. So, I’ll just bow out. Too much typing to explain.
jstoesz
April 6, 2012 @
9:58 AM
Pri,
I wanted to point out Pri,
I wanted to point out one or two things from my wife’s experience. My wife worked for a couple years as an ER Physician Assistant. She and her co-physicians quite regularly had no ethical issue with not treating many if not most of their patients. But they were required to do so by law, by hospital administrators, and by threat of suit. Most people who go to the ER should not be there. Also, most people who go to the ER are quite easy to determine if they have insurance or not. This idea that most people come to the ER comatose or something is the rare exception to the rule. The majority of people show up for coughs, colds, tooth aches, and STD’s. Edit, I forgot the biggest draw of all. Drugs. Most people show up to the ER looking to get a fix.
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.
no_such_reality
April 6, 2012 @
10:21 AM
jstoesz wrote:
So this [quote=jstoesz]
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.[/quote]
And then what? Kid in theER ends up with pneumonia or untreated TB. The alcoholic is there because of potential OD. The homeless woman was there with scabbiies that ended inulcerations from the scratching because she didn’t (couldn’t or did t know how) to get the script filled
So we kick hem out of the ER for no pay. Then what? The cost just get higher.
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.[/quote]
And then what? Kid in theER ends up with pneumonia or untreated TB. The alcoholic is there because of potential OD. The homeless woman was there with scabbiies that ended inulcerations from the scratching because she didn’t (couldn’t or did t know how) to get the script filled
So we kick hem out of the ER for no pay. Then what? The cost just get higher.[/quote]
You seem to think most people come to the emergency room for real emergencies.
This is not the case. Most problems go away if you ignore them.
Anonymous
April 6, 2012 @
1:18 PM
jstoesz wrote:Most problems [quote=jstoesz]Most problems go away if you ignore them.[/quote]
Agreed. (Except when my wife tells me I’m wrong, because she has an instinct for these things…)
But if the 1% that don’t go away cost 1000 times more to fix because of delayed treatment, the total cost to the system goes up.
jstoesz
April 6, 2012 @
1:34 PM
pri_dk wrote:jstoesz [quote=pri_dk][quote=jstoesz]Most problems go away if you ignore them.[/quote]
Agreed. (Except when my wife tells me I’m wrong, because she has an instinct for these things…)
But if the 1% that don’t go away cost 1000 times more to fix because of delayed treatment, the total cost to the system goes up.[/quote]
Yeah, it definitely helps that I live with a physician. But I think emotionally, she has that burden of knowledge. Where as I can sit happily in my ignorance of all the bad stuff that could be wrong with me of which I am sure there is plenty 🙂
Anonymous
April 6, 2012 @
1:15 PM
no_such_reality wrote:And [quote=no_such_reality]And then what? Kid in theER ends up with pneumonia or untreated TB.[/quote]
My own daughter once went to the doctor with some chest congestion. I didn’t want to bother, but my wife knew better. My daughter had pneumonia.
If we skip the diagnosis because of cost, then we may end up paying way more for the treatment (or worse.)
I understand jstoesz’s point and there is probably room for improvement, but it’s only one issue. And there are many causes. Why do people with a cold go to the emergency room? Because they can’t afford to go to the doctor, and they don’t know if it’s a cold or if it’s something worse.
But all of this reinforces what I said before, the solution must be comprehensive.
A few band aids like changing ER policies, tort reform, or interstate insurance markets are not going to solve the core problem.
jstoesz
April 6, 2012 @
1:20 PM
the two Family medical the two Family medical practices my wife has worked for will take people for low or no out of pocket cost when they don’t have insurance. I think that is pretty much the rule not the exception.
I think we as a country need to get real about this problem.
Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
Problem is, people think there is some 3rd way where you pay 20 bucks a month and all your healthcare needs are taken care of. Unless we get honest about these two rationing methods, we will never come to a real solution.
Our current health market is rampant stealing from Peter to pay for Paul’s medical bills.
The ACA just institutionalizes the theft through premium supports and puts a happy civic duty face on it. It is still taking from one to give to another. But now those doing the taking don’t have to feel bad about it and deal with those pesky bill collectors.
no_such_reality
April 6, 2012 @
1:53 PM
jstoesz wrote:Seems to me [quote=jstoesz]Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
[/quote]
You have option 2 today, except you’re already also paying for option 1 with the services being provided at the most expensive point in the chain.
As for rationing, your care is already rationed. if you have an HMO/PPO, they ration it. Medicare, the government does. HDHP, the plan provider did before you signed up.
And it’s all rationed by your ability to continue to cover the payments.
davelj
April 6, 2012 @
2:31 PM
no_such_reality wrote:jstoesz [quote=no_such_reality][quote=jstoesz]Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
[/quote]
You have option 2 today, except you’re already also paying for option 1 with the services being provided at the most expensive point in the chain.
As for rationing, your care is already rationed. if you have an HMO/PPO, they ration it. Medicare, the government does. HDHP, the plan provider did before you signed up.
And it’s all rationed by your ability to continue to cover the payments.[/quote]
True. Any national health care proposal has to address two huge legacy issues:
(1) In the 90s, “The ratio of the average American doctor’s income to the average American employee’s income was about 5.5. In Germany, it was 3.4; Canada, 3.2; Australia, 2.2; Switzerland, 2.1; France, 1.9; Sweden, 1.5; the United Kingdom, 1.4.” There are a whole bunch of reasons for this, but no matter: it’s a fact. So, any “public option” will have to figure out a way to pay doctors less, which isn’t easy.
(2) Insurance: “An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, over double the administrative overhead in Canada, on a percentage basis.” So, how do you get rid of the legacy insurance system? A huge obstacle.
So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.
no_such_reality
April 6, 2012 @
3:03 PM
davelj wrote:So, there you [quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
Simple, single payer. If the Doctor’s office only needs to have staff that manages billing and determining what treatments are needed in what order from one source, you’ve just eliminated a massive amount of the administrative costs.
Look about for BG’s note about the Dr’s knowing how to work the plan. Well, they need to do that for all the plans. One plan, one thing to know.
One plan, one payment schedule, their comp get’s controlled by how efficient and hopefully effective they are.
Or, they could go the cash route. Then who cares how much they make, because people are free to spend their money how they want.
davelj
April 6, 2012 @
4:56 PM
no_such_reality wrote:davelj [quote=no_such_reality][quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
Simple, single payer. If the Doctor’s office only needs to have staff that manages billing and determining what treatments are needed in what order from one source, you’ve just eliminated a massive amount of the administrative costs.
Look about for BG’s note about the Dr’s knowing how to work the plan. Well, they need to do that for all the plans. One plan, one thing to know.
One plan, one payment schedule, their comp get’s controlled by how efficient and hopefully effective they are.
Or, they could go the cash route. Then who cares how much they make, because people are free to spend their money how they want.[/quote]
I hear ya but that wasn’t my point. My point is that there are enormous, monied interests vested in keeping the system as-is. Unless you’re willing to go up against the AMA and the health insurance complex… you can’t get anywhere.
Look, we should probably require the country’s largest banks to hold 50%-75% more capital than is currently required. Does anyone really think the banking complex is going to let that happen?
I’m not optimistic about our health care system. Those vested interests have enormous power and influence.
sdduuuude
April 6, 2012 @
11:11 PM
davelj wrote:So, there you [quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
I’d say the answer is … competition.
[quote=davelj]I hear ya but that wasn’t my point. My point is that there are enormous, monied interests vested in keeping the system as-is. Unless you’re willing to go up against the AMA and the health insurance complex… you can’t get anywhere.
I’m not optimistic about our health care system. Those vested interests have enormous power and influence.[/quote]
Seems like my opinions of the medical industry aren’t so far out there. (davelj continues to be one of my favorite posters here, by the way). The AMA is a monopoly – just like AT&T was execpt instead of keeping a watchful, untrusting eye on the AMA, the government gives it its full support in keeping that monopoly in-tact. Davelj’s comparison to banking ring true with me.
Anonymous
April 7, 2012 @
8:12 AM
davelj wrote:My point is that [quote=davelj]My point is that there are enormous, monied interests vested in keeping the system as-is.[/quote]
No, that’s not it at all.
Its about patriotism and self-reliance and respect for real American values!
BTW, Does anybody know where I can buy a really big American flag pin?
Seriously, I agree with your sentiment and I’m not optimistic about the health care system either.
The fact that a bunch of random strangers on the internet can have a more constructive debate than congress shows just how bad the situation is.
March 25, 2012 @ 9:31 PM
Let’s see how prescient
Let’s see how prescient Piggington readers are.
I’m predicting that John Robert and Anthony Kennedy still will side with the liberal wing of the Court. Perhaps Scalia will too.
Time will tell…
March 25, 2012 @ 10:00 PM
Brian: Who’s SOCTUS?
Brian: Who’s SOCTUS?
March 25, 2012 @ 11:11 PM
Opps… my fingers type
Opps… my fingers type faster than I can read.
March 26, 2012 @ 7:18 AM
It doesn’t really matter.
It doesn’t really matter.
Insurance companies have already used obamacare as an excuse for why insurance premiums need to rise for everyone.
And as a result, employers have already used obamacare and the increase in insurance premiums as an excuse for why employees must now pay more for insurance…
Even if they did reverse obamacare in whole or part, the insurance companies aren’t going to be lowering premiums and even if insurance companies lower premiums, employers aren’t going to be start picking up the tab more like it was before….
The damage has already been done… No point in undoing it.
March 26, 2012 @ 7:48 AM
http://articles.latimes.com/1
http://articles.latimes.com/1993-09-16/news/mn-35821_1_health-care-reform-plan
“But where the White House puts the burden for providing health care on employers, the Republican plan places it on individuals, who would be required to purchase health insurance in the same manner that most states require motorists to carry automobile insurance.”
Obamacare is essentially the Senate GOP plan from 20 years ago. But when implemented by a Kenyan Muslim, of course it is under attack.
The best thing to do is to get the plan repealed, elect Romney, have him implement the same plan again, the whole country will now be for the plan, and the country can heal.
March 26, 2012 @ 7:54 AM
I like parts of the law,
I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.
March 26, 2012 @ 9:17 AM
BTW, you should answer this
BTW, you should answer this survey objectively based on what you think the Supreme Court will decide, not what you want it to do.
March 26, 2012 @ 11:39 AM
I have no idea what they’ll
I have no idea what they’ll do. But I really impressed my mom with my ability to recall wickard v filburn from law school. Sh heard about it on NPR …
March 26, 2012 @ 8:16 PM
ninaprincess wrote:I like
[quote=ninaprincess]I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.[/quote]
There are plenty of young people who do have an IPhone but don’t have insurance. If you are young, single, and healthy you can probably afford the insurance if you pass on the IPhone.
My read:
Requiring you to purchase health insurance or anything else – not constitutional
Refusing care if you didn’t buy coverage and don’t have the money – constitutional
April 4, 2012 @ 8:48 PM
sreeb wrote:
Refusing care if
[quote=sreeb]
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This “opt out” idea for health insurance doesn’t fly because even if it was known that the patient couldn’t pay our society doesn’t have the stomach for denying care. And the uninsured know it.
The fact is that everyone is covered in some way (insurance or safety net) and should contribute.
April 5, 2012 @ 8:15 AM
JohnAlt91941 wrote:sreeb
[quote=JohnAlt91941][quote=sreeb]
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
But impractical. What happens if someone unconscious is taken to a trauma center? Is the hospital supposed to check insurance before treatment? This “opt out” idea for health insurance doesn’t fly because even if it was known that the patient couldn’t pay our society doesn’t have the stomach for denying care. And the uninsured know it.
The fact is that everyone is covered in some way (insurance or safety net) and should contribute.[/quote]
Insurance isn’t the only way to pay for medial coverage. They could actually pay for the service. Why would it be OK to force them to pay for insurance but not OK to make someone pay the medical bill for services rendered to an uninsured trauma victim?
It isn’t a tax. It’s a fee for someone saving your ass.
The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.
April 5, 2012 @ 8:37 AM
sdduuuude wrote:
The supreme
[quote=sdduuuude]
The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ? Forcing poor people to buy insurance seems like a tax on poor people to me.[/quote]
Poor people were considered in the law. There is a sliding scale of subsidy for the coverage – up to household incomes 4x the poverty level.
People below 133% of the poverty level get medicaid.
April 5, 2012 @ 8:45 AM
Healthcare is broken in the
Healthcare is broken in the US.
My wife recently spent a evening in the ER being checked for internal injuries after a vehicle accident. Of the five people in the ER that night, she was the only one with insurance. Determined by listening to the people telling the ER nurses they didn’t have insurance.
After determining no injuries beyond bruising, the bill arrived at over $10,000. She was there 4 hours.
April 5, 2012 @ 10:03 AM
I honestly think the Supreme
I honestly think the Supreme Court could go any of the three listed directions when they rule. It sounded like Kennedy wasn’t very sympathetic to the mandate. Roberts is a conservative but also has ties to the insurance companies who LOVE the mandate. A 4-3-2 split of opinions is possible, and who knows how they might resolve that kind of split?
[quote=no_such_reality]Healthcare is broken in the US.[/quote]
It really is. I’m not convinced the ACA is anything more than minor first aid on a deep, festering wound. It might help a little bit, but unfortunately real, better options like single payer were stripped out in order to compromise with moderates.
That said, what alternatives are Republicans and conservatives really offering? Their message seems to be “Let’s repeal Obamacare and go back to the way it was before!” The trouble is, that system doesn’t work. Privatizing Medicare isn’t a real solution for anything other than cutting rich people’s taxes. I’d be a lot more open to “Repeal and Replace” if they had any real plan for “Replace”.
April 5, 2012 @ 8:54 AM
sdduuuude wrote:The supreme
[quote=sdduuuude]The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ?[/quote]
It is the right question. And there is a clear answer.
The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.
(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)
The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the “system” in some way at some point.
It’s not a “slippery-slope” when there is a clear boundary defining one side and the other.
April 5, 2012 @ 10:10 AM
pri_dk wrote:sdduuuude
[quote=pri_dk][quote=sdduuuude]The supreme court asked the right question – where does the government’s power to force people to buy stuff stop ?[/quote]
It is the right question. And there is a clear answer.
The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.
(There are a few obscure exceptions, but they are not significant enough to be relevant and the law provides for many of these exceptions anyway.)
The healthcare market is unique and distinct from any other market. Everyone has health. Everyone needs healthcare and uses the “system” in some way at some point.
It’s not a “slippery-slope” when there is a clear boundary defining one side and the other.[/quote]
The clear boundary is “any area of commerce in which everyone participates” ?
That isn’t a slippery slope. That is the bottom of the hill.
April 5, 2012 @ 11:49 AM
sdduuuude wrote:If the
[quote=sdduuuude]If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates […][/quote]
Um…a bit circular in your logic there?
What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?
Only one.
Now I suppose we could change that number to zero.
Would that be a step forward?
April 5, 2012 @ 7:16 PM
pri_dk wrote:What industry is
[quote=pri_dk]What industry is obligated, by law, to provide everyone goods or services regardless of your ability to pay?
Only one.
[/quote]
Well, maybe that’s the problem.
April 5, 2012 @ 10:19 AM
pri_dk wrote:The government
[quote=pri_dk]The government can control an area of commerce in which everyone participates. And everyone uses the healthcare system.[/quote]
Let me get this straight. If the government can force everyone to participate in a particular area of commerce, and they can control any area of commerce in which everyone participates, then they can force anyone to do anything at any time and control everything? Sounds like a great vision for America.
This is such a disasterous abuse of power, I can hardly find the words to describe how stupid it is. There are so many things wrong with this concept, I can’t believe anyone could support it.
Justifying this kind of control because “the healthcare system is broken” shows how much you all believe that you have the right to tell basically everyone in the country how to live their lives, as long as Congress says its OK.
The government needs to stay the hell out of people’s personal decisions. Period.
Lets let people how make the right decisions for themselves. If you need the government to make this decision for you, you might as well just give them your whole paycheck and let them decide which house you should buy, where to live, what food to eat, and on and on and on.
April 5, 2012 @ 9:37 AM
sreeb wrote:
Requiring you to
[quote=sreeb]
Requiring you to purchase health insurance or anything else – not constitutional
Refusing care if you didn’t buy coverage and don’t have the money – constitutional[/quote]
Charge anything (i.e. Rip off) to the person seeking healthcare in the name of free market – also constitutional!
April 5, 2012 @ 10:31 AM
ninaprincess wrote:I like
[quote=ninaprincess]I like parts of the law, especially the requirement that individuals need to have health insurance coverage. I know many of you don’t like this. But if we don’t require individuals to have coverage then I think we should allow hospitals to kick out patients with no money to pay which as a society we are not ready to do. I know many small business owners with income above $100,000 chose not to buy health insurance.[/quote]
Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc…) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don’t have a choice because the country is run by the people, not the corporations.
In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.
April 5, 2012 @ 11:00 AM
CONCHO wrote: . . . In the US
[quote=CONCHO] . . . In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.[/quote]
CONCHO, I agree with this post except the first sentence. “Reputable” insurance companies DO pay and have $5M or unlimited life caps if the worst happens. One needs to be careful in their selection of a plan. If it looks too cheap or you’ve never heard of it, leave it alone.
I agree that MUCH more copay/coinsurance will be put on the consumer in the future. There is nothing wrong with this. MANY people currently abuse the $10/$15 co-pay system and see medical professionals several times per month over problems and “over-testing” that I would visit Rite Aid for an OTC remedy because I have an individual HDHP and they have a “comprehensive plan” (mostly or all paid for by the government or an employer). They do it because they never see the bill. All these visits are for naught when the patient is finally “prescribed” ibuprofen, “rest” or a common antibiotic cream.
April 5, 2012 @ 11:39 AM
CONCHO wrote: Switzerland
[quote=CONCHO] Switzerland does this and will fine citizens who do not have health insurance. However, there is one huge difference between the US version and the Swiss. Because the Swiss have a real country run by the people rather than a fascist corporatocracy run by a tiny untouchable elite, the Swiss law also mandates exactly what a health insurance policy covers (basically everything, no pre-existing exclusions, etc…) AND how much profit the insurance companies are allowed to make (not much, like 5% or so). The insurance companies HATE the Swiss system. However they don’t have a choice because the country is run by the people, not the corporations.
In the US system, you will be required to pay a bunch of money for a crappy policy that won’t pay for anything. Premiums will go up every year, the insurance companies will get fatter and more profitable, and people will die younger and faster than ever before.
It’s coming, it’s not going away, get used to it. Bend over and prepare to pay. The only advice I can give is to keep yourself as healthy as possible. If it is advertised on TV or radio, don’t eat it. Lower your stress level as much as possible. Fortunately here in SD we can always cross the border for excellent medical care at a reasonable price. The rest of the country won’t be so lucky.[/quote]
Among the partisan crap that swirls around the healthcare discussion, it is nuggets of information like these that make reading this page worthwhile.
Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor’s interest to make this clear in the contract. And patients have no idea what their best interest is…most of them anyway.
April 5, 2012 @ 11:57 AM
dumbrenter wrote:Those of you
[quote=dumbrenter]Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway.[/quote]
Yup.
I find it hilarious that all these folks with private insurance cry “I was able to get health insurance, what’s the problem?”
They have no idea if the company will ever pay any claims.
If the insurance company doesn’t pay for your car accident injuries, go ahead and sue them. Good luck!
There’s the ol’ saying: “You don’t need insurance until you need it.”
Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.
April 5, 2012 @ 12:04 PM
pri_dk wrote:Regardless of
[quote=pri_dk]Regardless of the SCOTUS outcome, this is just a step the on long road to single payer. Someday we will catch up to the rest of the civilized word. The reason it is such a long road is one of our greatest national embarrassments.[/quote]
If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?
April 5, 2012 @ 12:41 PM
AN wrote:If the ultimate goal
[quote=AN]If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?[/quote]
There are lots of alternatives. That may be a good one.
Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.
Saying “NO!” to every proposal in between temper-tantrums about “socialism” does not qualify as adult conversation.
April 5, 2012 @ 1:40 PM
pri_dk wrote:[There are lots
[quote=pri_dk][There are lots of alternatives. That may be a good one.
Before we can make any progress, we need a congress that is willing to have an adult conversation about the issues.
Saying “NO!” to every proposal in between temper-tantrums about “socialism” does not qualify as adult conversation.[/quote]
Sorry, but I put blame on both side. Why can’t both side come up with a solution that is bipartisan (i.e. both side would be OK w/ the solution). It’s not an adult conversation when one side say, we’re in control, we don’t care what you say because your vote doesn’t matter, so we’ll do whatever we want. Then whine about it when the other side gain back some of the control and want to repeal it. This is more of a general statement than just healthcare. You can’t possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.
April 5, 2012 @ 2:08 PM
AN wrote:Why can’t both side
[quote=AN]Why can’t both side come up with a solution that is bipartisan […][/quote]
You must not have been following the same debate I was.
I was a Republican all my life, but the healthcare debate ended any loyalty I had.
“Socialism, death-panels, government takeover of health care…”
There was no sincere effort on the part of the Republicans to debate. They had no proposal then, and still have no plan now. They never attempted even the most modest compromise, they went “all in” hoping it would fail in order to score political points against Obama. And they are still playing that desperate hand.
[quote]You can’t possibly be surprised that the side that were basically casted aside as irrelevant in the passing of the bill want to repeal it when they gain back some of the power.[/quote]
No I’m not surprised at all that the Republicans would want to do something out of spite and as an attempt to seize political power. That’s all they are about these days. They don’t even bother to propose ideas – all they do is attack the other side. “Repeal and replace” is not a solution – it’s another term for “go back to square one.”
The fact that much of the current legislation they brand as an abomination is basically the same as historical Republican plans (going all the way back to Nixon) is proof that the Republicans have no interest in progressing any agenda that will fix healthcare. All they care about is hurting Obama. It’s a destructive fixation.
The Republican agenda is as transparent as it gets. It is obvious that has nothing to do with the health of the American people.
April 5, 2012 @ 3:04 PM
pri_dk, funny, because I’m
pri_dk, funny, because I’m actually coming from the other side. I was a registered Democrat for most of my life until recently. Now, I’m an independent. I see both the D & R’s agenda as transparent and neither side are really willing to talk about the real solution. They all are saying, it’s my way or the highway.
April 5, 2012 @ 3:05 PM
dup.
dup.
April 5, 2012 @ 12:51 PM
The fundamental problem with
The fundamental problem with Healthcare is there’s a virtual unlimited amount of demand for services especially if people don’t have to pay for them. In essence America had the best treatments available and you don’t have to wait to access them. Because of this the cost is incredibly high.
A single payer system lowers the cost but the effect is waiting for treatment. The reason it costs less is you have fewer doctors and hospitals providing that treatment so the cost is lower.
In pay to get treatment countries (Mexico, China, India, etc.) you have world class services available but you have to be wealthy enough to pay for them. You limit the demand for world class services through the cost. Low quality services are available for a lowered cost.
What system does America really want. Do you want to tax everybody at an incredibly high rate to provide world class services to everybody? Do you want to ration care with a waiting line? Do you want to determine available of services through success/wealth? Do you want to try something different like access determined by future contribution to society (i.e. otherwise health young 25 year old gets treatment before 80 year grandpa)?
Our current path bankrupts us so we have to determine the best way to balance cost, availability of services, and who has access to them. This isn’t about what we wish we could do it’s about what we can do.
April 5, 2012 @ 1:08 PM
livinincali,
Good post. You
livinincali,
Good post. You are asking the right questions and it’s a horrible shame that our government cannot have a mature debate around these questions.
As far as what system we want, I would say America in general would be very happy with a hybrid system where the general public has access to basic healthcare, and premium services are available to those that want to pay more.
With this system Dick Cheney can still pay for his “Cadillac” insurance that gives him a $700K heart transplant but a poor kid who breaks his leg is not faced with the choice of bankrupting his family or walking with a limp for life.
Of course the tricky part comes into play is when someone in the single-payer system needs the $700K heart transplant, but extremely costly cases can be rationed by age and other humanitarian factors (yes I said rationed because, like you point out, allocation is an inescapable aspect of economics.)
April 5, 2012 @ 1:36 PM
AN wrote:If the ultimate goal
[quote=AN]If the ultimate goal is to be a single payer system, then why not just extend medicare to all those who are uninsured?[/quote]
Because Obama and congress do not have the stomach to raise the medicare taxes that would be required to do this. Since almost everyone pays into the medicare system, and all at the same percentage of earned income, I would love to hear them explain to the country that regressive taxation as “their fair share.”
The system is indeed broken, and it cannot be fixed until everyone is aware of the true cost of healthcare. As long as someone else is paying, everyone involved has had every incentive to maximize benefits. Patients, doctors, hospitals, lawyers, pharmaceutical and device companies as well as the insurance companies, they all have spent the last 50 years milking the system.
Personally, I think that the only way out is to make the consumer aware of the true cost of care, and to regulate the providers (the industrial players, not just the doctors) much like we regulate utilities.
April 5, 2012 @ 3:12 PM
dumbrenter wrote:…Those of
[quote=dumbrenter]…Those of you on HDHP know exactly what CONCHO says here. the language of the insurance contract is so vague that these guys deny half the annual checkup costs that they are supposed to cover anyway. did you physician perform vision test? Nope, that is not considered part of an annual exam. did you get blood drawn for a cholesterol screening? It is considered lab work and not part of annual exam, so sorry, we do not cover that.
It would have been very helpful if they clearly identify what they cover and what they do not, but obviously it is against their and the doctor’s interest to make this clear in the contract. And patients have no idea what their best interest is…most of them anyway.[/quote]
dumbrenter, I’ve been on HDHP for 8 years. It IS spelled out what they cover and what will be applied to your (large) deductible when you sign up – that is – ALL x-rays, lab, special procedures and testing ordered by a doctor will be applied to your deductible UNLESS the carrier deems those x-rays, lab, special procedures or testing “preventative health.” The term “preventative health” means different things depending on age and gender (and whether they have already paid for same or a similar procedure in the recent past.
Vison care is an add-on with most HDHP’s. I have vision and discount dental thru other organizations so don’t have them with my medical carrier.
EVERYTHING is spelled out in the plan from the beginning, the copays (PCP, specialist, urgent care, emergency room, generic drugs, brand-name drugs, etc). When your application is accepted and your policy is issued for an agreed-upon monthly premium, a formulary is sent with that policy showing what drugs they cover and don’t cover. The policy also explains the procedure for signing up for clinical trials, getting surgery approved in advance, etc. The staffs of the vast majority of the GREAT doctors in SD who take the reputable HDHPs ALREADY KNOW exactly what these plans cover and how to go about getting advance approvals for surgery, lab work, special procedures and tests. In addition, they know how to bill appropriate “preventative care” properly so it will be covered 100% by the plan.
Most of the HDHPs cover at least $400 of “preventative care” per year without applying any of it to the patient’s deductible. Some cover MUCH MORE, depending on the patient’s age, gender and utilization.
HDHP medical bills are usually processed within one week and the patient can see the EOB’s online and print them out if they wish. I’m very happy with the huge choice of providers and service of the carrier.
I like healthcare the way it is set up now but this could change in March 2014 when I feel that myself and many more thousands of the “healthiest” HDHP subscribers in CA will be subject to much larger rate hikes. At that time, the HCRA provision allowing carriers to charge premiums based upon initial underwriting and utilization will end and the relatively “healthy” subscribers will no doubt be charged enough premium to subsidize the HDHP premiums of our vast brethren “contemporaries” who didn’t take such stellar care of themselves over the years.
If I didn’t have access to a HDHP, I could NOT afford the monthly premiums and I am not alone. A comprehensive individual HMO or PPO plan can be VERY costly between the ages of 50 and 65.
Hopefully, I won’t be priced out of coverage before I become eligible for Medicare (IF it’s still available) :={
April 6, 2012 @ 9:14 AM
bearishgurl wrote:
EVERYTHING
[quote=bearishgurl]
EVERYTHING is spelled out in the plan from the beginning, the copays (PCP, specialist, urgent care, emergency room, generic drugs, brand-name drugs, etc). [/quote]
I think the problem with your logic is that it isn’t spelled out in a way most people can understand. I have a HDHP. I am pregnant, and was trying to figure out how much my delivery is going to cost. I had to call up the broker to get them to explain it to me (with certainty, I had an idea) because there were so many conditions/caveats… and I am a lawyer. I read/write complicated things for a living. I can’t imagine what it is like for “normal people” who don’t read complex contracts on a regular basis, and who are sick and trying to decide what path to take under a HDHP. And therein lies the problem with those plans – people can legitimately not know what they are getting themselves into and/or not know if they should fight denials, because the interplay between what is and isn’t covered can be so complex.
April 4, 2012 @ 10:04 PM
sounds like you are making an
sounds like you are making an argument for taxing poor people…
April 5, 2012 @ 9:49 AM
Well when you all get don’t
Well when you all get don’t arguing the constitution we can talk about the real issue
Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.
April 5, 2012 @ 10:13 AM
no_such_reality wrote:Well
[quote=no_such_reality]Well when you all get don’t arguing the constitution we can talk about the real issue
Should Dick Cheney, and others like him at 71, get a heart transplant at a cost of more than $700,000? This Is the difficult question which is further complicated by who pays for it and how that paying for it affects costs for insurance coverage and care.[/quote]
Mr Cheney was no doubt insured and his “deep-pocketed” carrier paid most or all of his transplant bill (over and above the pittance paid by Medicare). It was probably a “Cadillac Plan” that he retained from his former cabinet position. I’m not as concerned about this as I am undocumented immigrants and border-crossers receiving care (incl “emergency” maternity) that clog the hospital emergency rooms in this county. These are the cases that affect ALL of our rates as the money to keep these ER’s open has to come from somewhere.
April 5, 2012 @ 10:01 AM
Part of the reason for having
Part of the reason for having health insurance is having negotiated rates for care. A self-pay would have to negotiate their own bill (I was successful in doing this once for a bill which encompassed a large deductible). I got it down from about a $2750 copay to <$800 by negotiating out frivolous charges. But to do this, I had to show up at a meeting at the billing office with my portion of the bill that I was responsible for and set up a payment plan for six months. If I fell off the plan, my bill would go back up to $2750 and be referred to collections. I ended up paying it in full in four months. Lots of self-payors just ignore the bills or give fake addresses to the ER when they're being seen. They don't care if their bills are reported to collections because they don't have any assets and some are homeless or don't even live in the US. I don't see how paying for health insurance coverage is going to be successfully enforced on anyone. It's like auto insurance. In some parts of the county (San Ysidro, for one), 73% of drivers are “uninsured” and the common limit of liability in Mexico (for those that are insured there) is $3K per vehicle. Yet they still drive and still sue the insured for injuries. Thankfully, the uninsured in a motor vehicle accident within CA can now only get their actual medical bills covered (paid directly) and property damage paid for (as part of tort reform). They CANNOT recover any punitive damages, so it’s not worth it anymore for them to “set up” an “accident” with a (presumed) insured driver.
April 5, 2012 @ 10:31 AM
Hey – I know. Lets force
Hey – I know. Lets force people to do it my way.
That always works.
Welcome to China.
April 5, 2012 @ 7:41 PM
I just wish we could separate
I just wish we could separate the market from the charity.
In other words, let the health-care market work like a market, with competing providers, prices set based on costs, demand, competition, etc. Let 1000 different people try 1000 different business plans and let the best rise to the top.
Then, if it turns out everyone can’t afford it, you provide money from a charity/welfare pool to give assistance to those who need the services and can’t afford it. Limit the distribution of those funds so that costs don’t go through the roof and you will find some sense of reasonability in the system.
Problem is, everyone tries to manipulate the market to include the charity within the market, which ruins the market, really for everyone, because you end up with no competition, individuals within government making decisions for millions of people and artificially high prices.
April 5, 2012 @ 7:49 PM
oops
oops
April 5, 2012 @ 7:49 PM
Kind of like food stamps.
The
Kind of like food stamps.
The government doesn’t force bread-makers and farmers to make a certain kind of bread or to price the bread at certain levels, or to sell bread to anyone who wants it – even if they can’t afford it.
And I think I can say, without fear of contradiction that EVERYONE participates in the food industry. Maybe we should make everyone buy only health food. Yeah. That’s the way I want it, so lets just force everyone to do it. That works every time, says the government official.
April 5, 2012 @ 8:37 PM
sdduuuude wrote:And I think I
[quote=sdduuuude]And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.[/quote]
Sorry, but you keep forcing an equivalence that just isn’t there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That’s the distinction. If you don’t understand this key point you are being disingenuous.
Your suggestion that we eliminate this distinction by removing the requirement to provide care to all does have practical advantages. And it is consistent with everything else – if you can’t afford it tough luck. But it would be hard to implement even if somehow we decided it was a good alternative. First, it’s not just the law, doctors have ethical codes that are similar. Also, we often simply don’t know if someone has the capacity to pay when they go to the hospital. They may be unconscious and, even if they have insurance, hospitals don’t know all the details of coverage.
The reality is that healthcare is a very complicated economic problem. It is by far the most complicated product there is. Attempts to dumb it down and compare it to other goods and services just don’t work.
Just a few characteristics that make healthcare unique (in addition to what I pointed out above):
– There are huge cost differences between applying preventative care early and treating problems later (save $80 and skip that checkup and you may end up with a $100,000 problem.)
– The benefits of the same treatment applied to two people can be drastically different (e.g. giving an 8 year old vs. an 80 year old a new heart.)
– The massive variability and unpredictability in costs (I myself haven’t been to the doctor except for a checkup in over five years, but may get into a car accident tomorrow.)
– The influence of personal choices (e.g. smoking or skydiving) on risks.
– Our ethical obligation as a society to provide basic needs, especially for children who cannot provide for themselves. (Like you said, it’s a combination of product and a charity some ways.)
This list could go on much longer. The point is that healthcare needs a comprehensive solution.
People working at corporations with insurance coverage think it’s easy (I used to think it was easy too). It is not. Try starting a business when you have a family and you will quickly learn what a mess our healthcare system is. The idea that the cost and ability to access healthcare is primarily a function of who you work for is ridiculous. Yet, that’s what we have in America today.
April 5, 2012 @ 9:54 PM
I was talking to someone who
I was talking to someone who I consider to be very level headed and reasonable the other day. He said he was not in favor of the health care bill. I assumed it was the mandate. And he said no, in fact he thought it was quite logical. But then he mentioned there’s a clause in which all Muslims will be exempt from the bill! I asked him did he actually read the bill?
Of course not, turned out theres been a lot of chain e-mails making the rounds. if you are registered Republican chances are you received one of these.
Here’s what factcheck.org has to say about this one:
http://www.factcheck.org/2010/05/dhimmitude-and-the-muslim-exemption/
April 5, 2012 @ 11:43 PM
pri_dk wrote:sdduuuude
[quote=pri_dk][quote=sdduuuude]And I think I can say, without fear of contradiction that EVERYONE participates in the food industry.[/quote]
Sorry, but you keep forcing an equivalence that just isn’t there. Grocery stores are not required by law to give food to someone that walks in and is starving. Emergency rooms are required to provide services. That’s the distinction. If you don’t understand this key point you are being disingenuous.
[/quote]
I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can’t afford to pay for it?
So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can’t afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers’ rights.
My point is this: That providers are forced to provide, even for free, is a major part of the problem. My comments about separating the charity from the market itself apply here – the gov gives food stamps so they don’t have to interfere in the bread market. Beaurocrats don’t have to create recipes, bake, ship, and distribute bread, thank god.
Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.
Also note – it eliminates all the political discussions of providers, price, service, etc. It takes the gov out of the market. We would be left with the tax burden of providing for the free-riders, but it would be explicit, not hidden in a complete beaurocratic bastardization of a market.
Here’s a guy that has an intersting viewpoint on the matter:
http://globaleconomicanalysis.blogspot.com/2012/04/massachusetts-health-care-system-model.html
His “let it be” comment rings true with me – as in, let the market be a market.
April 5, 2012 @ 11:54 PM
I can simplify all this:
If
I can simplify all this:
If you put together a plan and at some point you decide or realize that, due to the plan, it is necessary to force everyone in the country to buy something that they might otherwise not choose to buy, then there’s probably something wrong with the plan.
April 6, 2012 @ 6:56 AM
I understand your point. That
There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can’t take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don’t treat patient regardless of their ability to pay.
It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.
April 6, 2012 @ 7:16 AM
livinincali wrote:
I
[quote=livinincali]
There is a loophole in the EMTALA that theoretically allows a hospital to exist that can refuse treatments to patients but they can’t take a single cent from Medicare or Medicade. Therefore virtually no hospitals exist that don’t treat patient regardless of their ability to pay.
It might not be a bad idea to think about a private medical Co-Op type arrangement. Could you get a couple thousand households together paying $5,000 per year to setup a $10 million dollar a year local clinic/hospital. It would be an interesting case study about how low you could make medical costs if you eliminate all the middle men and figure out what care would actually be available on that kind of budget.[/quote]
Very good point on the role of Medicare in “making” hospitals take the uninsured.
The bottom line here is we as a society have already gone half way. And going half way is costing us dearly. Either we roll back to a China equivalent, which means getting rid of Medicare as well as EMTALA, or we take the next step, which is the mandate.
The fear with the repeal is we then do nothing for another couple more decades when the problem goes from bad to worse.
April 6, 2012 @ 7:16 AM
sdduuuude wrote:I understand
[quote=sdduuuude]I understand your point. That this is the only market where providers are forced to provide. But note Just note – they are forced to provide by the government. So, gov creates this situation that you say justifies their right to force people to buy something they might not choose to buy.
What I hear you saying is that the gov only has the right to force consumers to buy insurance in markets where they have already made the bad decision to force the providers in that inudstry into providing a product for anyone even if they can’t afford to pay for it?[/quote]
Both government and the medical industry have a requirement to provide care – it’s part of their ethical standards. I can’t say I know all the specifics, but I think it is not easy to separate the laws from the ethical codes.
Personally, I wouldn’t so quickly dismiss this as a “bad decision” although there are no doubts limits to the feasibility.
[quote]So, if they chose to force bread providers to sell bread to anyone who asks for it, even if they can’t afford it, then it would be OK to force all citizens to buy futures on bread? See my point? Perhaps the Supreme Court should focus on the providers’ rights.[/quote]
Sorry but you are arguing the slippery slope again and there just isn’t one. Plus there is no “providers rights” issue here at all. There are no healthcare providers that feel that their rights are being violated. They want to provide care – to everybody. It’s what they do. Of course they need to do it in an economically feasible way. The healthcare industry is a mix of for profit and non-profit businesses (yet another reason it is different…)
[quote][…] the gov gives food stamps so they don’t have to interfere in the bread market. Beaurocrats don’t have to create recipes, bake, ship, and distribute bread, thank god.[/quote]
Again, I think you are overreaching with your analogy. The new legislation does not tell providers how to provide care. It does nothing analogous to “create recipes, bake, ship, and distribute bread.”
[quote]Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.[/quote]
Well, that’s basically what we have now and it doesn’t work for many reasons.
[quote]Here’s a guy that has an intersting viewpoint on the matter:
http://globaleconomicanalysis.blogspot.com/2012/04/massachusetts-health-care-system-model.html%5B
His “let it be” comment rings true with me – as in, let the market be a market.[/quote]
Sorry but that article is very flawed. The the most glaring issue is that he is comparing the US system with countries that are heavily government subsidized and he doesn’t even realize it.
He’s right that costs have to come down but “allowing consumers to purchase insurance across state lines” – although a good idea – is hardly going to solve the cost problem alone.
I think your goal of “taking government out of the market” is honestly a bit naive. Healthcare is incredibly complicated. Because of the risks and variability there have to be shared risk pools (i.e. insurance) and there is no way that 300 million people can manage it all themselves as individuals.
Like I said before, you can’t “dumb down” healthcare economics to the level of grocery shopping. (In economics parlance it is a market with a massive amount of Information Asymmetry: http://en.wikipedia.org/wiki/Information_asymmetry) One side (insurance companies) has all the information. They write the contracts, they know the costs, the treatments, etc. The other side (the consumer) cannot possibly keep up.
Markets with information asymmetry need government to referee. There are lots of examples where this works well (mortgages, insurance, stock market, …)
Many people who are healthy or have decent employer-provided insurance have no idea how complicated it is. You go to the doctor, the bill gets paid. Anybody who has to get their own insurance quickly learns that it’s a mess: You have no idea what you are really buying, no idea if the insurance company will honor claims, no idea how to dispute it if they don’t…
I suppose one can just not get insurance and live in fear of bankruptcy. And if you have a spouse and a few kids, your risk of bankruptcy is five times higher…
Although the individual mandate may turn out to be technically unconstitutional (I really have no guess either way), I don’t understand why people have such an issue with being required to buy something they’d be fools not to buy anyway.
April 6, 2012 @ 7:49 AM
Agree with pri-dk. +1
As for
Agree with pri-dk. +1
As for the republicans, after the last few years, this year I will take the extra effort to change to independent after being a republican since I started voting 2 decades ago.
April 6, 2012 @ 9:38 AM
Just extend medicare to all
Just extend medicare to all and fund it with a flat income tax (on all AGI) and national sales tax. People will try it’s not fair to the poor, BS, one trip to the doctor costs them, and us, more than they’ll pay in taxes.
People can keep private insurance if they want for their cadillac plan or have the medicare for everything else.
Your company, if they are funding a health plan can then choose to stop and pocket the money, stop and provide you a stipend, or keep offering the plan.
It’ll get the people without insurance out of the most expensive point of treatment and into regular care.
It is that simple.
Want to complain about it not controlling costs? You must be stupid. If you can’t figure out that your medical bill is twice if not five times as much as it should be because they are covering for all the non-pays that are there. My recent ER visit is a prime example.
April 6, 2012 @ 10:14 AM
ocrenter wrote:
As for the
[quote=ocrenter]
As for the republicans, after the last few years, this year I will take the extra effort to change to independent after being a republican since I started voting 2 decades ago.[/quote]
The Republicans have become the party of riled up pitchfork peasants. The have abandoned any pretense of intellectual honesty. ACA was the republican answer to health care reform all along. But when Obama too it on as his own, the Republicans choose to cut off their noses to spite their faces.
As to health care in general, as a developed nation, we tried the free-market method and it failed miserably based on what we spend as a portion of GDP.
April 6, 2012 @ 10:13 AM
pri_dk wrote:Quote:Similarly,
[quote=pri_dk][quote]Similarly, we could let the healthcare market be a private market, but offer assistance for the needy to buy medical insurance from any number of competing businesses at market rates. I’m against the whole idea of such welfare, but if we insist on providing it, it is better to provide the welfare externally to the market rather than change the market to be more charitable. This way, people feel the true cost of healthcare – as someone said earlier.[/quote]
Well, that’s basically what we have now and it doesn’t work for many reasons.[/quote]
No, that isn’t even close to what we have now.
April 6, 2012 @ 1:06 PM
sdduuuude wrote:No, that
[quote=sdduuuude]No, that isn’t even close to what we have now.[/quote]
Ok duuuude, c’mon.
We have a private healthcare market for insurance. It’s the only market for insurance.
We offer assistance to the needy through medicare, medicaid, various state programs, etc. (which are basically medical insurance programs.)
Not excatly what you described, but pretty damn close.
One could say that the new laws actually make it more like you described, by making more people participate in the private market.
One of the biggest problems is that the private “market” is so tied to employers. It’s a a very strange market – what you can buy, who you can buy it from, and what you actually get is mostly a function of who you work for.
That’s why we have medicare (because old people don’t have employers), that’s why some people don’t think there’s a problem (because they have no clue how much their employers pay for insurance), and that’s why we have self-employed people who have to prepare for a lawsuit with their insurance company every time they go to the doctor.
April 6, 2012 @ 11:01 PM
pri_dk wrote:One could say
[quote=pri_dk]One could say that the new laws actually make it more like you described, by making more people participate in the private market.
.
.
.
That’s why we have medicare (because old people don’t have employers), that’s why some people don’t think there’s a problem (because they have no clue how much their employers pay for insurance), and that’s why we have self-employed people who have to prepare for a lawsuit with their insurance company every time they go to the doctor.[/quote]
Only comment I have about your post is this – you said the new laws make the market more of a free market, like I describe, because it forces more people to participate in the market. But, forcing people into the market, by definition, makes it not a free market – with 100% certainty.
Second, I agree with your comment about the wierdness of the market, which is really my point. It is such a convoluted system of “you must do this” and “you can’t do this” and price-fixing and welfare, it is soooooo not a free market.
That there are laws regarding what employers must provide makes it even less a free market – or, as you put, ‘wierd’
My thoughts on the medical profession are, admittedly, way out there. Would make Ron Paul look mainstream. So, I’ll just bow out. Too much typing to explain.
April 6, 2012 @ 9:58 AM
Pri,
I wanted to point out
Pri,
I wanted to point out one or two things from my wife’s experience. My wife worked for a couple years as an ER Physician Assistant. She and her co-physicians quite regularly had no ethical issue with not treating many if not most of their patients. But they were required to do so by law, by hospital administrators, and by threat of suit. Most people who go to the ER should not be there. Also, most people who go to the ER are quite easy to determine if they have insurance or not. This idea that most people come to the ER comatose or something is the rare exception to the rule. The majority of people show up for coughs, colds, tooth aches, and STD’s. Edit, I forgot the biggest draw of all. Drugs. Most people show up to the ER looking to get a fix.
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.
April 6, 2012 @ 10:21 AM
jstoesz wrote:
So this
[quote=jstoesz]
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.[/quote]
And then what? Kid in theER ends up with pneumonia or untreated TB. The alcoholic is there because of potential OD. The homeless woman was there with scabbiies that ended inulcerations from the scratching because she didn’t (couldn’t or did t know how) to get the script filled
So we kick hem out of the ER for no pay. Then what? The cost just get higher.
April 6, 2012 @ 1:12 PM
no_such_reality wrote:jstoesz
[quote=no_such_reality][quote=jstoesz]
So this problem of treating people at the ER could be minimized if we had the stomach as a society to throw the meth heads out on the street. But the lawyers, the administrators, and the law does not give physicians that kind of discretion.[/quote]
And then what? Kid in theER ends up with pneumonia or untreated TB. The alcoholic is there because of potential OD. The homeless woman was there with scabbiies that ended inulcerations from the scratching because she didn’t (couldn’t or did t know how) to get the script filled
So we kick hem out of the ER for no pay. Then what? The cost just get higher.[/quote]
You seem to think most people come to the emergency room for real emergencies.
This is not the case. Most problems go away if you ignore them.
April 6, 2012 @ 1:18 PM
jstoesz wrote:Most problems
[quote=jstoesz]Most problems go away if you ignore them.[/quote]
Agreed. (Except when my wife tells me I’m wrong, because she has an instinct for these things…)
But if the 1% that don’t go away cost 1000 times more to fix because of delayed treatment, the total cost to the system goes up.
April 6, 2012 @ 1:34 PM
pri_dk wrote:jstoesz
[quote=pri_dk][quote=jstoesz]Most problems go away if you ignore them.[/quote]
Agreed. (Except when my wife tells me I’m wrong, because she has an instinct for these things…)
But if the 1% that don’t go away cost 1000 times more to fix because of delayed treatment, the total cost to the system goes up.[/quote]
Yeah, it definitely helps that I live with a physician. But I think emotionally, she has that burden of knowledge. Where as I can sit happily in my ignorance of all the bad stuff that could be wrong with me of which I am sure there is plenty 🙂
April 6, 2012 @ 1:15 PM
no_such_reality wrote:And
[quote=no_such_reality]And then what? Kid in theER ends up with pneumonia or untreated TB.[/quote]
My own daughter once went to the doctor with some chest congestion. I didn’t want to bother, but my wife knew better. My daughter had pneumonia.
If we skip the diagnosis because of cost, then we may end up paying way more for the treatment (or worse.)
I understand jstoesz’s point and there is probably room for improvement, but it’s only one issue. And there are many causes. Why do people with a cold go to the emergency room? Because they can’t afford to go to the doctor, and they don’t know if it’s a cold or if it’s something worse.
But all of this reinforces what I said before, the solution must be comprehensive.
A few band aids like changing ER policies, tort reform, or interstate insurance markets are not going to solve the core problem.
April 6, 2012 @ 1:20 PM
the two Family medical
the two Family medical practices my wife has worked for will take people for low or no out of pocket cost when they don’t have insurance. I think that is pretty much the rule not the exception.
I think we as a country need to get real about this problem.
Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
Problem is, people think there is some 3rd way where you pay 20 bucks a month and all your healthcare needs are taken care of. Unless we get honest about these two rationing methods, we will never come to a real solution.
Our current health market is rampant stealing from Peter to pay for Paul’s medical bills.
The ACA just institutionalizes the theft through premium supports and puts a happy civic duty face on it. It is still taking from one to give to another. But now those doing the taking don’t have to feel bad about it and deal with those pesky bill collectors.
April 6, 2012 @ 1:53 PM
jstoesz wrote:Seems to me
[quote=jstoesz]Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
[/quote]
You have option 2 today, except you’re already also paying for option 1 with the services being provided at the most expensive point in the chain.
As for rationing, your care is already rationed. if you have an HMO/PPO, they ration it. Medicare, the government does. HDHP, the plan provider did before you signed up.
And it’s all rationed by your ability to continue to cover the payments.
April 6, 2012 @ 2:31 PM
no_such_reality wrote:jstoesz
[quote=no_such_reality][quote=jstoesz]Seems to me there will only be two ways to ration care.
1. Government deciding who gets what and when…6 months for a 20 year old to get a meniscus repair, etc.
2. People self ration based on what they can afford…Grandma can’t get a hip cause she can’t afford it, etc.
[/quote]
You have option 2 today, except you’re already also paying for option 1 with the services being provided at the most expensive point in the chain.
As for rationing, your care is already rationed. if you have an HMO/PPO, they ration it. Medicare, the government does. HDHP, the plan provider did before you signed up.
And it’s all rationed by your ability to continue to cover the payments.[/quote]
True. Any national health care proposal has to address two huge legacy issues:
(1) In the 90s, “The ratio of the average American doctor’s income to the average American employee’s income was about 5.5. In Germany, it was 3.4; Canada, 3.2; Australia, 2.2; Switzerland, 2.1; France, 1.9; Sweden, 1.5; the United Kingdom, 1.4.” There are a whole bunch of reasons for this, but no matter: it’s a fact. So, any “public option” will have to figure out a way to pay doctors less, which isn’t easy.
(2) Insurance: “An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, over double the administrative overhead in Canada, on a percentage basis.” So, how do you get rid of the legacy insurance system? A huge obstacle.
So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.
April 6, 2012 @ 3:03 PM
davelj wrote:So, there you
[quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
Simple, single payer. If the Doctor’s office only needs to have staff that manages billing and determining what treatments are needed in what order from one source, you’ve just eliminated a massive amount of the administrative costs.
Look about for BG’s note about the Dr’s knowing how to work the plan. Well, they need to do that for all the plans. One plan, one thing to know.
One plan, one payment schedule, their comp get’s controlled by how efficient and hopefully effective they are.
Or, they could go the cash route. Then who cares how much they make, because people are free to spend their money how they want.
April 6, 2012 @ 4:56 PM
no_such_reality wrote:davelj
[quote=no_such_reality][quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
Simple, single payer. If the Doctor’s office only needs to have staff that manages billing and determining what treatments are needed in what order from one source, you’ve just eliminated a massive amount of the administrative costs.
Look about for BG’s note about the Dr’s knowing how to work the plan. Well, they need to do that for all the plans. One plan, one thing to know.
One plan, one payment schedule, their comp get’s controlled by how efficient and hopefully effective they are.
Or, they could go the cash route. Then who cares how much they make, because people are free to spend their money how they want.[/quote]
I hear ya but that wasn’t my point. My point is that there are enormous, monied interests vested in keeping the system as-is. Unless you’re willing to go up against the AMA and the health insurance complex… you can’t get anywhere.
Look, we should probably require the country’s largest banks to hold 50%-75% more capital than is currently required. Does anyone really think the banking complex is going to let that happen?
I’m not optimistic about our health care system. Those vested interests have enormous power and influence.
April 6, 2012 @ 11:11 PM
davelj wrote:So, there you
[quote=davelj]So, there you have it. The different in costs between us and our developed peers really comes from two areas: physician pay and insurance. How, exactly, do you reduce the former and eliminate the latter? I have no idea.[/quote]
I’d say the answer is … competition.
[quote=davelj]I hear ya but that wasn’t my point. My point is that there are enormous, monied interests vested in keeping the system as-is. Unless you’re willing to go up against the AMA and the health insurance complex… you can’t get anywhere.
I’m not optimistic about our health care system. Those vested interests have enormous power and influence.[/quote]
Seems like my opinions of the medical industry aren’t so far out there. (davelj continues to be one of my favorite posters here, by the way). The AMA is a monopoly – just like AT&T was execpt instead of keeping a watchful, untrusting eye on the AMA, the government gives it its full support in keeping that monopoly in-tact. Davelj’s comparison to banking ring true with me.
April 7, 2012 @ 8:12 AM
davelj wrote:My point is that
[quote=davelj]My point is that there are enormous, monied interests vested in keeping the system as-is.[/quote]
No, that’s not it at all.
Its about patriotism and self-reliance and respect for real American values!
BTW, Does anybody know where I can buy a really big American flag pin?
Seriously, I agree with your sentiment and I’m not optimistic about the health care system either.
The fact that a bunch of random strangers on the internet can have a more constructive debate than congress shows just how bad the situation is.