Why do you want Health care Reform?

[Spursmania]

Since we all have differing opinions about Health Care reform, I am interested in knowing what you personally would like to see reformed? Or why you would not want any reform?

This is not a bashing thread. I just want to compare what we all would like to see changed to what is being proposed.

Do you want access to insurance? Prescriptions? Better quality Doctors? care? Premiums too high? Hospital fees too high? Also, tell me who you think should pay for the reform?

[sam1617]

Cheaper insurance, or cheaper health care. I would prefer a system that is localized, where members of a community form a co-op for their health insurance, with doctors being less vulnerable to frivolous law suits, so they are more willing to attempt complicated procedures (and also decrease costs of regular procedures), to actually improve quality of life for the afflicted .

[DarkReign]

I dont want what this is turning out to be.

I wanted Pharma companies to be reigned in on costs and advertising (there was a time it was illegal to advertise prescriptions) to health providers/insurance companies.

I wanted insurance to be non-profit across the board. Pay the doctors what they get paid, pay the employees of the health industry what is negotiated like any other industry, pay executives what they negotiate. But at the end of the day, Healthcare should not be about corporate profit to stock holders.

Any profits should be redistributed to the payers based on a percentage of their share of the "profits", not to stock holders.

Ive never understood a for-profit, corporate model for the healthcare industry. That seems a very...diabolical thinking. You get rich when people get sick? Your company is traded on the NYSE and your main business is health insurance?! Shit like that, no examples.

[Marcus Bryant]

Because we live in Disney land in which the only thing preventing us from the happy utopian ending are a set of evil cartoon caricatures who are greedily keeping the blessings of state run health care from the masses.

Lest we forget the standard egoist use of the state by politicians and 'reformers' to affirm their personal goodness.

[SnakeBoy]

Cheaper insurance, or cheaper health care. I would prefer a system that is localized

In a sense we do have a localized system (by state) and it's part of the problem. That's one of the few good ideas McCain had, to do away with individual state requirements and set some national health insurance policy requirements so that insurance companies could come up with policies and market them to everyone in the country.

Interesting how Massachusetts is used as the poster child for how effective the new healthcare system will be...


TABLE 3. INDIVIDUAL MARKET, AVERAGE ANNUAL PREMIUMS BY STATE - SINGLE COVERAGE, 2006-2007
State Average Annual Premium
Massachusetts $8,537
New Jersey $5,326
New York $4,734
Rhode Island $4,412
Pennsylvania $3,949
Maine $3,686
Louisiana $3,377
New Hampshire $3,368
New Mexico $3,362
Connecticut $3,326
Nevada $3,118
North Carolina $3,080
South Carolina $2,981
Florida $2,949
South Dakota $2,914
Montana $2,866
Texas $2,782
Wyoming $2,688
National $2,613
Arizona $2,591
California $2,565
West Virginia $2,540
Colorado $2,537
Kentucky $2,537
Missouri $2,518
Nebraska $2,505
Indiana $2,504
Illinois $2,499
Ohio $2,498
Mississippi $2,489
Oklahoma $2,435
Minnesota $2,424
Georgia $2,419
Kansas $2,363
Virginia $2,359
Delaware $2,346
North Dakota $2,316
Tennessee $2,221
Maryland $2,208
Alabama $2,208
Iowa $2,202
Arkansas $2,153
Washington $2,015
Idaho $2,006
Michigan $1,878
Utah $1,574
Oregon $1,297
Wisconsin $1,254
Source: America’s Health Insurance Plans.
Note: Results from Alaska and the District of Columbia, where the responding companies reported fewer than 500 policies in force,
are included in the national totals but are not reported separately.
http://www.ahipresearch.org/pdfs/Individual_Market_Survey_December_2007.pdf

[sabar]

I hope that we can start a domino chain of socialized services so that my children can sit on their asses at their state-assigned job or housing unit and get fed/watered/educated/medicated by big brother while paying their 75% tax rate to keep it all going.

[DarkReign]

Michigan $1,878

I assume this is what the insured pays (ie the employee), not the insurer (ie the employer).

Because if this is to say how much an annual costfor health insurance is, they are clearly making shit up.

It costs my company $1109 a month for a family. Of which, the employee supplements $60 a week for (~$240 a month, depending on how many weeks).

[Marcus Bryant]

I hope that we can start a domino chain of socialized services so that my children can sit on their asses at their state-assigned job or housing unit and get fed/watered/educated/medicated by big brother while paying their 75% tax rate to keep it all going.

And therein lies the true point of these proposed, allegedly benevolent actions by the state. The masses are easier to control the more dependent they are on the state. Instead of a society of free, responsible individuals, we shall have one of dependent, irresponsible children.

[Marcus Bryant]

Not to mention that we will have our lives run by a special group who regard human life not just on par with other animal life, but as a lower class species. Except for their own enlightened asses, of course.

Classicism of another variety runs straight through all of these grand social policy schemes, but the mass is too stupid to figure out, and will gladly trade more of their liberty for free excrement.

[DarrinS]

Reduced cost. Tort reform.

[SnakeBoy]

I assume this is what the insured pays (ie the employee), not the insurer (ie the employer).

Because if this is to say how much an annual costfor health insurance is, they are clearly making shit up.

It costs my company $1109 a month for a family. Of which, the employee supplements $60 a week for (~$240 a month, depending on how many weeks).

It's the avg single coverage premium. Texas avg. is $2782/yr, I pay $3264/yr to cover my wife and myself. Seems about right to me.

I put the link to the pdf if you wat to read the whole thing. It has avg annual Family coverage at $4118 in Michigan.

[ploto]

To start: I simply want people whose jobs do not provide health insurance coverage to be able to buy into a program that is not profit-driven.

[DarkReign]

It's the avg single coverage premium. Texas avg. is $2782/yr, I pay $3264/yr to cover my wife and myself. Seems about right to me.

I put the link to the pdf if you wat to read the whole thing. It has avg annual Family coverage at $4118 in Michigan.

Per year?

Thats saying it costs the insured (ie the employee) $4118 on avergae per year for their family coverage?

This is an average?

So wait...

You pay $3264 a year for Two Person insurance?! What the fucking fuck?! I'd have to think your employer is covering the rest, yes?

[DarkReign]

Im not specifying you, SnakeBoy, so dont take it this way.

I am pretty close to scanning my insurance bill as an employer for this thread.

Those average are fucking stupid and not even close to average. That, or I am getting balled by HAP....yes, HAP, the single worst insurance a company can offer. We just went through a re-up process, too.

We had 4 carriers come in to quote, HAP was still by far the cheapest for moderately good coverage.

[DarkReign]

You pay $3264 a year for Two Person insurance?! What the fucking fuck?! I'd have to think your employer is covering the rest, yes?

Thats $272 a month. For two person coverage.

Someone is paying the rest of the bill, because the rest of the bill is 2x that amount at least.

[SnakeBoy]

I'd have to think your employer is covering the rest, yes?

No we both work on a contract basis so that's the total cost $272/month. Well, we have a $1500 deductible so I guess you would add that to our total healthcare cost. Actually it would only be $1005 ($1500 - 33%) more since we have a tax free MSA that we put the $1500 into each year.

Strange thing is in 5 years the most I've ever paid out of pocket was $270. The docs usually settle for whatever insurance pays. I just started allergy shots ad the serum was $4200. The office manager actually told me "they can't say they will only accept whatever insurance pays because that is technically insurance fraud so they HAVE to send me a bill but there is no due date for payment unnndeerstand wink wink".

[SnakeBoy]

We used to pay almost double that with Assurant then we shopped around and changed plans. Good coverage, we can see any Dr. we want, and if we want to go to a specialist we just go (no need to see a primary care Dr. first).

[ElNono]

Well, I'm in New Jersey... number two in that list. :depressed

[TDMVPDPOY]

i think they should make it compulsory 1% across the board on all taxable income, and 2% if you earn too much....

just like in australia its 1% across the board..if you earn over 100k you pay 2%, if you dont wanna be penalise the extra 1% then go get private health care and only force to pay 1% only. You still get to claim a tax rebate on ur private healthcare subscription and other medical related expenses.

The problem is there is too many ppl freeloading the system and overusing it...and if you have an aging population like baby boomers...then it just clogs up the system cause they use the resource to much

[DarkReign]

No we both work on a contract basis so that's the total cost $272/month. Well, we have a $1500 deductible so I guess you would add that to our total healthcare cost. Actually it would only be $1005 ($1500 - 33%) more since we have a tax free MSA that we put the $1500 into each year.

Strange thing is in 5 years the most I've ever paid out of pocket was $270. The docs usually settle for whatever insurance pays. I just started allergy shots ad the serum was $4200. The office manager actually told me "they can't say they will only accept whatever insurance pays because that is technically insurance fraud so they HAVE to send me a bill but there is no due date for payment unnndeerstand wink wink".

Holy. Shit.

2 person coverage from HAP at our company is $832.60 per month.

[doobs]

I like stuff that costs zero.

[Spursmania]

We used to have Humana, then Principal and now we have Aetna. Under Principal, we paid 979.00 a month in premiums. Now under Aetna we pay 687.00 a month for a healthy and young family of myself, my spouse and our 2 kids.
We have 2,500/5,000 deductibles as well. So, we basically pay for all our health care throughout the year as well, since we have never reached the deducctibles yet.

So, 9,244 a year in insurance premiums has always been mind boggling. We need insurance reform. But, the reality is this bill doesn't come close to specifically addressing the problem. And, believe me, we don't want the government plan which will drive out competition and essentially leave us all with VA type quality healthcare. I mean if me, my spouse or child come down with cancer, I want the best treatment possible.

Also, I just had a small prescription filled at the pharmacy. The cost was 116.99, with my insurance, we got a 8 dollar discount to that cost. Pretty laughable. These same drugs would have cost $20 elsewhere. But, this bill does not really address this issue either.

[SnakeBoy]

Well you should shop around more DR. The assurant policy that was almost double we had around 5 years ago was actually the plan my wife's practice was providing for their employee's. Some physicians my wife wanted to didn't take that plan so she found some independent insurance lady who went through a gazillion plans. We settled on this one through Blue Cross/Blue Shield. It was a long process (took a few months), insurance lingo makes my head explode.

What is HAP?

[LnGrrrR]

Since we all have differing opinions about Health Care reform, I am interested in knowing what you personally would like to see reformed? Or why you would not want any reform?

This is not a bashing thread. I just want to compare what we all would like to see changed to what is being proposed.

Do you want access to insurance? Prescriptions? Better quality Doctors? care? Premiums too high? Hospital fees too high? Also, tell me who you think should pay for the reform?

I've got "free health care", being in the military, so I've got no strong dog in this fight. I'm for it merely based on 1) compassion and 2) the theories I've read that stating how much we spent on emergency room visits for diseases that we could've got earlier.

The emergency room argument is also one reason why I'm in favor of increased immigration. Make it easier for them to become a citizen, or at least get a green card... that way they can start paying taxes! :D

[Spursmania]

Well you should shop around more DR. The assurant policy that was almost double we had around 5 years ago was actually the plan my wife's practice was providing for their employee's. Some physicians my wife wanted to didn't take that plan so she found some independent insurance lady who went through a gazillion plans. We settled on this one through Blue Cross/Blue Shield. It was a long process (took a few months), insurance lingo makes my head explode.

What is HAP?

In, my spouses practice, they all have to have the same plan. Problem is there are a few who have children with disabilities. My understanding was other partner's high use of the insurance plan increases our plan.

[byrontx]

Six years ago, when my wife was pregnant, I was laid-off/fired/quit (something like that). The company owed me a lot of back pay. I had to settle for .30 on the dollar to keep it from being drawn out forever. Then the Cobra kicked in at a horrendous rate but I had little choice with a baby on the way. Blue Cross then mucked up my account so that every claim was denied and required me to call and walk every payment through the system. I had started my own company and this bogged me down using time I could ill afford to waste. I can see why would-be entrepreneurs are reluctant to start a new venture because of our screwed up health care system; choosing instead to remain in jobs were they are protected from the grind that could be placed on them if they left then had a significant health issue.

I purchased insurance for us like my wife was used to seeing; co-pay on office visits, etc; I had never had a serious health issue. Starting out in my own company I used just about all cash, assets and credit to get the venture going. Then one morning around 4 a.m., I woke up with chest pains. After a three day stay in the hospital (never found out what the problem was) and follow up visits I racked up $12-$15,000 in medical bills that were not covered by my insurance. The bills were devastating, coming when they did. When a competitor had a new protective patent come out I did not have the funds to redesign and ended up shutting down the venture. The medical bills that streamed in for a year after that, coupled with the economic harm of the failed venture, nearly put me into bankruptcy (I have never carried consumer debt and had a paid-off house but even with that it was touch and go). I should mention that had I been able to get my venture off the ground (and I am not laying all the blame on the medical bill crunch) it would have been a $20 million company by now employing a good number of people in good paying jobs. It is an industry I have been involved in since 1991 and I am a name in the industry; that is no false claim.

For my wife, 5 year old son and I right now I have to budget $1200 a month for medical expenses and insurance. I still have a few health issues that require some treatment and medication. I believe, based on self-education that these could be indicative of a larger underlying health problem but the tests cost $2000 which I am not going to spend right now (trying to get a different business venture going).

I think Fox News calls that rationed care.

I think the medical system is all fucked up and I am no socialist. I am glad our President has the balls to take on the problem.

[SonOfAGun]

Work hard, play hard, medicate hard

Fuck lines.

[SnakeBoy]

I am glad our President has the balls to take on the problem.

Dude he's NOT taking on the problem. He's telling Pelosi/Reid get something anything passed and I'll sign it so I can put a checkmark next to healthcare. Same as he did with the stimulus, that's worked out great right?

It might be different if he put together a solid plan and submitted to congress.

[101A]

Holy. Shit.

2 person coverage from HAP at our company is $832.60 per month.

MUCH more govt. mandates on group insurance; including very limited pre-x exclusions; mandatory benefits.

Individual covg can be DENIED - and is underwritten individually; gonna cost a lot less; 'cause the company can assess its risk much more accurately.

What about life insurance; doesn't get worse than dead -- should that be allowed to be for profit?

or home; or auto, or disability........should all insurance be excluded from profit, because, ultimately, it "preys" on people's misfortune?

or how about....

auto body shops, morgues, cemetaries?

[SnakeBoy]

Individual covg can be DENIED - and is underwritten individually; gonna cost a lot less; 'cause the company can assess its risk much more accurately.


That's a good point. We did have to get a physical/blood tests before they would issue the pollicy.

[ElNono]

Six years ago, when my wife was pregnant, I was laid-off/fired/quit (something like that). The company owed me a lot of back pay. I had to settle for .30 on the dollar to keep it from being drawn out forever. Then the Cobra kicked in at a horrendous rate but I had little choice with a baby on the way. Blue Cross then mucked up my account so that every claim was denied and required me to call and walk every payment through the system. I had started my own company and this bogged me down using time I could ill afford to waste. I can see why would-be entrepreneurs are reluctant to start a new venture because of our screwed up health care system; choosing instead to remain in jobs were they are protected from the grind that could be placed on them if they left then had a significant health issue.

I purchased insurance for us like my wife was used to seeing; co-pay on office visits, etc; I had never had a serious health issue. Starting out in my own company I used just about all cash, assets and credit to get the venture going. Then one morning around 4 a.m., I woke up with chest pains. After a three day stay in the hospital (never found out what the problem was) and follow up visits I racked up $12-$15,000 in medical bills that were not covered by my insurance. The bills were devastating, coming when they did. When a competitor had a new protective patent come out I did not have the funds to redesign and ended up shutting down the venture. The medical bills that streamed in for a year after that, coupled with the economic harm of the failed venture, nearly put me into bankruptcy (I have never carried consumer debt and had a paid-off house but even with that it was touch and go). I should mention that had I been able to get my venture off the ground (and I am not laying all the blame on the medical bill crunch) it would have been a $20 million company by now employing a good number of people in good paying jobs. It is an industry I have been involved in since 1991 and I am a name in the industry; that is no false claim.

For my wife, 5 year old son and I right now I have to budget $1200 a month for medical expenses and insurance. I still have a few health issues that require some treatment and medication. I believe, based on self-education that these could be indicative of a larger underlying health problem but the tests cost $2000 which I am not going to spend right now (trying to get a different business venture going).

I think Fox News calls that rationed care.

I think the medical system is all fucked up and I am no socialist. I am glad our President has the balls to take on the problem.

Kudos for bringing a real life story into this.

[101A]

MUCH more govt. mandates on group insurance; including very limited pre-x exclusions; mandatory benefits.

Individual covg can be DENIED - and is underwritten individually; gonna cost a lot less; 'cause the company can assess its risk much more accurately.

What about life insurance; doesn't get worse than dead -- should that be allowed to be for profit?

or home; or auto, or disability........should all insurance be excluded from profit, because, ultimately, it "preys" on people's misfortune?

or how about....

auto body shops, morgues, cemetaries?


...I can do this all day:

Then there's food.

Pretty much right up there in terms of importance. Should farmers, grocery stores and restaurants be allowed to make a profit?

The point is: We either believe and trust that the free market is the best way to deliver bountiful goods and services (both necessary and not so much) at reasonable prices, or we do not. If we don't, then we don't for anything; because that is where, ultimately, this will lead us. We are on a slippery slope, and we're about to pour a mixture of grease and butter on it
- capitalism sucks, but it's still better than every other economic system!

[ElNono]

...I can do this all day:

Then there's food.

Pretty much right up there in terms of importance. Should farmers, grocery stores and restaurants be allowed to make a profit?

The point is: We either believe and trust that the free market is the best way to deliver bountiful goods and services (both necessary and not so much) at reasonable prices, or we do not. If we don't, then we don't for anything; because that is where, ultimately, this will lead us. We are on a slippery slope, and we're about to pour a mixture of grease and butter on it
- capitalism sucks, but it's still better than every other economic system!

If the free market would really exist and operate as designed, you might actually be onto something. But in practical terms, we have to look somewhere else.

[ElNono]

Not to mention that the free market doesn't solve the basic altruistic nature of part of the business. What's the incentive for a pharmaceutical to create an actual cure for disease as opposed to a palliative?

[Marcus Bryant]

Not to mention that the free market doesn't solve the basic altruistic nature of part of the business. What's the incentive for a pharmaceutical to create an actual cure for disease as opposed to a palliative?

A free society complete with a free press.

[101A]

If the free market would really exist and operate as designed, you might actually be onto something. But in practical terms, we have to look somewhere else.

Why?

Why should we settle for what we KNOW is going to be worse in the long run? Is there not enough evidence that the more central control of an economy means less wealth to go around - exponentially so?

It is hyperbole anymore, but is equality more important than quality? Is EVERYONE poor better than some poor, some rich?

[101A]

A free society complete with a free press.

...and lawyers.

[101A]

Not to mention that the free market doesn't solve the basic altruistic nature of part of the business. What's the incentive for a pharmaceutical to create an actual cure for disease as opposed to a palliative?


Another pharmaceutical that creates the cure which makes the palliative worthless.

[ElNono]

Another pharmaceutical that creates the cure which makes the palliative worthless.

But that's not a sound business decision. A better business decision is to create another competing palliative, and join into the cash-cow. If it includes price-fixing between the companies instead of actual competition, then much better.
After all, you need to pay off congressman, and selling cures one time ain't going to get it done.

BTW, that's the free market we live in today.
And don't get me wrong, I'm not advocating the government plan.

[ElNono]

Why?

Why should we settle for what we KNOW is going to be worse in the long run? Is there not enough evidence that the more central control of an economy means less wealth to go around - exponentially so?


Don't automatically assume I'm suggesting the proposed plan to be better. I don't like it any more than you do. But the current system is simply just as corrupt.


It is hyperbole anymore, but is equality more important than quality? Is EVERYONE poor better than some poor, some rich?

No. I'm not against those that can pay and get better quality care to do so. But I am for a baseline access to care for those that can't afford it.
It's bullshit the amount of bankruptcies common people either face or have to go through because of this inflated system. The status quo sucks donkey balls, and something needs to be done about it.

[Spursmania]

Socialist Feels the Heat at Health Care Town Hall (http://www.dakotavoice.com/2009/07/socialist-feels-the-heat-at-health-care-town-hall/)

By Bob Ellis (http://www.dakotavoice.com/author/bob-ellis/) on July 21st, 2009
http://www.dakotavoice.com/wp-content/uploads/2009/07/ScreenPrint_71.jpgRobert Broadus

Senator Ben Cardin (D-MD) held a town hall meeting yesterday to peddle socialized medicine. But all was not cheers and rose petals at the meeting.
Robert Broadus of Clinton, Maryland wasn’t very enthusiastic (http://www.wltx.com/news/story.aspx?storyid=76346&catid=299) about the liberals’ plan to treat him like a serf:

Perhaps the most controversial, came from Robert Broadus of Clinton, Maryland, an audience member who had lost his job and replaced it with one that paid him far less money.
“I decided not to get the health insurance. That’s working out for me because I’m able to save that extra money and give it to my family members and use it on myself. Senator Cardin, I want to know are you going to tell me an individual…that I have to buy health care or else you’re going to fine me $2,500 every year I don’t get it? Our founding fathers assured us we have a Bill of Rights and I want to see you uphold that,” Broadus said in an increasingly emotional voice and to scattered applause.
This man is indignant that some elitist in Washington is going to tell him how he must spend the money that he himself earned. (”How dare he,” socialist Ben Cardin must be thinking).
Cardin responded with the patronizing excuse that if the man were injured and unable to pay, the public would end up paying for his health care.
So how is that different than the socialist health care programs like Medicare, Medicaid, SCHIP and so on that are already in place? Or socialist plans the liberals want to impose on the American people going forward?
Essentially the only difference is that Broadus might be able to pay his own bills under a free market system, and if we moved to return our system to a fully free market model, costs would go down and make people like Broadus even more capable of paying for their own health care.
I know people who don’t have insurance but still pay off their hospital bills in payments. They are not in a position to afford health care premiums, but limit their use of the health care system and choose to pay their own way instead of sticking someone else with the bill.
I had some rather large medical bills several years ago. The hospital gave me a bunch of forms I could have used to stick it to the taxpayers for my bills, but I threw them in the trash and paid off the hospital in installments. I’m an American, and Americans don’t force other Americans to pay their way. They may need to rely on the good will and charity of other Americans once in a while, but they don’t call out the government thugs to take another American’s property by force.
Socialist model only drive up costs because people abuse the system (http://www.dakotavoice.com/2009/07/candy-dish-lessons-on-socialized-medicine/), and ineffective government oversight drives costs through the roof. There is no incentive anywhere from top to bottom in socialist systems to control costs and fight waste and abuse.
We need more Americans like Robert Broadus of Maryland who recognize what it means to be an American. We need more Americans like Broadus who understand that they are not wards of the state, not ignorant children who must have their lives run for them, not serfs to be pushed around and dictated to by the powerful elites.
We need more Americans who are willing to assert their God-given freedom (http://www.ushistory.org/Declaration/document/index.htm) and tell the socialist usurpers in Washington where they can stick un-American ideas like socialized health care.

[Wild Cobra]

Health care is not a right. The sooner everyone realizes that, the sooner we can have a proper discussion.

Again, I say start with Tort Reform. One step at a time to see what works. Tort reform is an obvious first step.

We will nearly completely lose the right to sue if the system is socialized. Why not start in a controlled manner, where we still keep legal rights?

[Spursmania]

Health care is not a right. The sooner everyone realizes that, the sooner we can have a proper discussion.

Again, I say start with Tort Reform. One step at a time to see what works. Tort reform is an obvious first step.

We will nearly completely lose the right to sue if the system is socialized. Why not start in a controlled manner, where we still keep legal rights?

It's unbelievable how many people believe healthcare is a right. And, how many people want other Americans to pay for their own healthcare.

[ElNono]

Again, I say start with Tort Reform.

Well, Texas passed tort reform, and that's all it did. On it's own, it didn't do much of anything as far as lowering costs go. What's next?

[Spursmania]

Well, Texas passed tort reform, and that's all it did. On it's own, it didn't do much of anything as far as lowering costs go. What's next?

True, it did get passed. However, it didn't have the affect people expected. More tort reform is needed. Medical Malpractice suits and their defense run into the billions of dollars.

Insurance costs need to be addressed immediately, but the procedures and hospital and providers' cost must be set, so the insurance companies are obligated to pay for these procedures and cannot refuse the claims. So, Congress must address hospital costs and procedures first. That is the problem right now. Congress' failure to do it's homework on the costs of hospital and provider care.

Congress also has to broker a deal with the pharmaceutical companies regarding the cost of drugs. These are the many problems, that the bill does not address. How can we decide to go ahead and flood the system with 47 million more people when the system itself is still broken? System reform must come first. The savings reaped from it's reformation would then allow more people into the system at a gradual but sustainable pace.

[Wild Cobra]

Well, Texas passed tort reform, and that's all it did. On it's own, it didn't do much of anything as far as lowering costs go. What's next?
Maybe their tort reform isn't good enough?

[ElNono]

Maybe their tort reform isn't good enough?

What else can you do? They capped the awards, that's about all you can do as far as Tort reform is concerned, right?

[ploto]

It costs my company $1109 a month for a family. Of which, the employee supplements $60 a week for (~$240 a month, depending on how many weeks).

You must still be supplying really good insurance with decent co-pays. I pay $2400/yr for coverage for one healthy person with a $5000 deductible. I just have it for anything catastrophic. It has never paid out one penny.

[Wild Cobra]

What else can you do? They capped the awards, that's about all you can do as far as Tort reform is concerned, right?
I don't know how far they went.

First of all, there is always a risk when undergoing a medical procedure. Most claims should be immediately dismissed, unless fault is clearly seen. Sorry if I'm so hard about that, but if there is a 5% chance someone will die after a procedure, should the families of those who die have the right to sue? Again, unless fault is evident, I say absolutely not.

One reason medicine is so expensive is because of the liability insurance doctors and hospitals pay. Keep those costs in mind when you pay a bill. That is the primary reason government can make it cheaper. You won't have legal recourse against the government. It may be cheaper in the long run, but paid for by taxes instead. Then with all the red tape, the quality will be far less than we have now.

[Wild Cobra]

You must still be supplying really good insurance with decent co-pays. I pay $2400/yr for coverage for one healthy person with a $5000 deductible. I just have it for anything catastrophic. It has never paid out one penny.
My insurance is $53.95 every two weeks with me and my youngest daughter covered. We have a $25 co pay and I forget what the copay is on medications. I've only had to get a skin cream for a rash, so I just paid the $6.95 out of pocket. My daughter also just pays for her synthroid, but that's cheap anyway. This is a Blue Cross Blue Shield plan through my work. I don't know how much of the cost they pay. Probably about 90%.

[Marcus Bryant]

Naturally answers are proposed which do not address the heart of the matter. The basic problem is that most pay for routine health care services through a 3rd party payer. Most use a 3rd party payer as it is part of their or a family member's compensation or it is a government program. It's a standard workplace benefit owing to its exclusion from the income tax. When you pay a fraction of the cost of those routine services, then you are less likely to shop around and you are less likely to balk at additional, perhaps generally unnecessary services.

Greater government intervention in health care services is debated under the assumption that the government currently is not greatly involved. It is precisely its history of involvement which has led us to the mess we are in. Now we can understand that and move towards a solution based on that understanding, and recognize that any kind of reform should be based on the reality that the provision of health care services is a service, and as such is subject to all of the basic laws of economics which apply to every other good and service produced by a private party, or we can pretend that it is something else, and come up with an even greater monstrosity of stupidity, and continue to address everything but the root cause.

Of course, these debates are usually nonproductive. If someone believes the Earth was formed 5,000 years ago, in spite of all evidence to the contrary, because their faith tells them so, then it's generally not worth spending the time discussing matters of science and history with them. Such it usually is with those who advocate greater state involvement in health care services. It's not politics to them, it's religion, and they should be regarded as the ignorant fundamentalists they are.

[ElNono]

True, it did get passed. However, it didn't have the affect people expected. More tort reform is needed. Medical Malpractice suits and their defense run into the billions of dollars.


Well, these are just some numbers I found on the case of Texas specifically:
LINK (http://www.okwatchdog.org/userImages/files/Texas%20tort%20reform%20factsheet.pdf)
There's obviously disparage opinions about this. But at least this showed a critical point of view backed with actual statistics.

Now, the thing with tort reform is that once you cap the awards, I'm not sure there's much more you can do. Correct me if I'm wrong, please.
I do think this is a step that's necessary, but on it's own will basically not accomplish much at all.


Insurance costs need to be addressed immediately, but the procedures and hospital and providers' cost must be set, so the insurance companies are obligated to pay for these procedures and cannot refuse the claims. So, Congress must address hospital costs and procedures first. That is the problem right now. Congress' failure to do it's homework on the costs of hospital and provider care.

What do you suggest to 'address hospital costs and procedures'? Honest question.


Congress also has to broker a deal with the pharmaceutical companies regarding the cost of drugs. These are the many problems, that the bill does not address. How can we decide to go ahead and flood the system with 47 million more people when the system itself is still broken? System reform must come first. The savings reaped from it's reformation would then allow more people into the system at a gradual but sustainable pace.

I'd be interested to also know what's your proposal on reigning in pharma costs, if you would like to explain what's on your mind. I don't see it happening without touching their bottom line. But I'm open to other ideas.

The fact that you don't see neither pharma co's or insurance co's screaming foul on the proposed reform tells me already it's most likely garbage.
That said, I seriously doubt it's going to be passed anyways.

[ElNono]

I don't know how far they went.

They basically limited noneconomic damages to $750,000, among a few other things like class action reform and what not so there's no loopholes to that cap.


First of all, there is always a risk when undergoing a medical procedure. Most claims should be immediately dismissed, unless fault is clearly seen. Sorry if I'm so hard about that, but if there is a 5% chance someone will die after a procedure, should the families of those who die have the right to sue? Again, unless fault is evident, I say absolutely not.

No doubt.


One reason medicine is so expensive is because of the liability insurance doctors and hospitals pay. Keep those costs in mind when you pay a bill. That is the primary reason government can make it cheaper. You won't have legal recourse against the government. It may be cheaper in the long run, but paid for by taxes instead. Then with all the red tape, the quality will be far less than we have now.

So the story says, but that has not reigned in costs in Texas.
You know I'm actually in favor of tort reform just like the one applied on Texas. However, without also addressing Insurance and Pharmaceutical reform, and figuring out a way that any of those malpractice insurance savings eventually reach the patients, you're not really see much of a difference.

[ElNono]

Naturally answers are proposed which do not address the heart of the matter. The basic problem is that most pay for routine health care services through a 3rd party payer. Most use a 3rd party payer as it is part of their or a family member's compensation or it is a government program. It's a standard workplace benefit owing to its exclusion from the income tax. When you pay a fraction of the cost of those routine services, then you are less likely to shop around and you are less likely to balk at additional, perhaps generally unnecessary services.

Greater government intervention in health care services is debated under the assumption that the government currently is not greatly involved. It is precisely its history of involvement which has led us to the mess we are in. Now we can understand that and move towards a solution based on that understanding, and recognize that any kind of reform should be based on the reality that the provision of health care services is a service, and as such is subject to all of the basic laws of economics which apply to every other good and service produced by a private party, or we can pretend that it is something else, and come up with an even greater monstrosity of stupidity, and continue to address everything but the root cause.

Of course, these debates are usually nonproductive. If someone believes the Earth was formed 5,000 years ago, in spite of all evidence to the contrary, because their faith tells them so, then it's generally not worth spending the time discussing matters of science and history with them. Such it usually is with those who advocate greater state involvement in our lives. It's not politics to them, it's religion, and they should be regarded as the ignorant fundamentalists they are.

I believe I understand you point Marcus. If I parse your writing correctly, you would rather not have insurance companies at all, and everyone would pay what they can afford and fight for prices and reduce costs themselves.
No government intervention or regulation of, mostly, any sort (I would think you would still like to have a government agency such as the FDA to at least ensure quality, or maybe you wouldn't want that either?)
You would do away with Medicare and Medicaid too? Just wondering how deep your government cleansing would go.

If that's indeed your proposition, I respect it, even though I don't necessarily share it.

[Wild Cobra]

Well, these are just some numbers I found on the case of Texas specifically:
LINK (http://www.okwatchdog.org/userImages/files/Texas%20tort%20reform%20factsheet.pdf)

That's not very helpful.


Now, the thing with tort reform is that once you cap the awards, I'm not sure there's much more you can do. Correct me if I'm wrong, please.
I do think this is a step that's necessary, but on it's own will basically not accomplish much at all.

It's not the upward cap, in fact, I'm against that. There are legitimate cases where a cap cannot cover a persons life expenses.

It's the lawsuits them self. You should not be able to sue for just anything.


What do you suggest to 'address hospital costs and procedures'? Honest question.

How can you without forcing everyone to pay who comes in. Part of the cost we pay is covering the cost of those who don't pay. When a hospital charges for a pack of sterilized tools, it costs probably twice as much as it should. Same with nurse time, doctor time, etc. The reason is so they can pay for the people who they treat, and cannot collect from. Otherwise, hospitals would go bankrupt. Most insurances just pay these, and pass the cost to the consumer. That's why when I shop for a doctor or hospital, and let them know I'm paying with cash ahead of time, I can find reasonable prices. It's still not as cheap as it should be, but I get a break from the going rate. To be cheaper, we have to eliminate frivolous lawsuits.


I'd be interested to also know what's your proposal on reigning in pharma costs, if you would like to explain what's on your mind. I don't see it happening without touching their bottom line. But I'm open to other ideas.

It's not a right to have cheap medicine and they have the right to profit from their discoveries. In Article 1 section 8 of the constitution:

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;


The fact that you don't see neither pharma co's or insurance co's screaming foul on the proposed reform tells me already it's most likely garbage.
That said, I seriously doubt it's going to be passed anyways.

No, they just know it's unconstitutional.

[Marcus Bryant]

I believe I understand you point Marcus. If I parse your writing correctly, you would rather not have insurance companies at all, and everyone would pay what they can afford and fight for prices and reduce costs themselves.
No government intervention or regulation of, mostly, any sort (I would think you would still like to have a government agency such as the FDA to at least ensure quality, or maybe you wouldn't want that either?)
You would do away with Medicare and Medicaid too? Just wondering how deep your government cleansing would go.

If that's indeed your proposition, I respect it, even though I don't necessarily share it.

I would do away with the tax exclusion of health care benefits. Generally, for routine health care services, we should operate under a system in which those are paid for by individuals, with charities, families, and friends to help those who cannot pay for those (like with every other necessity - ie food, clothing, and shelter). The real question lies with catastrophic coverage. You will continue to have a market for insurance to cover big ticket medical expenses. Yes, Medicare and Medicaid should eventually go away as well. It's Medicare, and not Social Security, which is the entitlement program set to bankrupt this country long term. Yet we blithely proceed and cowardly pass that on to the next generation.

And the FDA is a joke. Big Pharma uses and abuses it to give the sheen of respectability to their products while using its lobbyists and paid for politicians to get the results it wants.

[ElNono]

That's not very helpful.

Do you have better statistics?


It's not the upward cap, in fact, I'm against that. There are legitimate cases where a cap cannot cover a persons life expenses.

It's the lawsuits them self. You should not be able to sue for just anything.


I'm not a lawyer, so I couldn't tell you how feasible and/or legal to do something like that would be. Maybe Spursmania knows. The Tort reforms I know all cap the upper limit.


How can you without forcing everyone to pay who comes in. Part of the cost we pay is covering the cost of those who don't pay. When a hospital charges for a pack of sterilized tools, it costs probably twice as much as it should. Same with nurse time, doctor time, etc. The reason is so they can pay for the people who they treat, and cannot collect from. Otherwise, hospitals would go bankrupt. Most insurances just pay these, and pass the cost to the consumer. That's why when I shop for a doctor or hospital, and let them know I'm paying with cash ahead of time, I can find reasonable prices. It's still not as cheap as it should be, but I get a break from the going rate. To be cheaper, we have to eliminate frivolous lawsuits.

So you're basically saying that no services should be rendered ever if the patient(s) can't afford it? Or that we should all move to a out-of-pocket system without insurance companies? Maybe both?


It's not a right to have cheap medicine and they have the right to profit from their discoveries. In Article 1 section 8 of the constitution:

Sure. But the Constitution doesn't set what the limit is. I think there could be some wiggle room there. Then again, you are basically ok with the current, or potentially even higher prices of medicine? I mean, with a health provider you can sit down and haggle for a price, but not with pharma.


No, they just know it's unconstitutional.

You actually mixed this up with the previous pharma comment. I was referring to the currently proposed healthcare reform bill.

[ElNono]

I would do away with the tax exclusion of health care benefits. Generally, for routine health care services, we should operate under a system in which those are paid for by individuals, with charities, families, and friends to help those who cannot pay for those (like with every other necessity - ie food, clothing, and shelter). The real question lies with catastrophic coverage. You will continue to have a market for insurance to cover big ticket medical expenses. Yes, Medicare and Medicaid should eventually go away as well. It's Medicare, and not Social Security, which is the entitlement program set to bankrupt this country long term. Yet we blithely proceed and cowardly pass that on to the next generation.

And the FDA is a joke. Big Pharma uses and abuses it to give the sheen of respectability to their products while using its lobbyists and paid for politicians to get the results it wants.

Thanks.

[Trainwreck2100]

I'd like to cut down on frivolous lawsuits made by johnny no insurance, just cause the doc left his keys in your chest doesn't mean you should win the lottery

[Spursmania]

Well, these are just some numbers I found on the case of Texas specifically:
LINK (http://www.okwatchdog.org/userImages/files/Texas%20tort%20reform%20factsheet.pdf)
There's obviously disparage opinions about this. But at least this showed a critical point of view backed with actual statistics.

Now, the thing with tort reform is that once you cap the awards, I'm not sure there's much more you can do. Correct me if I'm wrong, please.
I do think this is a step that's necessary, but on it's own will basically not accomplish much at all.

THE OK FOUNDATION FOR CONSUMER & PATIENT RIGHTS is hardly a bipartisan view nor does it take into the consideration the amount of money spent on medical defense nor the number of lawsuits filed. As I said, it's helped considering the cap levels;however, Doctors still pay an obscene amount of money to insurance companies because of the many lawsuits filed.



What do you suggest to 'address hospital costs and procedures'? Honest question.

I think the costs need to be adjusted yearly for inflation. They must use a cost index to fairly compensate for the annual increases in costs. I know the reimbursement for machines my spouse's practice use are based on utilization rates. This is complicated and obviously meant for the experts.



I'd be interested to also know what's your proposal on reigning in pharma costs, if you would like to explain what's on your mind. I don't see it happening without touching their bottom line. But I'm open to other ideas.
The fact that you don't see neither pharma co's or insurance co's screaming foul on the proposed reform tells me already it's most likely garbage.
That said, I seriously doubt it's going to be passed anyways.


AMA, the pharmaceutical companies and the insurance companies have agreed to come to the table with Obama if the bill is passed in a bi-partisan manner. As a result, you don't see them publicly campaigning for it. Seeing how the bill won't pass moderate or Republican muster, this deal will probably be off the table. My bet is that money is being passed on via lobbyists at this juncture. They were actually very crafty to do that. That way they don't look like the bad guys gunning against reform.

[LnGrrrR]

I'd like to cut down on frivolous lawsuits made by johnny no insurance, just cause the doc left his keys in your chest doesn't mean you should win the lottery

I don't know about the lottery, but I'd be mighty pissed off if a doc left keys in MY chest :lol

[Trainwreck2100]

I don't know about the lottery, but I'd be mighty pissed off if a doc left keys in MY chest :lol

you should be pissed off, if you have insurance

[ElNono]

THE OK FOUNDATION FOR CONSUMER & PATIENT RIGHTS is hardly a bipartisan view nor does it take into the consideration the amount of money spent on medical defense nor the number of lawsuits filed.

I didn't claim it to be a bipartisan view, I actually stated they offer a critical view to tort reform.


As I said, it's helped considering the cap levels;however, Doctors still pay an obscene amount of money to insurance companies because of the many lawsuits filed.

Well then, can we legally limit the amount of lawsuits filed? This is your field of expertise, I believe.


I think the costs need to be adjusted yearly for inflation. They must use a cost index to fairly compensate for the annual increases in costs. I know the reimbursement for machines my spouse's practice use are based on utilization rates. This is complicated and obviously meant for the experts.

So you think doctors and hospitals are currently underpaid? Who's at fault if that's the case? Insurance companies?


AMA, the pharmaceutical companies and the insurance companies have agreed to come to the table with Obama if the bill is passed in a bi-partisan manner. As a result, you don't see them publicly campaigning for it. Seeing how the bill won't pass moderate or Republican muster, this deal will probably be off the table. My bet is that money is being passed on via lobbyists at this juncture. They were actually very crafty to do that. That way they don't look like the bad guys gunning against reform.

I have no doubts they're funneling all the dough they can to maintain the status quo. No suggestions for lowering the costs of medicine?

[Wild Cobra]

Do you have better statistics?

Why waste my time? Facts make statistics. Statistics don't make facts. The report was very general. Without specifics, it is meaningless. Just a set of numbers.


I'm not a lawyer, so I couldn't tell you how feasible and/or legal to do something like that would be. Maybe Spursmania knows. The Tort reforms I know all cap the upper limit.

That has no effectiveness against the number of frivolous claims and the amount of time devoted to defend against them. What you have is the medical costs going to lawyers, rather than the services intended to be paid for. How mush does all that legal protection cost?


So you're basically saying that no services should be rendered ever if the patient(s) can't afford it? Or that we should all move to a out-of-pocket system without insurance companies? Maybe both?

In a sense, yes. Health care IS NOT A RIGHT!


Sure. But the Constitution doesn't set what the limit is. I think there could be some wiggle room there. Then again, you are basically ok with the current, or potentially even higher prices of medicine? I mean, with a health provider you can sit down and haggle for a price, but not with pharma.

Wiggle all you want. If you interfere with their profits, they will have no incentives to lay out the costs for new research and development. Careful, or such fields will die....

Like the lack of doctors in that report you cited. When you remove profitability, there is no incentive. What else killed the supply and demand equation for obstetricians?

[Spursmania]

So you think doctors and hospitals are currently underpaid? Who's at fault if that's the case? Insurance companies?

I have no doubts they're funneling all the dough they can to maintain the status quo. No suggestions for lowering the costs of medicine?


Well, what is it that you like about the current proposal? Do you think this bill does its job of lowering medical costs or lowering drug costs?

[ElNono]

Why waste my time? Facts make statistics. Statistics don't make facts. The report was very general. Without specifics, it is meaningless. Just a set of numbers.

Ok.


That has no effectiveness against the number of frivolous claims and the amount of time devoted to defend against them. What you have is the medical costs going to lawyers, rather than the services intended to be paid for. How mush does all that legal protection cost?

You tell me. Can you actually legally limit the number of lawsuits filed?


In a sense, yes. Health care IS NOT A RIGHT!

I don't think it is a right either. It's clearly a service, IMHO. Now, what do you suggest would be a viable way to assist those who cannot afford that service, if you have any suggestion at all on that topic?


Wiggle all you want. If you interfere with their profits, they will have no incentives to lay out the costs for new research and development. Careful, or such fields will die....

Well, considering that most of the major pharma's spend around 50% of their budget in marketing, I really doubt we would be making much of a dent on their R&D.
So, in a nutshell, you really don't think medicine prices in the US are inflated, correct?


Like the lack of doctors in that report you cited. When you remove profitability, there is no incentive. What else killed the supply and demand equation for obstetricians?

Whatever it did, it wasn't lawsuits. That specific entry indicated that after tort reform, they still didn't get any more doctors than before in that area.

[Wild Cobra]

You tell me. Can you actually legally limit the number of lawsuits filed?

Yes, there are several different ways of doing it. One method is to make the petitioning party pay if they lose. Maybe not all, but enough that people think twice before filing a lawsuit.


I don't think it is a right either. It's clearly a service, IMHO. Now, what do you suggest would be a viable way to assist those who cannot afford that service, if you have any suggestion at all on that topic?

That is a different topic. It used to be people helped their neighbors and community. I do know that in this case, government will make things worse. Not better.


Well, considering that most of the major pharma's spend around 50% of their budget in marketing, I really doubt we would be making much of a dent on their R&D.
So, in a nutshell, you really don't think medicine prices in the US are inflated, correct?

I doubt that's an accurate number. What number is that based on? Profits? Definitely not gross expenditures.


Whatever it did, it wasn't lawsuits. That specific entry indicated that after tort reform, they still didn't get any more doctors than before in that area.

But it was the wrong tort reform. Any lawsuit is damaging to a doctor. TV lawyers are always advertising for cases against one thing or another. If a doctor has to spend his day defending a case, how can he make money. It doesn't matter if the petitioner is only awarded $1. The time in court is time the doctor is not making money.

[SnakeBoy]

Now, the thing with tort reform is that once you cap the awards, I'm not sure there's much more you can do.

Well my wife's opinion is that although the tort reform has lowered mapractice insurance some it still hasn't addressed the issue of preventing lawsuits. So there is still alot of defensive medicine going on in Texas. I think something like a loser pays all legal fees law (better yet losing attorney pays legal fees) would go along way in reducing lawsuits and overall healthcare costs.

My wife just recently fired a patient. The husband called the exchange at night with the message for her of "If she doesn't want to get sued she better call me right away". She called him, answered his stupid question, and the next day sent the lady a letter that she needed to find a new doctor.

I don't know all the answers but I think more effective tort reform would have the goal of reducing frivolous lawsuits so physicians aren't practicing defensive medicine which would reduce overall healthcare costs. I think capping awards in the cases of gross negligence might benefit insurance companies but doesn't have a very positive effect on overall healthcare costs.

[ElNono]

Well, what is it that you like about the current proposal?

Nothing in particular.
If you press me for a silver lining, I would have to say that it would shake up the current system and force current and future administrations to actually address the issue, for better or worse. But that's as far I'm willing to go as far as trying to find a positive.


Do you think this bill does its job of lowering medical costs or lowering drug costs?

I don't think it will in it's current form, no.

[Wild Cobra]

I don't know all the answers but I think more effective tort reform would have the goal of reducing frivolous lawsuits so physicians aren't practicing defensive medicine which would reduce overall healthcare costs. I think capping awards in the cases of gross negligence might benefit insurance companies but doesn't have a very positive effect on overall healthcare costs.
I agree. The doctor shouldn't have to be concerned with protecting his ass. He should be concerned with practicing the best medicine he can, and only get sued if he makes a monumental fuck-up.

[SnakeBoy]

If you interfere with their profits, they will have no incentives to lay out the costs for new research and development. Careful, or such fields will die....


In general I agree with that but when it comes to big pharmas profits they are raping us. I don't think they should be non profit but something needs to be done about their practices.

http://i61.photobucket.com/albums/h57/texasrainmaker/ProfitsOilVsOtherIndust3rdQ2005.gif

[ElNono]

Yes, there are several different ways of doing it. One method is to make the petitioning party pay if they lose. Maybe not all, but enough that people think twice before filing a lawsuit.

I see. So you can't really prevent people from suing, you would simply discourage them from doing it.


That is a different topic. It used to be people helped their neighbors and community. I do know that in this case, government will make things worse. Not better.

So you would leave those cases to charity/family/community assistance, much like what Marcus Bryant proposed. Do you think with the current costs of healthcare that's a feasible alternative?


I doubt that's an accurate number. What number is that based on? Profits? Definitely not gross expenditures.


I'll try to look up the article for you. It's probably a couple of years old, but it might be archived somewhere.


But it was the wrong tort reform. Any lawsuit is damaging to a doctor. TV lawyers are always advertising for cases against one thing or another. If a doctor has to spend his day defending a case, how can he make money. It doesn't matter if the petitioner is only awarded $1. The time in court is time the doctor is not making money.

Gotcha.

[ElNono]

I don't know all the answers but I think more effective tort reform would have the goal of reducing frivolous lawsuits so physicians aren't practicing defensive medicine which would reduce overall healthcare costs. I think capping awards in the cases of gross negligence might benefit insurance companies but doesn't have a very positive effect on overall healthcare costs.

The other question is wether those cost savings would actually be passed down to the consumer, or be pocketed by the provider. I don't really see an actual implicit incentive for the provider to pass the savings along, do you?

[Wild Cobra]

So you would leave those cases to charity/family/community assistance, much like what Marcus Bryant proposed. Do you think with the current costs of healthcare that's a feasible alternative?

I don't know. Life is tough, and as nice as it would be to help everyone out, it just doesn't happen. Never has, and never will. I do know it was easier for people to help each other before the ever increasing tax rates on the middle class. Not just income taxes, but property taxes, user fees, etc. etc. It all adds up to far too much government.

Charity does help in many cases. I have a payroll deduction of $70 every pay period. half that goes to Doernbecher Children's Hospital (http://en.wikipedia.org/wiki/Doernbecher_Children%27s_Hospital). I give cash at times for needs. I think it's safe to say that we conservatives like to give our money to people who need help. I like to control where my money goes. I'll help a single mother or a child with my money, and don't want to see it help keep a drug user alive. Community outreach generally covers the people who both need and deserve help. Still, with government always finding new tactics to separate us from our money, it's harder to have money to give to others.

[Wild Cobra]

In general I agree with that but when it comes to big pharmas profits they are raping us. I don't think they should be non profit but something needs to be done about their practices.

http://i61.photobucket.com/albums/h57/texasrainmaker/ProfitsOilVsOtherIndust3rdQ2005.gif
A long term average would be a better indicator. There might have been no major payouts in the 3rd quarter of 2005. When you operate an industry prone to lawsuits, you put away money when you can so you aren't dissolved at the first big lawsuit.

Have a 10 year average for each industry by chance?

[Wild Cobra]

The other question is wether those cost savings would actually be passed down to the consumer, or be pocketed by the provider. I don't really see an actual implicit incentive for the provider to pass the savings along, do you?
It's called competition. When a provider can increase his customer base by charging less for the same service, he will. Competition takes pricing down to a fair level. They can only compete so far before having to maintain a livable profit.

[ElNono]

I doubt that's an accurate number. What number is that based on? Profits? Definitely not gross expenditures.

Here's one of the articles from the Public Library of Science. This one actually contains older data than the one I recall reading, but basically amounts to the same.

LINK (http://www.pubmedcentral.nih.gov/articlerender.fcgi?doi=10.1371/journal.pmed.0050001)

Now, there has been some changes in the last few months regarding direct promotion to doctors (mostly prompted exactly because of this). I don't really have any newer numbers to see how this affects their marketing budget.

[SnakeBoy]

The other question is wether those cost savings would actually be passed down to the consumer, or be pocketed by the provider. I don't really see an actual implicit incentive for the provider to pass the savings along, do you?

I'm not talking about savings for the doctor, I'm talking about tests & procedures that are being done that the doctor wouldn't otherwise do. That would result in lower insurance costs.

I'll give you an example. I had a bump on my head that I got when I banged my head as a kid, just a fatty tissue cyst, pretty common no big deal. A few years ago I decided to get it removed because of my slowly receding hairline. So I went to the surgeon my wife recommended. First thing, he sends me for an MRI to make sure it wasn't attached to the skull. I was like wtf that's pretty obvious and my wife says that's called CYA. Then he does the simple surgery in the hospital OR with an anesthesiologist present. Total cost $12K.

My sister had the same damn thing. Her husband is in the military. So she goes to get hers removed and the military surgeon does the procedure in the office, just a local anesthetic. 30 minutes in the office and he's done. That's a hell of alot cheaper. And my surgeon didn't get one dime from the MRI or the hospital OR, it was all CYA.

[Wild Cobra]

Here's one of the articles from the Public Library of Science. This one actually contains older data than the one I recall reading, but basically amounts to the same.

LINK (http://www.pubmedcentral.nih.gov/articlerender.fcgi?doi=10.1371/journal.pmed.0050001)

Now, there has been some changes in the last few months regarding direct promotion to doctors (mostly prompted exactly because of this). I don't really have any newer numbers to see how this affects their marketing budget.
OK, I followed one of the links:

PRESCRIPTION DRUGS
FDA Oversight of Direct-to-Consumer Advertising Has Limitations (http://www.gao.gov/new.items/d03177.pdf), part of text:

Pharmaceutical companies spend more on research and development
initiatives than on all drug promotional activities, including DTC
advertising. According to industry estimates, pharmaceutical companies
spent $30.3 billion on research and development and $19.1 billion on all
promotional activities, which includes $2.7 billion on DTC advertising, in
2001. Pharmaceutical companies have increased spending on DTC
advertising more rapidly than they have increased spending on research
and development. Between 1997 and 2001, DTC advertising spending
increased 145 percent, while research and development spending
increased 59 percent. Promotion to physicians accounted for more than 80
percent of all promotional spending by pharmaceutical companies in 2001.
Total promotional spending was equivalent to 12 percent of drug sales in
the United States in 2001.

OK..

$30.3 billion R&D
$19.1 billion promotional

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?

20% of that, which would now be the maximum for commercials is now $3.8 billion. That's a pretty small part of the profits.

Granted, the numbers may have increased, but still. If only 20% of that promotional money is in commercials, it is a small part of the total.

[ElNono]

I don't know. Life is tough, and as nice as it would be to help everyone out, it just doesn't happen. Never has, and never will.

As far as healthcare is concerned, I have to assume you mean in the United States? Life is tough everywhere, but somehow other places manage to help everyone out in that department.

I think this is the Big Elephant in the room. What do we do with these people.
And I've yet to hear of a proposal in this thread that addresses this specifically that's really practical and realistic.
Some of them only need temporary help, just as it happened with my wife, without driving them to the verge of bankruptcy, which takes years to recover from.
Now, I'm not suggesting the government needs to fill out that role. But if it's not the government, then who? How? Nobody? Screw them all?
Or as Marcus would say: Let's just simply accelerate the demise of the sick and poor and move on?

[ElNono]

OK, I followed one of the links:

PRESCRIPTION DRUGS
FDA Oversight of Direct-to-Consumer Advertising Has Limitations (http://www.gao.gov/new.items/d03177.pdf), part of text:


OK..

$30.3 billion R&D
$19.1 billion promotional

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?

20% of that, which would now be the maximum for commercials is now $3.8 billion. That's a pretty small part of the profits.

Granted, the numbers may have increased, but still. If only 20% of that promotional money is in commercials, it is a small part of the total.

The 2004 numbers (according to the pharma lobby group) are right there on the article:



Based on the data provided by IMS [4], the Pharmaceutical Research and Manufacturers of America (PhRMA), an American industrial lobby group for research-based pharmaceutical companies, also contends that pharmaceutical firms spend more on research and development (R&D) than on marketing: US$29.6 billion on R&D in 2004 in the US [5] as compared to US$27.7 billion for all promotional activities.[4]


Actually, that paper went back to the raw data and run the calculations again. Their conclusion was:



Using the IMS figure of US$15.9 billion for the retail value of samples, and adding the CAM figures for detailing and other marketing expenses after correcting for the 30% estimate of unaccounted promotion, we arrived at US$57.5 billion for the total amount spent in the US in 2004, more than twice what IMS reported (see Table 1).


But even if you use the 'official' numbers, you're still at around 50-50.

[ElNono]

I'm not talking about savings for the doctor, I'm talking about tests & procedures that are being done that the doctor wouldn't otherwise do. That would result in lower insurance costs.

I'll give you an example. I had a bump on my head that I got when I banged my head as a kid, just a fatty tissue cyst, pretty common no big deal. A few years ago I decided to get it removed because of my slowly receding hairline. So I went to the surgeon my wife recommended. First thing, he sends me for an MRI to make sure it wasn't attached to the skull. I was like wtf that's pretty obvious and my wife says that's called CYA. Then he does the simple surgery in the hospital OR with an anesthesiologist present. Total cost $12K.

My sister had the same damn thing. Her husband is in the military. So she goes to get hers removed and the military surgeon does the procedure in the office, just a local anesthetic. 30 minutes in the office and he's done. That's a hell of alot cheaper. And my surgeon didn't get one dime from the MRI or the hospital OR, it was all CYA.

I'm well aware of the cover your ass syndrome.
At the same time, you also have these (http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all) kind of doctors. (it's actually a long read, but if you have the time, I believe it's well worth it).

[SnakeBoy]

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?


Now your making stuff up. I posted this a while back but 3-4 years ago my wife's practicing banned drugs reps because they were interfering with the practice. They were bringing breakfast and lunch for everyone at the office (about 30 people) every single day. And these were pricey meals from places like the palm. They weren't doing that to give out free drugs, they were doing that to try and get the doctors to pimp their drugs.

[SnakeBoy]

I'm well aware of the cover your ass syndrome.
At the same time, you also have these (http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all) kind of doctors. (it's actually a long read, but if you have the time, I believe it's well worth it).

Yeah I've read that before. Physician owned hospitals are a bad idea. Fixing healthcare is really complicated. I'm not saying better tort reform is the full solution, just a piece of the solution.

[Wild Cobra]

As far as healthcare is concerned, I have to assume you mean in the United States? Life is tough everywhere, but somehow other places manage to help everyone out in that department.

Do do that, we would drop our citizens standard of living to that of the European Nations. You want that?

Is that worth it to you, to make universal medicine happen? Do you want to pay another 10% or more in taxes to make such a program work?

Ever live in Europe? I have. Their middle class lives about as good as our poor here do.

[Wild Cobra]

But even if you use the 'official' numbers, you're still at around 50-50.
Still, the promotional amount to doctors really matters. If that 80% number still applies, then 40% ius to doctors, primarily in free medicine for them to give their patients.

We now have

50% R&D

40% Free drugs to patients

10% commercials

[Wild Cobra]

Now your making stuff up. I posted this a while back but 3-4 years ago my wife's practicing banned drugs reps because they were interfering with the practice. They were bringing breakfast and lunch for everyone at the office (about 30 people) every single day. And these were pricey meals from places like the palm. They weren't doing that to give out free drugs, they were doing that to try and get the doctors to pimp their drugs.
Maybe so, but I do know that doctors get a great deal of free medicine to give their patients. It promotes the doctor to write the prescriptions, especially when a patient says he likes it and wants more.

Dining and wining is part of most new venture transactions, right?

No, I'm not making things up. My doctor has told me about all the free stuff he gets to hand out.

Besides, let's say you're talking about a $1,000 meal. Was it a big enough office that maybe they were prepared to give $100,000 or more in free drugs out, to get new clients for those drugs?

I'm not saying I like these approaches. They would likely do just as well to simply ship free samples without using reps.

[ElNono]

Do do that, we would drop our citizens standard of living to that of the European Nations. You want that?

Would we now? Do you have information to back that up, or you're simply making it up?


Is that worth it to you, to make universal medicine happen? Do you want to pay another 10% or more in taxes to make such a program work?

Where that extra 10% or more number comes from? I'm on the record that I would be willing to pay an extra 5% in taxes if necessary for the right plan that covers everyone.


Ever live in Europe? I have. Their middle class lives about as good as our poor here do.

Wow, talk about random generalizations. Do you actually have anything to back that up? I do actually have family both in France and Italy, middle class family. And Europe is fairly big. Standards of living vary pretty radically among different countries.

[ElNono]

Still, the promotional amount to doctors really matters. If that 80% number still applies, then 40% ius to doctors, primarily in free medicine for them to give their patients.

We now have

50% R&D

40% Free drugs to patients

10% commercials

Actually, you don't need to assume or make up any numbers. The report I linked to includes figures for sample medicine ($15.9 billions in 2004). The tally looks more like this:

34% R&D

66% Promotional material (which can be broken down in 20% sample drugs and 46% for the rest)

Again, my original point stands, they do spend circa 50% on promotional material, and you would hardly make a dent on R&D. Furthermore, your guess that their research would be hampered and their demise assured is simply bollocks.

[spurster]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

[ElNono]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

Because it's all about me, me, me. Look at the average answers to my questions in this thread. To some of them, the motivation for reducing costs has very little if anything to do with increasing access to care (life is tough), and everything to do with saving a buck for themselves. The quality of care claim is actually fairly hilarious because I'm absolutely convinced that if they could pick between a cheaper suboptimal treatment vs a more expensive high quality treatment that both yield the same outcome, they'll go with the cheaper one every time, quality be damned.

That said, I do respect that some of them are coherent in what they say. The problem is with the incoherent people. If you claim that the government couldn't possibly handle a system as complex as healthcare properly, you can't turn around and say the government does a great job handling the military or national security (systems that are just as complex or more). At that point, you're just making excuses.

[Marcus Bryant]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

Oh, if it were that simple. And, yeah, who should be concerned about silly things like liberty and the source of those "lower costs" when the ideological mirage of a benevolent state is at stake? Also, how about accurately assessing the source of the problems with the health care service industry, instead of jumping to a solution which is rife with plenty of problems which its proponents selectively choose to ignore?

[101A]

Naturally answers are proposed which do not address the heart of the matter. The basic problem is that most pay for routine health care services through a 3rd party payer. Most use a 3rd party payer as it is part of their or a family member's compensation or it is a government program. It's a standard workplace benefit owing to its exclusion from the income tax. When you pay a fraction of the cost of those routine services, then you are less likely to shop around and you are less likely to balk at additional, perhaps generally unnecessary services.

Greater government intervention in health care services is debated under the assumption that the government currently is not greatly involved. It is precisely its history of involvement which has led us to the mess we are in. Now we can understand that and move towards a solution based on that understanding, and recognize that any kind of reform should be based on the reality that the provision of health care services is a service, and as such is subject to all of the basic laws of economics which apply to every other good and service produced by a private party, or we can pretend that it is something else, and come up with an even greater monstrosity of stupidity, and continue to address everything but the root cause.

Of course, these debates are usually nonproductive. If someone believes the Earth was formed 5,000 years ago, in spite of all evidence to the contrary, because their faith tells them so, then it's generally not worth spending the time discussing matters of science and history with them. Such it usually is with those who advocate greater state involvement in health care services. It's not politics to them, it's religion, and they should be regarded as the ignorant fundamentalists they are.


:toast

[DarkReign]

Well you should shop around more DR. The assurant policy that was almost double we had around 5 years ago was actually the plan my wife's practice was providing for their employee's. Some physicians my wife wanted to didn't take that plan so she found some independent insurance lady who went through a gazillion plans. We settled on this one through Blue Cross/Blue Shield. It was a long process (took a few months), insurance lingo makes my head explode.

What is HAP?

We did the shopping around bit. 4 separate companies (BC/BS, HAP and two other minor people I cant remember).

HAP is Health Alliance Plan. http://www.hap.org/

[Shelly]

I wonder if morePCP docs are going to start going the way of concierge medicine (http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html).

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

Seems like it's only PCP that are going this route. I don't see how specialist docs could survive practicing this way.

[ElNono]

I wonder if morePCP docs are going to start going the way of concierge medicine (http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html).

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

Seems like it's only PCP that are going this route. I don't see how specialist docs could survive practicing this way.

My PCP has been only seeing MDVIP (http://www.mdvip.com) patients only for a couple of years now.

[ploto]

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

It makes no sense to me because you still need insurance for specialists, lab work, prescriptions, and hospital care. What healthy person would ever spend $3000/yr at their PCP? And the notion that you now will get full access to the physician, well supposedly so do hundreds of other people.

It's all about making money and physicians thinking it is more lucrative to have a set number of people pay cash up front instead of dealing with insurance claims. Really it is separating the have's from the have not's even moreso in the provision of health care.

[boutons_deux]

boutique medicine is free-market, capitalistic rationing of health care, not that wrongies have any objection to it.

[Marcus Bryant]

boutique medicine is free-market, capitalistic rationing of health care, not that wrongies have any objection to it.

...as well as a "free-market, capitalistic" provision of health care services. Health care services are not some monolithic entity which exists regardless.

[Shelly]

My PCP has been only seeing MDVIP (http://www.mdvip.com) patients only for a couple of years now.

I'm confused--so you belong to this?


It makes no sense to me because you still need insurance for specialists, lab work, prescriptions, and hospital care. What healthy person would ever spend $3000/yr at their PCP? And the notion that you now will get full access to the physician, well supposedly so do hundreds of other people.

It's all about making money and physicians thinking it is more lucrative to have a set number of people pay cash up front instead of dealing with insurance claims. Really it is separating the have's from the have not's even moreso in the provision of health care.

When I first heard about this type of practice a few years ago, my understanding was that most of the patients were participating were older and had the means, like you stated. Or they're all hypochondriacs :lol But obviously, some people are willing to pay for this. But seriously, how many times does one need to see a PCP?

However, my friend is bummed because she's been with her doc for a long time and really liked her.

[Trainwreck2100]

I wonder if morePCP docs are going to start going the way of concierge medicine (http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html).

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

Seems like it's only PCP that are going this route. I don't see how specialist docs could survive practicing this way.

tell him his show on USA is golden

[ElNono]

I'm confused--so you belong to this?

He's an old friend of my boss, and we actually have a commercial venture with him. We received complimentary memberships to that program from him way back when he joined the program. It's silly anyways, because we had full access to him even before he was part of it.

I do get my yearly physical done through it though.

[ploto]

When I first heard about this type of practice a few years ago, my understanding was that most of the patients were participating were older and had the means, like you stated. Or they're all hypochondriacs :lol But obviously, some people are willing to pay for this. But seriously, how many times does one need to see a PCP?

I know a physician who thought he would do this, but when he could not find enough people to pay upfront to support it, he gave up on the idea. I think he also met some physician, who discovered, like you hinted, that many of these people were hypochondriacs who wanted to see the doctor all the time and for hours. Or they were lonely and wanted someone to talk to.

You know how people act at a buffet; it was the same mentality. The cost was the same regardless, so they are going to get their money's worth.

[spurster]

To get evidence-based medicine. Here is one example:

http://www.nytimes.com/2009/07/17/health/17screening.html

[mookie2001]

have yall noticed all the white people against "socialism" and doctors "deciding on our life and death", canada this, canada that -HAVE insurance now

how fucking stupid, what difference does it make to someone without insurance if they have to wait 6 months for a medical procedure

[mookie2001]

i havent heard any poor people without insurance bitching and moaning about canada

[Wild Cobra]

how fucking stupid, what difference does it make to someone without insurance if they have to wait 6 months for a medical procedure
Because that money comes from somewhere. The best current estimates that people actually ran numbers with have this current plan costing over $500 billion annually more than what they already plan to take. That comes out of working peoples money somehow. Either in direct more taxes, more employer taxes, fees, etc.

Can't take care of yourself? Move back in with your parents, or deal with it. Life's a bitch, then you die. Only taxes and death are certain. Stop asking that I pay more or my hard earned money in taxes for you can get freebies. Shit, I already pay too much in taxes, and it will be even more when the Bush Tax cuts expire. It wouldn't bother me so much if everyone payed the same percentage I do. If the poor people also paid the same rate of taxes, then maybe they would care about taxes going up. Without a vested interest, liberal politicians pandering to get the poor vote, will destroy this nation as we know it.

[FuzzyLumpkins]

Any industry where there is a vertical demand slope needs to be regulated. IOW, if people will pay any price for something that they need then the market will not regulate itself. If you're child is dying is there any price you will not pay to save his life?

This is exactly what the current health care system preys on. It is the reason why health care costs are spiraling out of control and quite frankly even the most stringent right wingers realize that they system as it is now just does not work.

In in the food industry massive subsidies keep prices low. Water and power is heavily regualted because in today's society you need them to live.

For some reason health care just gets a free pass. This is despite about half of adults under the age of 28 don't have health care and the millions with preexisiting conditions as well.

You may not give a shit but the small business owner who pays his taxes and contribute to society yet cannot get a policy because he has been diagnosed with diabetes sure as hell cares.

All other insurance is regulated. Flood insurance is handled by the government. P and C like home and auto insurance has to have their rates approved by the state every year.

Yet health insurance gets a free pass.

The discussion is so damn irritating as well. So much of the naysaying is based on greed. So often you hear, 'Fuck them, I'm not paying for there health care I have enough to worry about.' It doesn't matter when you show countries like Canada and England where infant mortality and life expectancy are much better and the much much lower per capita cost of health care would mean a lower amount most individuals would have to pay.

This type of behavior is not surprising in a culture where we are killing our economy with credit and don't have the foresight to see that a variable loan might be an issue.

Then there are all the lies and fear mongering. I heard someone say that if health care is state run then noncovered health care would be unavailable 'just like it is in England.' Like there is no cosmetic surgery in the isle across the pond. Thats just a bald faced lie.

You hear Aetna decry how Medicare and Medicaid pay less to doctors which means they cannot compete.

Well no shit, Sherlock. Thats the whole point. The cost of health care needs to be brought down and you fuckers aren't getting the job done.

And make no mistake, there is no incentive for health care insurers to lower cost in the long term. While within a particular policy period, they will try and deny claims and the like; in the long run higher prices mean higher premiums and since they take a percentage, that means more profits.

10% of $100,000 beats the hell out of 10% of $50,000.

People are just stupid though. They will eat up 'reviews' produced by insurance and doctor owned entities that at best distort the truth and will ignore the empirical evidence that is every other western nation.

[FuzzyLumpkins]

My favorite health care fearmongering lie has been 'there are only 3 MRI's in Canada.' The whole supposed point being that health care must therefore be worse there. Who gives a shit about major statistical indexes like infant mortality and the like. Who cares that a 4 year old could actually look it up and see that its a lie but I digress.

Lets look at the opposite side of that equation. How much is an MRI costing us?

I got hurt around Christmas time last year and had an MRI to check out my head neck and back. I looked at the bill and it was a bit over $6k. This was after my X-rays were negative so really the MRI was bullshit but again I digress. Lets just say the cost of getting an MRI is $5k. Im looking for easy math.

The cost of a 3 tesla MRI machine is about $3 million dollars. Its the industry standard where they lay you on the table and slide your ass in there. Lets say the cost of running and maintaining the machine is $1mil per annum --its a bit much but supercooled electromagnets do take a bit of power-- and lets say the techs cost about $1mil to actually run the machine every year.

Thats a grand total of $5 mil the first year and once the sunk cost of $3 mil is paid its $2 mil annually.

Lets say for the sake of argument a particular MRI does 10 scans a day. I am sure that the actual number is much more than that but again I am trying to use easy math that makes a point.

10 scans a day at $5k a run is $50k a day. Not bad, eh? Well lets say the machine only runs 300 days out of a year. The number is obviously going to be much higher --they aren't going to shut it off for two months when health care needs are daily-- but again were talking easy math that makes a point. Well that comes out to $15,000,000 a year.

Now the numbers I used should have been higher but even with these very conservative numbers that first year is a $10 mil return. That goes up to $13 mil annually from then on. Who the hell wouldn't want a 10 year return of $127 million on a $3 million dollar investment?

Its complete and utter usuring bullshit. Well WTF are you going to say when your oncologist says you need one? No?

Oh and don't give me any horseshit about R&D costs. The machine was invented in '73 and the fuckers charging $5k didn't invent a fucking thing.

[mookie2001]

wc you have insurance then i assume

and if i have a procedure i need and i cant get insurance to pay even if i got insurance because its pre existing, im supposed to be worried about the economy and socialized medicine and move back in with my parents

the worst cast senario is i cant get medical care, same as always

[Wild Cobra]

wc you have insurance then i assume

and if i have a procedure i need and i cant get insurance to pay even if i got insurance because its pre existing, im supposed to be worried about the economy and socialized medicine and move back in with my parents

the worst cast senario is i cant get medical care, same as always
I've had several years with no insurance. Just payed out of pocket. I was able to shop around and find a great private practice, that had decent cash rates. They still have my business now that I have Blue Cross Blue Shield.