WSJ: Ten GOP Health Ideas for Obama [Archive]

spursncowboys

02-10-2010, 10:40 AM

By NEWT GINGRICH AND JOHN C. GOODMAN (http://online.wsj.com/search/search_center.html?KEYWORDS=NEWT+GINGRICH+AND+JOHN +C.+GOODMAN&ARTICLESEARCHQUERY_PARSER=bylineAND)

'If you have a better idea, show it to me." That was President Barack Obama's challenge two weeks ago to House Republicans regarding health-care reform. He has since called for a bipartisan forum, not to start over on health reform but to "move forward" on the "best ideas that are out there."

The best ideas out there are not those that were passed by the House and Senate last year, which consist of more spending, more regulations and more bureaucracy. If the president is serious about building a system that delivers more quality choices at lower cost for every American, here's where he should start:

• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.

• Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.

So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.

• Don't cut Medicare. The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.

• Protect early retirees. More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.

• Inform consumers. Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.

• Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.

• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.
The solutions presented here can be the foundation for a patient-centered system. Let's hope the president has the courage to embrace them.

Drachen

02-10-2010, 11:24 AM

A couple of honest questions:
First, regarding the 500 billion dollar cut. Since this doesn't go to benefits for those on Medicare, would you (anyone who agrees with these proposals) be willing to cut that payment while not lowering Medicare tax. Take this money and sock it away so that Medicare remains funded?

Also regarding removing red tape, I am not sure that I like this since as currently constituted, many people still get sick and die from drugs that pass all of that red tape. Lowering the bar seems to increase the likelihood of such things.

I like the idea of self administration of meds. When I was younger I had asthma and though it wasn't really bad, it would get bad in some parts of the year and I required a shot. The doctor allowed my mom to administer it, but we did have to go in if there was a change in the amount. I want to do that allergy immunotherapy which requires a shot once a week. I want to do this, but it will cost me $25 a week for each "specialist visit." Unfortunately I am unable to do this.

I don't have too many problems with the rest of the proposals, but do feel some things have been left out. Make HSAs go in perpetuity. If I contribute 2k to my HSA this year, and spend 1500. That means I have to go crazy in december trying to find something to buy (I spent $182 on December 30th, 2009 at CVS, so that my money wouldn't vanish). There is no reason this money shouldn't carry over for a year when I may need 3k from my HSA.

Also, what suggestions are there for those who after these are enacted, still can't afford health insurance? Expanded Medicare?

Lastly, what about those who are idiots and still don't get medical insurance? Do you fine them? I don't want to continue to pay for their ER visits (through my taxes) especially when they go to the ER for something that could be taken care of much cheaper (like the flu). I know that this is a contentious point with the current proposal because of those who want to exercise their freedom to not buy insurance. Could we give three choices or four: Get insurance, prove that you have X amount in your HSA with which to cover any catastrophic illnesses (which increases as you age), get fined, or have some kind of demarcation that you arent allowed ER access (I would rather not let the last one be an option).

I like the idea of health care coverage for all, and think it should be a goal, but I want to listen to both sides. I also don't mind the idea of my taxes going up, but initially only to pay down the debt. This is why I had such a problem with the Bush tax cuts. It was like "WE finally have money to pay down the de... oh never mind." I dont want that last statement to spark a "repig v dumbocrap" thing here, I just didn't like that policy.

Anyway, I would appreciate some (thought out and eloquent, not a bunch of shouting and idiotic) answers if yall have the time.

coyotes_geek

02-10-2010, 11:29 AM

• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

Yes Newt, we'd all like to make insurance more affordable. But tax credits don't do anything to change the internal workings and cost structure of the industry. All tax credits will do is trade off a health care cost problem for a government defecits problem.

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

The bit about being able to purchase insurance across state lines is a good idea. I hope that happens. The bit about portable insurance also sounds good in concept, but how good it would actually be depends on what it would take to "encourage" employers to participate. If that encouragement involves the government giving away money to someone, that's not accomplishing anything.

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.

That sounds all warm and fuzzy, but there's not really any substantive ideas in here.

• Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.

So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.

Nice concept, but as above, a substantive idea on how to accomplish this goal is missing.

• Don't cut Medicare. The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.

Newt stresses the importance of ignoring the medicare problem. No idea on how to fix it, just don't cut it.

• Protect early retirees. More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.

If an employer wants to do something like that for the benefit of their employees, great. But the burden of protecting early retirees falls solely on the person wanting to retire early. If you can't afford to provide health insurance for yourself in that in between phase then you can't afford to retire early. Simple as that.

• Inform consumers. Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.

Good idea.

• Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.

Obviously a hot topic for a lot of people. How much this would actually reduce costs is highly debateable, but even if it is just a small step in the right direciton, it's worth doing IMO.

• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

:lol at the notion of the government stopping fraud.

• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.
The solutions presented here can be the foundation for a patient-centered system. Let's hope the president has the courage to embrace them.

This will take care of itself. The companies making the medical breakthroughs want them to be accessible to patients. Nobody wants to make a product that nobody can use.

coyotes_geek

02-10-2010, 12:05 PM

A couple of honest questions:
First, regarding the 500 billion dollar cut. Since this doesn't go to benefits for those on Medicare, would you (anyone who agrees with these proposals) be willing to cut that payment while not lowering Medicare tax. Take this money and sock it away so that Medicare remains funded?

That $500 billion cut was nothing more than a gimmick to make a $1.5 trillion dollar program look like it only costs $1.0 trillion. It's the federal government wussing out and making the individual states decide how to cut benefits or raise taxes.

Also regarding removing red tape, I am not sure that I like this since as currently constituted, many people still get sick and die from drugs that pass all of that red tape. Lowering the bar seems to increase the likelihood of such things.

Point taken, but just to play devils advocate there are also people who get sick and die from not having access to drugs that are still stuck in the process of getting through that red tape. There is a balance to be struck.

I like the idea of self administration of meds. When I was younger I had asthma and though it wasn't really bad, it would get bad in some parts of the year and I required a shot. The doctor allowed my mom to administer it, but we did have to go in if there was a change in the amount. I want to do that allergy immunotherapy which requires a shot once a week. I want to do this, but it will cost me $25 a week for each "specialist visit." Unfortunately I am unable to do this.

Agree on the self med. My wife went through something similar.

I don't have too many problems with the rest of the proposals, but do feel some things have been left out. Make HSAs go in perpetuity. If I contribute 2k to my HSA this year, and spend 1500. That means I have to go crazy in december trying to find something to buy (I spent $182 on December 30th, 2009 at CVS, so that my money wouldn't vanish). There is no reason this money shouldn't carry over for a year when I may need 3k from my HSA.

It would be nice to be able to carry over something. But if you make it too big then I'd think you'd start running a risk of HSA's being abused as tax shelters.

Also, what suggestions are there for those who after these are enacted, still can't afford health insurance? Expanded Medicare?

Lastly, what about those who are idiots and still don't get medical insurance? Do you fine them? I don't want to continue to pay for their ER visits (through my taxes) especially when they go to the ER for something that could be taken care of much cheaper (like the flu). I know that this is a contentious point with the current proposal because of those who want to exercise their freedom to not buy insurance. Could we give three choices or four: Get insurance, prove that you have X amount in your HSA with which to cover any catastrophic illnesses (which increases as you age), get fined, or have some kind of demarcation that you arent allowed ER access (I would rather not let the last one be an option).

If we want to be serious about reducing health care costs, then some level of denying treatment to those who can't pay for it has to be part of the solution. The longer we pretend that we don't have to make that tough choice, the longer it will take to solve this problem.

RandomGuy

02-10-2010, 12:14 PM

That sounds all warm and fuzzy, but there's not really any substantive ideas in here.

/thread.

.. he says, tongue in cheek.

Pretty much sums up the "ideas" put forth. I, for one, would be delighted, in a schadenfreude sense, to impliment every single one of these GOP ideas, toss out any Democratic ideas, and watch how dismally they fail to address the true scope of the problem.

The party of No Ideas has fully lived up to its sarcastic moniker.

spursncowboys

02-10-2010, 12:16 PM

/thread.

.. he says, tongue in cheek.

Pretty much sums up the "ideas" put forth. I, for one, would be delighted, in a schadenfreude sense, to impliment every single one of these GOP ideas, toss out any Democratic ideas, and watch how dismally they fail to address the true scope of the problem.

The party of No Ideas has fully lived up to its sarcastic moniker.
What is the problem?

RandomGuy

02-10-2010, 12:23 PM

• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

ooh some bad phrasing here, if not a wee bit misleading.

Let's get a bit more accurate here:

Every year up to $120 billion is stolen by criminals who defraud both private insurers and public programs like Medicare and Medicaid.

The National Health Care Anit-Fraud Association gets its data in places like the 2007 FBI report on financial crimes.

http://www.fbi.gov/publications/financial/fcs_report2007/financial_crime_2007.htm#health

That private insurance also gets defrauded doesn't quite fit in with the "Big wasteful government, booga booga booga!" narrative, so that small detail gets left out to make it appear that the scope of the problem is somehow limited to the big bad goverment, "but oh by the way, don't cut those programs, because that is our other "big" idea". Don't know whether to laugh, cry or roll my eyes at that one. :lol :rolleyes :depressed

coyotes_geek

02-10-2010, 12:26 PM

The party of No Ideas has fully lived up to its sarcastic moniker.

We're trapped between the party of no ideas and the party of bad ideas.

TeyshaBlue

02-10-2010, 12:29 PM

Drachen

02-10-2010, 12:31 PM

That $500 billion cut was nothing more than a gimmick to make a $1.5 trillion dollar program look like it only costs $1.0 trillion. It's the federal government wussing out and making the individual states decide how to cut benefits or raise taxes.

Point taken, but just to play devils advocate there are also people who get sick and die from not having access to drugs that are still stuck in the process of getting through that red tape. There is a balance to be struck.

Agree on the self med. My wife went through something similar.

It would be nice to be able to carry over something. But if you make it too big then I'd think you'd start running a risk of HSA's being abused as tax shelters.

If we want to be serious about reducing health care costs, then some level of denying treatment to those who can't pay for it has to be part of the solution. The longer we pretend that we don't have to make that tough choice, the longer it will take to solve this problem.

HSA's: They could become tax shelters, but those who use them as such better have a ton of medical expenses at the end of their lives on which to use this enormous tax shelter. If someone wanted to get that money back to use on non-health related purchases, give it to them taxed at the highest tax rate + some fine. If you want to avoid that, however, one could also look at the average cost of healthcare for a certain age (say 25) allow that person to put the average + X% into their HSA untaxed, then the rest (if they so choose) is taxed at their regular rate.

As far as the "sick and die before drugs are released", without the red tape many more could get sick and die because a drug shouldn't have been released. Additionally, that arguement could be used over and over again until there is no time between the development of a drug and its issue to the public. Due Dilligence shouldn't be cut. Perhaps there could be some way to open drug trials wider to allow far greater amounts of people to get into them, if they so decide, and if they sign a waiver stating that they know they may die and won't sue.

I am ok with the whole denial part as long as sufficient other options are given. If these options are turned down then there needs to be an active event that lets that person know that they will be denied care (like you sign a waiver stating that you have decided not to have medical coverage, and will not save for your medical well being). That way idiots who decide this KNOW that they have decided not to receive coverage.

Oh, and as far as medicaid/medicare (and any other such programs). There needs to be a sliding scale. It seems that currently these types of programs have a hard cap. For example, if this person makes between 0 and 30000 then they cant afford this service so we will provide it, but if they make 30001, they can. If those in the government believe that someone making 30001 can afford it, then the person making 30000 can fund at least, say, 85% with the government kicking in only 15% (I know it is more like 99%/1%, but I am allowing for brackets).

RandomGuy

02-10-2010, 12:31 PM

Truth be told about fraud:

I will always exist under any program, private or public. Steps can and should be taken to mitigate it.

Given the billions we throw at the Department of Homeland Security after a few thousand of US got killed, surely we can probably save our economy a bit if we diverted a bit of money from that to fighting some of the financial fraud that threatens and kills us far more than nutjobs with box cutters or exploding underwear.

One of the issues with such fraud is that a good chunk of it has to be handled by the states, who have, to be generous, some resource problems for unsexy things like insurance fraud investigations.

I fully agree with the idea of stopping health care fraud. But if more "big government" solutions aren't the answer, as presumedly for the GOP they aren't, can some enterprising Republican step up and tell me what the alternatives are for fighting such fraud?

TeyshaBlue

02-10-2010, 12:35 PM

DarrinS

02-10-2010, 12:37 PM

RandomGuy

02-10-2010, 12:41 PM

So pricing transparency and insurance portability are not ideas?

They are, hence the qualifier "pretty much" as opposed to "completely".

Don't get me wrong. I think we should achieve a lot of the goals/ideas here.

But I just don't see anything really altogether substantial.

Buying health insurance across state lines is one example, but that would have to entail some MAJOR changes in the way heath insurance, if not insurance overall, is regulated. Those major changes would cost a LOT of money, and is one of the "sounds good, but the devil is in the details" issues.

I would be all for doing these things, if I really thought they would work. Who knows, maybe they would. Let the GOP's ideas be incorporated into the Health care form bill, lock, stock, and barrel. That way they have to take ownship of and accept responsibility for the problem instead of just pissing and moaning that they hate the Democrats ideas like a bunch of whiny babies in order to gain political points for their party at the expense of actually, say, doing something for the public good.

coyotes_geek

02-10-2010, 12:44 PM

HSA's: They could become tax shelters, but those who use them as such better have a ton of medical expenses at the end of their lives on which to use this enormous tax shelter. If someone wanted to get that money back to use on non-health related purchases, give it to them taxed at the highest tax rate + some fine. If you want to avoid that, however, one could also look at the average cost of healthcare for a certain age (say 25) allow that person to put the average + X% into their HSA untaxed, then the rest (if they so choose) is taxed at their regular rate.

I don't have a problem with any of that.

As far as the "sick and die before drugs are released", without the red tape many more could get sick and die because a drug shouldn't have been released. Additionally, that arguement could be used over and over again until there is no time between the development of a drug and its issue to the public. Due Dilligence shouldn't be cut. Perhaps there could be some way to open drug trials wider to allow far greater amounts of people to get into them, if they so decide, and if they sign a waiver stating that they know they may die and won't sue.

No doubt there's a balance to be found here. I guess it's really just an issue as to whether or not there is a way to speed up the process without cutting corners. Conceding a strong personal sense of cynicism of the governemnt, I do beleive that there are inefficiencies in the FDA process that we would benefit from eliminating.

I am ok with the whole denial part as long as sufficient other options are given. If these options are turned down then there needs to be an active event that lets that person know that they will be denied care (like you sign a waiver stating that you have decided not to have medical coverage, and will not save for your medical well being). That way idiots who decide this KNOW that they have decided not to receive coverage.

The question becomes what other options are there? You either buy coverage or you don't.

Oh, and as far as medicaid/medicare (and any other such programs). There needs to be a sliding scale. It seems that currently these types of programs have a hard cap. For example, if this person makes between 0 and 30000 then they cant afford this service so we will provide it, but if they make 30001, they can. If those in the government believe that someone making 30001 can afford it, then the person making 30000 can fund at least, say, 85% with the government kicking in only 15% (I know it is more like 99%/1%, but I am allowing for brackets).

I think something similar is inevitable. I also think some kind of age hike for eligibilty is coming.

RandomGuy

02-10-2010, 12:50 PM

Until you answer the real question, "What drives up health care costs?", you will never be able to address the problem.

If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more competition. As it stands now, employers are picking up most of premium costs.

I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

Are doctors practicing "defensive medicine", or... are they simply reimbursed by the procedure, and maximizing their income by advocating only mildly useful procedures?

If people had to pay out of pocket for routine medical expenses, costs would go down.

Problem is that doesn't make economic sense. That would simply mean that people would simply avoid routine medical expenses. If you increase the price for any given product, you decrease the total amount of that product supplied to the market.

The idea that reducing the amount of routine medical expenses that might prevent much more costly curative care down the road would imply that there is a good chance of such a solution actually driving total systemic costs UP, not down.

One idea I have heard floated around to overcome this:

Pay doctors by the health care outcomes, not by the procedure.

TeyshaBlue

02-10-2010, 12:53 PM

They are, hence the qualifier "pretty much" as opposed to "completely".

Yet you close with the absolute:

The party of No Ideas has fully lived up to its sarcastic moniker. ;)

Buying health insurance across state lines is one example, but that would have to entail some MAJOR changes in the way heath insurance, if not insurance overall, is regulated. Those major changes would cost a LOT of money, and is one of the "sounds good, but the devil is in the details" issues.
I agree. The details is where the potential for fraud usually thrives. I can't think of any reason why the government cant task the insurers to develop this plan as a requirement. Face it, if we want to move forward with any meaningful reform, that does not involve completely dissolving the current, intermediary heavy system, then we need to involve these player and get some kind of buy in.

ElNono

02-10-2010, 12:54 PM

We're trapped between the party of no ideas and the party of bad ideas.

RandomGuy

02-10-2010, 12:55 PM

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

What about the private market shifting costs to medicare and medicaid through hikes in insurance premiums that force people and companies to drop coverage and join the ranks of the uninsured?

The uninsured, especially those that don't qualify for the government programs, shift THEIR costs to (surprise!) the insurance companies, who as paying customers, have to foot the bill for the uninsured hospital stays of everybody caught outside our current non-system.

Oddly enough, the uninsured also shift their costs to banks and other creditors, who have to eat non-productive loans when people are forced into bankruptcy.

There is a LOT of cost shifting going on, because we don't want to do the obvious thing and pay for everything up front and transparently. (single payor anyone?)

TeyshaBlue

02-10-2010, 12:58 PM

The idea that reducing the amount of routine medical expenses that might prevent much more costly curative care down the road would imply that there is a good chance of such a solution actually driving total systemic costs UP, not down.

One idea I have heard floated around to overcome this:

Pay doctors by the health care outcomes, not by the procedure.

I agree, this is likely to discourage visits in the short term. The potential exists, however, as doctors begin to see their schedules empty, that they begin to coax patients back with lower costs or some other incentive.

I'm still on the single payor bandwagon, and it's a lonely wagon to be on. But, I can see a hybrid approach where a single payor system can be resonsible for the routine office visits leaving the specialist and higher cost procedures in the hands of the current insurance companies. The companies dispense with an enormous amount of processing and other staff expenditures. In exchange, they would have to offer coverage with no exclusions and their premiums would be leveraged by the aggregate. Premium costs would also be required to be reduced and should be as a consequence of no longer paying routine visit costs.

RandomGuy

02-10-2010, 01:04 PM

Here is a fun thign to think about:

Woman is on blood pressure medication. Woman loses insurance, but makes too much to qualify for government assistance.

She cannot afford the medication, so she stops taking it.

Within a few months, she has a stroke and other complications, heading into the emergency room, where they spend more money in emergent tertiary care in the failed attempt to save her life than it would have cost the big bad goverment to simply have paid for the medications for the rest of her life.

This is a true story told by an emergency room doctor advocating for health care reform.

I think the current paralysis on the part of congress will likely continue to play out. The GOP has no stake in helping the Democrats succeed, and see only political gain in opposing anything the president and his party propose.

Therefore, nothing will really be done, making the current problem of uninsured worse.

I wish it were otherwise, but I don't see anything substantive happening. I wish the president luck in doing SOMETHING.

Drachen

02-10-2010, 01:09 PM

The question becomes what other options are there? You either buy coverage or you don't.

Heavily funded HSA's.

ElNono

02-10-2010, 01:14 PM

If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more competition. As it stands now, employers are picking up most of premium costs.

No such thing. People would simply stop going to the doctor because they either can't afford it or because they think they're smart enough and will never get sick. It's exactly what happens with the uninsured right now. What ends up happening is you have a more sick society overall, and the cost eventually surfaces later on in the form of chronic conditions (diabetes, etc), for things that should have been completely avoided with a modicum of preventive medicine.

I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.

Tort reform is supposed to address this. I wouldn't be against some sort of reform, but it's not the panacea people make it out to be.

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

As already said by RandomGuy, there's a lot of cost shifting going on at multiple levels.

To me, prices are inflated. I understand doctors trying to charge $150 a visit, because there might be a market out there for that. Also, because insurance co's will only pay $80 back. The same guy works just as well receiving the fixed price of $48 from Medicare. The difference being that he won't end up driving a Benz or playing golf on saturdays.

Drugs are another major factor. The patent protection they enjoy need to be severely limited. I don't mind them recouping their investment, but right now they spend more on advertising than R&D. They enjoy a temporary virtual monopoly that far exceeds merely recouping investment.

George Gervin's Afro

02-10-2010, 03:18 PM

What I haven't heard from the GOP is which of their ideas are they willing to compromise on. If they say none they then have zero interest in working with Obama. Before you dead enders respond keep in mind the moniroty party doesn't dictate any debate. The GOP should accept that not all of their ideas would be implemented and actually identify which one's they would be willing to compromise on.

mogrovejo

02-10-2010, 03:34 PM

A few bad, big government ideas. Marginally better than the ideas coming off the gang of Chicago.

This would be an exponentially better article:

Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

Eliminate junk lawsuits.

mogrovejo

02-10-2010, 03:36 PM

Congressman Paul Ryan ideas aren't perfect or even very good, but they're the best in the mainstream political market by far and away. Those are the ideas that the GOP should get behind.

ChumpDumper

02-10-2010, 03:37 PM

So what laws will apply to policies bought across state lines?

And as far as "junk" lawsuits go, how much did tort reform in Texas lower insurance premiums?

I'd like to see some numbers for that.

coyotes_geek

02-10-2010, 03:50 PM

One idea I have heard floated around to overcome this:

Pay doctors by the health care outcomes, not by the procedure.

Is something like that really practical when it comes to health care? Seems to me like all this would do is make doctors turn away patients once they come down with something that would be expensive to treat.

coyotes_geek

02-10-2010, 03:58 PM

So what laws will apply to policies bought across state lines?

And as far as "junk" lawsuits go, how much did tort reform in Texas lower insurance premiums?

I'd like to see some numbers for that.

Premiums went up. Are there any numbers that specifically identify tort reform as the reason they did? Or any suggesting that premiums wouldn't have gone up as much had we not enacted tort reform?

Winehole23

02-10-2010, 04:13 PM

Premiums went up.Tort reform in Texas wasn't enough to keep premiums from going up. That says something right there, because we know doctors saw considerable savings in the cost of insurance because of it.

TeyshaBlue

02-10-2010, 04:17 PM

So what laws will apply to policies bought across state lines?

And as far as "junk" lawsuits go, how much did tort reform in Texas lower insurance premiums?

I'd like to see some numbers for that.

Insurance premium cost is not a good metric for healthcare costs.

*edit*
Screw me. Winehole just said the same thing.

coyotes_geek

02-10-2010, 04:35 PM

Heavily funded HSA's.

Depending where those funds would come from, I wouldn't neccissarily be opposed. I've suggested on here a couple of times a program where we tax junk food and disribute the proceeds to everyone via HSA accounts.

Drachen

02-10-2010, 05:30 PM

Depending where those funds would come from, I wouldn't neccissarily be opposed. I've suggested on here a couple of times a program where we tax junk food and disribute the proceeds to everyone via HSA accounts.

No, I was saying heavily funded HSAs by the individual. I was talking about the conditions under which someone could be denied service. I said give them some options and if they turn all of them down, let them sign a waiver of medical service. Then I was asked what other options are there outsided of insurance or no insurance, and I said heavily funded HSAs.

If there is some rich guy out there who wanted to exercise his freedom from insurance, but didn't want to be penalized for exercising it he could fund his HSA to a certain level. So if someone refuses to get insurance, doesn't qualify for medicaid (due to income), and refuses to fund an HSA at a level where he/she is able to cover the costs of his/her medical bills in the event of catastrophic event, then he/she can sign a waiver that states that they refuse medical service. Of course this conversation was being held in the context of the cost of medicine (and insurance) coming down.

mogrovejo

02-10-2010, 06:19 PM

ElNono

02-10-2010, 06:39 PM

Is having health-care insurance really that important? What's the impact of lack of health-care insurance on one's health? Would universal healthcare, covering the uninsured, save lives?

It's not about 'having health insurance or not'. It's about general, affordable access to care. A lot of people go bankrupt trying to pay back their medical bills. They did receive emergency care, but it basically destroyed their finances. If paying out of pocket would be cheaper than having insurance, then people would simply pay out of pocket.

The current system is inherently a scam at many levels, the two I think are the biggest are:

1) Dropping your coverage when you lose your job, specifically when you lose your job because of a medial condition. This is an issue that spirals out of control very quickly. My wife actually went through this so I know first hand it takes many years to get back on your feet after something like that.

2) People being moved from the private to the public system after a certain age. The private company milks the person for all they have until they actually will need coverage the most. Then they dump them to the public system and we taxpayers need to pick up the bill. It's like a company selling you car insurance, but if your car is over 10 years old (and most likely to malfunction) then the taxpayers pick up the bill in case of an accident.

mogrovejo

02-10-2010, 06:47 PM

It's not about 'having health insurance or not'. It's about general, affordable access to care. A lot of people go bankrupt trying to pay back their medical bills. They did receive emergency care, but it basically destroyed their finances. If paying out of pocket would be cheaper than having insurance, then people would simply pay out of pocket.

The current system is inherently a scam at many levels, the two I think are the biggest are:

1) Dropping your coverage when you lose your job, specifically when you lose your job because of a medial condition. This is an issue that spirals out of control very quickly. My wife actually went through this so I know first hand it takes many years to get back on your feet after something like that.

2) People being moved from the private to the public system after a certain age. The private company milks the person for all they have until they actually will need coverage the most. Then they dump them to the public system and we taxpayers need to pick up the bill. It's like a company selling you car insurance, but if your car is over 10 years old (and most likely to malfunction) then the taxpayers pick up the bill in case of an accident.

I didn't understand your answer. Would general, affordable access to health-care save lives or not?

I agree with your 2 points. 1) The employer based health system must be dismantled ASAP. 2) Same for Medicare.

ElNono

02-10-2010, 06:51 PM

I didn't understand your answer. Would general, affordable access to health-care save lives or not?

Yes.

I agree with your 2 points. 1) The employer based health system must be dismantled ASAP. 2) Same for Medicare.

You conclusions are not the same as mine. For number 1, I think regulation of insurance companies to close that loophole should exist. For number 2, I actually think Medicare should be EXPANDED not dismantled.

mogrovejo

02-10-2010, 07:04 PM

Yes.

How do you know? Have you read the article? Do you have a peer-reviewed study of your own?

ElNono

02-10-2010, 07:21 PM

How do you know? Have you read the article? Do you have a peer-reviewed study of your own?

I've read the article. His conclusion is basically that there's not enough data in the two studies he cited to prove that having ready access to care will save lives. Obviously, that also doesn't prove that having ready access won't save lives either.

Obviously, hand picking his datasets works real well to put together that story. There's plenty of datasets on death rates (http://en.wikipedia.org/wiki/List_of_countries_by_death_rate) from the World Health Organization (http://en.wikipedia.org/wiki/World_Health_Organization), the United Nations (http://en.wikipedia.org/wiki/UN) and the CIA World Factbook (http://en.wikipedia.org/wiki/CIA_World_Factbook). You will always find multiple countries with smaller death rates than the US and having single payor systems (which are pretty much what's used everywhere else in the world).

We have discussed this topic extensively, including the numbers, with other forum members a long while ago. I vividly recall having at least a discussion about it with Wild Cobra and SnC some time ago.

Now, I'm not going to do your homework for you. Feel free to use the Search function above.

mogrovejo

02-10-2010, 07:37 PM

I've read the article. His conclusion is basically that there's not enough data in the two studies he cited to prove that having ready access to care will save lives. Obviously, that also doesn't prove that having ready access won't save lives either.

Obviously, hand picking his datasets works real well to put together that story. There's plenty of datasets on death rates (http://en.wikipedia.org/wiki/List_of_countries_by_death_rate) from the World Health Organization (http://en.wikipedia.org/wiki/World_Health_Organization), the United Nations (http://en.wikipedia.org/wiki/UN) and the CIA World Factbook (http://en.wikipedia.org/wiki/CIA_World_Factbook). You will always find multiple countries with smaller death rates than the US and having single payor systems (which are pretty much what's used everywhere else in the world).

We have discussed this topic extensively, including the numbers, with other forum members a long while ago. I vividly recall having at least a discussion about it with Wild Cobra and SnC some time ago.

Now, I'm not going to do your homework for you. Feel free to use the Search function above.

McArdle is a girl.

1) I don't think you read the entire article. She cited more than two studies:

For a long time, two of the best studies were Sorlie et al. (http://www.ncbi.nlm.nih.gov/pubmed/7979836) (1994), which used a large sample of census data from 1982 to 1985; and Franks, Clancy, and Gold (http://www.ncbi.nlm.nih.gov/pubmed/8336376) (1993).

Richard Kronick of the University of California at San Diego’s Department of Family and Preventive Medicine, an adviser to the Clinton administration, recently published the results of what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality. He used a sample of more than 600,000, and controlled not only for the standard factors, but for how long the subjects went without insurance, whether their disease was particularly amenable to early intervention, and even whether they lived in a mobile home. In test after test, he found no significantly elevated risk of death among the uninsured.

In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”

2) Correlation isn't causation. I'm not sure if you're comparing comparable things. What additional studies, not mentioned in the article, would you recommend?

3) I guess your answer is you don't know but you have faith, right?

EVAY

02-10-2010, 07:53 PM

I agree, this is likely to discourage visits in the short term. The potential exists, however, as doctors begin to see their schedules empty, that they begin to coax patients back with lower costs or some other incentive.

I'm still on the single payor bandwagon, and it's a lonely wagon to be on. But, I can see a hybrid approach where a single payor system can be resonsible for the routine office visits leaving the specialist and higher cost procedures in the hands of the current insurance companies. The companies dispense with an enormous amount of processing and other staff expenditures. In exchange, they would have to offer coverage with no exclusions and their premiums would be leveraged by the aggregate. Premium costs would also be required to be reduced and should be as a consequence of no longer paying routine visit costs.

This acually sounds interesting. I don't know enough about the issue to say whether or not it would work, but do you know if some politician in either party is suggesting it?

ElNono

02-10-2010, 08:02 PM

McArdle is a girl.

1) I don't think you read the entire article. She cited more than two studies:

Again, I think we're having a communication problem. I'm not arguing the article or it's conclusions, because it limited itself to the datasets available for the US under the current system. That's why I said:

It's not about 'having health insurance or not'. It's about general, affordable access to care.

2) Correlation isn't causation. I'm not sure if you're comparing comparable things. What additional studies, not mentioned in the article, would you recommend?

I think the article (not the studies the article is based on) is one big strawman. It draws conclusions that mortality rate wouldn't change if we were to expand Medicare into a public option, when the studies merely address death risk between the insured vs uninsured in the current system.

Do you have any peer reviewed study that projects what the changes in mortality rate would be (if any) with the expansion of Medicare into a public option? Because those studies the article is based on do not, and the article itself is far from a peer reviewed document, it's merely an opinion piece.

3) I guess your answer is you don't know but you have faith, right?

What isn't an opinion? That article is an opinion piece too. Until we give it an actual shot we won't know conclusively. I formed my opinion from looking at the published numbers of a couple different reputable sources that clearly show that better access to care reduce mortality rate.

What did you form your opinion from?

ElNono

02-10-2010, 08:16 PM

I'm still on the single payor bandwagon, and it's a lonely wagon to be on. But, I can see a hybrid approach where a single payor system can be resonsible for the routine office visits leaving the specialist and higher cost procedures in the hands of the current insurance companies. The companies dispense with an enormous amount of processing and other staff expenditures. In exchange, they would have to offer coverage with no exclusions and their premiums would be leveraged by the aggregate. Premium costs would also be required to be reduced and should be as a consequence of no longer paying routine visit costs.

This is what I think would work.

mogrovejo

02-10-2010, 08:19 PM

I think the article (not the studies the article is based on) is one big strawman.

Why? A strawman against who? It answers a very precise question. You may not like the question or the answer, but that doesn't make the article a strawman.

Do you have any peer reviewed study that projects what the changes in mortality rate would be (if any) with the expansion of Medicare into a public option?

If gaining insurance has a large effect on people’s health, we should see outcomes improve dramatically between one’s early and late 60s. Yet like the Kronick and Rand studies, analyses of the effect of Medicare, which becomes available to virtually everyone in America at the age of 65, show little benefit. In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”

Of course, you can always argue that a bigger expansion will change things.

I formed my opinion from looking at the published numbers of a couple different reputable sources that clearly show that better access to care reduce mortality rate.
Great. Do you mind to mention a couple of those reputable sources.

Until we give it an actual shot we won't know conclusively
I see.

ElNono

02-10-2010, 08:28 PM

Why? A strawman against who? It answers a very precise question. You may not like the question or the answer, but that doesn't make the article a strawman.

When the conclusion is:

But we should have had a better handle on the case for expanded coverage—and, more important, the evidence behind it—before we embarked on a year-long debate that divided our house against itself.

and none of the studies attempt to tackle or project expanded coverage, trying to claim such studies are the evidence on expanding coverage is, indeed, a strawman.

Great. Do you mind to mention a couple of those reputable sources.

I already did.

ChumpDumper

02-10-2010, 09:22 PM

Insurance premium cost is not a good metric for healthcare costs.That's the bottom line for consumers of insurance, so why not?

SouthernFried

02-10-2010, 09:32 PM

Until you answer the real question, "What drives up health care costs?", you will never be able to address the problem.

If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more competition. As it stands now, employers are picking up most of premium costs.

I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

This is it in a nutshell.

Until this happens...
if people payed out of pocket, they would shop around more and it would create more competition

...costs will rise and services will suffer.

Of course, it will never happen to the degree it needs to...and everyone will have their own little "fixes" and ideas that attack little niches and fringes of the problem, without ever adressing the problem.

The solution is out there...the desire to solve the problem using the best solution out there is not.

Problem will never be solved.

And you can put money on that prediction.

We will have less free market solutions, and more tinkering by politicians and beaurocrats trying to fix a problem they are unwilling to really fix.

This is how it works.

...and so it goes.

Yonivore

02-10-2010, 09:50 PM

Until this happens...

if people payed out of pocket, they would shop around more and it would create more competition
...costs will rise and services will suffer.
The Republican's portability proposal would create instant competition that would drive insurance prices down overnight.

Unfortunately, this isn't really about health care costs or uninsured Americans. Nothing in the Democrat plan will drive prices down and, by their own calculations, some 15 to 20 million Americans will remain uninsured after implementation. Not to mention the cutting of Medicare and Medicaid services, rationing of care as all socialistic health care schemes ultimately do, etc...

It's about gaining government control over 17% of the economy. Period.

SouthernFried

02-10-2010, 09:55 PM

The portability issue is a case in point.

Why isn't insurance as portable as it should be?

Not because companies limit themselves to certain states. It's because some govt beaurocrat limits them.

Govt creates the problems it then goes about trying to fix.

This is always the case...and will always be the case in healthcare. As long as govt is involved...there are going to be problems it just can't seem to ever fix.

...and so it goes.

Yonivore

02-10-2010, 10:14 PM

ChumpDumper

02-10-2010, 10:18 PM

No one ever answers this question:

Under what state's laws will a portable plan be governed?

ChumpDumper

02-10-2010, 10:19 PM

The Republican's portability proposal would create instant competition that would drive insurance prices down overnight.Surely you have some independent (read: not Heritage Foundation, etc.) verification of this claim.

Winehole23

02-11-2010, 01:31 AM

McArdle is a girl.Is a woman.

Winehole23

02-11-2010, 02:39 AM

Are you a boy?

ChumpDumper

02-11-2010, 04:32 AM

That is disturbing.

coyotes_geek

02-11-2010, 09:03 AM

No one ever answers this question:

Under what state's laws will a portable plan be governed?

Doesn't matter. Make it the state where the policy holder resides, make it the state where the policy provider resides. Let congress pick one or the other and be done with it. Either way still results in people having more options.

TeyshaBlue

02-11-2010, 09:41 AM

That's the bottom line for consumers of insurance, so why not?

Because the presence of a profit model distorts the relationship of actual, delivered healthcare costs to premium costs....ie...Winehole's example of doctors premium cost reduction for malpractice insurance seemingly having no impact on rising premiums for consumers.

TeyshaBlue

02-11-2010, 09:45 AM

No one ever answers this question:

Under what state's laws will a portable plan be governed?

It would have to be governed by Federal law.

coyotes_geek

02-11-2010, 10:09 AM

It would have to be governed by Federal law.

Are you talking about a federal law to replace the 50 different sets of state laws, or federal law to dictate which state's laws govern in whatever situations?

i.e, is the law going to make a policy written in Texas follow the same rules as a policy written in Oklahoma, or is the law going to say that someone in Oklahoma who likes the policy written under Texas' rules can get that policy and Oklahoma just has to deal with it?

TeyshaBlue

02-11-2010, 10:12 AM

Either scenario could work. But it will take Federal law to implement it.

coyotes_geek

02-11-2010, 10:15 AM

Agreed.

Drachen

02-11-2010, 10:26 AM

Look, if we are talking about creating efficiencies, and therefore cost savings in the system, then there should be federal insurance guidelines. The fact that an insurance company has to keep 50 different rules straight, fill out 50 different sets of forms while following 50 different procedures, likely costs a lot more money than if all of those scenarios were boiled down to 1. Also if you allow state laws to remain consider this: I work in Hawaii for a business, business is good, I am doing so well in fact that I am head hunted away from my business which wants to give me a raise, a bonus and a move to New York. I like my insurance that I have, so I bring it with me under the new Portability rules. 2 years pass and I develop some kind of disease get it treated and then find out my insurance company isn't paying for something. After a lot of back and forth with the company I decide to escalate it, do I write the HI dept of insurance or the NY DOI? If I need to go further than that and sue the company, do I need to take time off and fly all the way back to HI for the duration of the lawsuit?
Federal guidelines take care of this problem.

coyotes_geek

02-11-2010, 10:45 AM

Marcus Bryant

02-11-2010, 11:10 AM

Life, liberty, efficiency, and the pursuit of happiness.

spurster

02-11-2010, 12:36 PM

I agree with transparency if that means the costs are made public in advance, and that when I agree to a procedure, I and the doctor/hospital/clinic sign off on the total cost in advance.

I agree that insurance should not be used for co-pays on the small stuff.

I could agree to some kind of limit on lawsuits if insurers would agree to pay for the health costs of mistakes/poor outcomes, and make that information public so we would know which doctors are causing the most problems. Currently, lawsuits appear to be the main control on bad medicine. Have you read about the criminal case in West Texas against a whistleblower?

Any tax credits for insurance would increase the deficit because they will mainly be used by the people who already have insurance. The tax credit for people who don't have insurance is unlikely to be enough to make much of a difference because they aren't paying much income tax anyway.

Marcus Bryant

02-11-2010, 12:41 PM

Marcus Bryant

02-11-2010, 12:44 PM

Or, why does suspicion of ulterior motives drop for many erstwhile individualists when Fortune 500 companies seek limits on justice?

Marcus Bryant

02-11-2010, 12:46 PM

Special rights in the law for the commons = socialism.

Special rights in the law for the plutocracy = blessed God-endowed free enterprise.

ElNono

02-11-2010, 01:09 PM

Right, trial lawyers have their excesses but they do fill a role, and are more effective, imo, than whatever regulatory schemes which can be drawn up.

Regarding the quack doc of Kermit, TX, I think that's a pretty good example of how licensing intended to protect the public from quacks now protects quacks from being exposed.

My God man! Haven't you heard trial lawyers are destroying America? What are libtards going to say next time? That global warming is real?

/Cobra Commander

Marcus Bryant

02-11-2010, 01:14 PM

Or, why efficiency shouldn't be held paramount as a concern in governance. You can have liberty and free enterprise without it. The rights of individuals trump efficiency. Justice is a part of that.

mogrovejo

02-11-2010, 02:35 PM

When the conclusion is:

But we should have had a better handle on the case for expanded coverage—and, more important, the evidence behind it—before we embarked on a year-long debate that divided our house against itself.

and none of the studies attempt to tackle or project expanded coverage, trying to claim such studies are the evidence on expanding coverage is, indeed, a strawman.

I've already quoted this:

Yet like the Kronick and Rand studies, analyses of the effect of Medicare, which becomes available to virtually everyone in America at the age of 65, show little benefit.

In a recent review of the literature, Helen Levy of the University of Michigan and David Meltzer of the University of Chicago noted that the latest studies of this question “paint a surprisingly consistent picture: Medicare increases consumption of medical care and may modestly improve self-reported health but has no effect on mortality, at least in the short run.”

You may don't like the conclusions of the studies, but they are there.

I already did.

You mean the dataset showing correlation between socialized health-care and a smaller mortality rate? You must be kidding, right?

mogrovejo

02-11-2010, 02:36 PM

Special rights in the law for the commons = Special rights in the law for the plutocracy enterprise = socialism.

Fixed.

ElNono

02-11-2010, 02:39 PM

I've already quoted this:

What you quoted is irrelevant. I quoted what the conclusion of the article is. To get to that conclusion from the studies is a big stretch.

You may don't like the conclusions of the studies, but they are there.

I don't have a problem with the conclusion of the studies. I have a problem with the conclusion of the article. Please stop moving the goalposts.

You mean the dataset showing correlation between socialized health-care and a smaller mortality rate? You must be kidding, right?

No, I'm not kidding.

mogrovejo

02-11-2010, 02:47 PM

What you quoted is irrelevant. I quoted what the conclusion of the article is. To get to that conclusion from the studies is a big stretch.

I don't have a problem with the conclusion of the studies. I have a problem with the conclusion of the article. Please stop moving the goalposts.

Isn't the conclusion of the article basically the same of yours: that we need better evidence on this issue and that we need to challenge our assumptions?

I think the only difference is that you're happy with the conventional thinking, the author wasn't and looked for evidence that supported it: couldn't find none and found that previous socialized health-care expansions, like Medicare, had little to no impact.

No, I'm not kidding.

Ok, but let me tell you that buying ice-creams don't cause girls to use shorter skirts.

ElNono

02-11-2010, 02:57 PM

Isn't the conclusion of the article basically the same of yours: that we need better evidence on this issue and that we need to challenge our assumptions?

I think the only difference is that you're happy with the conventional thinking, the author wasn't and looked for evidence that supported it: couldn't find none and found that previous socialized health-care expansions, like Medicare, had little to no impact.

No, the way I understand it, the conclusion from her article is that we shouldn't expand Medicare until there's 'more data'. But there's no reason to think we can get any more data on that subject under the current system. Unless we either take datasets from other countries where their 'Medicare' was expanded into a public option and extrapolate numbers from there OR we actually expand Medicare and get the numbers, there will be no conclusive data at all.

Which really adds nothing to the topic, hence my qualification as a strawman.

Ok, but let me tell you that buying ice-creams don't cause girls to use shorter skirts.

:jack

ChumpDumper

02-11-2010, 06:15 PM

What's the point of letting people buy insurance across state lines if the federal governemnt is going to step in and make the insurance across all state lines look the same?

Letting the insurance companies pick a state and then sell their policies nationwide under that state's rules gives the insurance companies the efficiencies you're looking for and it gives the consumers more options.If the policy is governed under the same laws, what is going to make costs for the consumer go down?

ChumpDumper

02-11-2010, 06:17 PM

mogrovejo

02-11-2010, 06:33 PM

No, the way I understand it, the conclusion from her article is that we shouldn't expand Medicare until there's 'more data'. But there's no reason to think we can get any more data on that subject under the current system. Unless we either take datasets from other countries where their 'Medicare' was expanded into a public option and extrapolate numbers from there OR we actually expand Medicare and get the numbers, there will be no conclusive data at all.

Which really adds nothing to the topic, hence my qualification as a strawman.

She doesn't limit herself to Medicare. And yes, she's saying two things: declaring that more people are dying because of lack of health-care insurance is not supported by the evidence; that without further data we should be cautions and not embark in radical, expensive and transformative government programs. It's a question of prudence.

:jack

If you're inferring causation out of correlation, it's a fair warning.

coyotes_geek

02-11-2010, 07:16 PM

If the policy is governed under the same laws, what is going to make costs for the consumer go down?

The policies wouldn't be governed under the same laws. They'd be governed by the different laws across the different states. Give consumers the ability to look beyond their own state's borders and they benefit from having more options.

ChumpDumper

02-11-2010, 07:19 PM

The policies wouldn't be governed under the same laws. They'd be governed by the different laws across the different states. Give consumers the ability to look beyond their own state's borders and they benefit from having more options.So if they bought a policy from across the country, they would have to sue them across the country in the case of a dispute.

Sounds like a boon for consumers!

coyotes_geek

02-11-2010, 07:21 PM

So if they bought a policy from across the country, they would have to sue them across the country in the case of a dispute.

Sounds like a boon for consumers!

So are you saying that consumers don't benefit from having additional options? Also, what health care remedies do you have in mind that don't involve the possibility of complicated lawsuits?

ElNono

02-11-2010, 07:28 PM

She doesn't limit herself to Medicare. And yes, she's saying two things: declaring that more people are dying because of lack of health-care insurance is not supported by the evidence; that without further data we should be cautions and not embark in radical, expensive and transformative government programs. It's a question of prudence.

But a purported single-payor or mixed system would remove insurance entirely. It would provide better access to care, which has nothing to do with having insurance or not.
Something I mentioned a lot of posts ago and you seemingly either ignore or fail to comprehend.

At that point, being insured would be irrelevant. And you can't calculate the effects of that on mortality until such a system is in place. You simply can't extrapolate the numbers from studies of the uninsured on the current system.

There's other deeper issues also that go beyond mortality rates. How many bankruptcies are declared each year by the uninsured on medical-related expenses?

And BTW, I don't like the current proposal any more than you do, because it wouldn't address any of these concerns anyway.

ChumpDumper

02-11-2010, 07:29 PM

So are you saying that consumers don't benefit from having additional options?How much would it lower premiums?

Surely someone has run the numbers.

Just saying it will work doesn't make it so. Tort reform didn't lower premiums in Texas, although it purportedly gave them additional options.

ElNono

02-11-2010, 07:31 PM

Tort reform didn't lower premiums in Texas, although it purportedly gave them additional options.

This is what most people fail to comprehend. Unless the private sector competes on quality versus a free public option, OR there's some sort of price fixing, the service providers will merely pocket the difference and keep the prices up. Most every other country on the planet already figured this one out.

Either that, or we keep the current system where your medical care depends on who employs you or your economic status.

coyotes_geek

02-11-2010, 08:13 PM

How much would it lower premiums?

Surely someone has run the numbers.

As far as I know no one has run the numbers because no one has put something similar into an actual piece of legislation.

Now why are you opposed to giving consumers more options to choose from?

Just saying it will work doesn't make it so. Tort reform didn't lower premiums in Texas, although it purportedly gave them additional options.

Can you show me the data showing how tort reform specifically caused premiums to go up? Since both those events have already happened, unlike being able to sell insurance across state lines, surely someone has run those numbers. Merely observing that we enacted tort reform and premiums went up doesn't prove that tort reform was the reason. How do we know that premiums wouldn't have gone up as much had we not enacted tort reform?

ChumpDumper

02-11-2010, 08:21 PM

As far as I know no one has run the numbers because no one has put something similar into an actual piece of legislation.It doesn't have to be in a piece of legislation for someone to estimate its effect.

Now why are you opposed to giving consumers more options?I am skeptical that it will result in lower bottom line costs for consumers. You have don't nothing to change my mind.

Can you show me the data showing how tort reform specifically caused premiums to go up? Since both those events have already happened, unlike being able to sell insurance across state lines, surely someone has run those numbers.Um, premiums went up.

Not down.

Way up, in fact.

Tort reform was touted as a solution for rising health costs for consumers.

It didn't work.

mogrovejo

02-11-2010, 08:37 PM

Explaining the difference between correlation and causation to simpletons is a lost cause. Thank God Palin is the stupid one.

mogrovejo

02-11-2010, 08:40 PM

This is what most people fail to comprehend. Unless the private sector competes on quality versus a free public option, OR there's some sort of price fixing, the service providers will merely pocket the difference and keep the prices up.

Why? If they have to compete against each other, why would they be able to do that? If there's no serious competition, like in the current system, of course that's going to happen. But if there's competition, how would they resist to smart competitors without passing some of the gains to the consumers? I mean, do we need a public option on restaurants to make sure that they don't keep the prices up?

As for the price fixing - people have been trying it for thousands of years. At least since the Romans. Unsurprisingly, it never worked. Like ever.

ChumpDumper

02-11-2010, 08:42 PM

Hey, you are the guys saying tort reform will help lower costs for consumers and keep beating the drum for it.

Why did it not help after it was enacted?

mogrovejo

02-11-2010, 08:43 PM

But a purported single-payor or mixed system would remove insurance entirely. It would provide better access to care, which has nothing to do with having insurance or not.

Like the Medicare? Little effect. Maybe if the Medicare was extended to everybody things would change. Can't see why, but maybe.

At that point, being insured would be irrelevant. And you can't calculate the effects of that on mortality until such a system is in place. You simply can't extrapolate the numbers from studies of the uninsured on the current system.

Well, it seems to me that you simply have a problem with projection studies - and therefore as it can't be proved by empirical evidence that something won't produce good results, than something must be done. That's okay, but not very persuasive, I think.

In any case, the point of the article is that those who claim that lack of insurance is killing people don't have the evidence on their side.

ElNono

02-11-2010, 08:46 PM

Why? If they have to compete against each other, why would they be able to do that? If there's no serious competition, like in the current system, of course that's going to happen. But if there's competition, how would they resist to smart competitors without passing some of the gains to the consumers? I mean, do we need a public option on restaurants to make sure that they don't keep the prices up?

They're not interested in competing. They're happy to cater to the 55% of the population that can afford the services. That's what we have right now.
I mean, free market has been attempting to tackle this for ages and never succeeded. What makes you think all of a sudden will?

As for the price fixing - people have been trying it for thousands of years. At least since the Romans. Unsurprisingly, it never worked. Like ever.

Price fixing works pretty well for this specific case in many countries. Including the negotiated prices for medicines and services in countries like the UK and France. It's simply not seen as a business, but as a provided service, like Police, Fire Dept or the Postal service.

ElNono

02-11-2010, 08:48 PM

Like the Medicare? Little effect. Maybe if the Medicare was extended to everybody things would change. Can't see why, but maybe.

No, not like Medicare. But you don't seem interested in talking about anything but Medicare.

In any case, the point of the article is that those who claim that lack of insurance is killing people don't have the evidence on their side.

Did anybody in this thread claim that? I think it was another instance of you talking to yourself.

coyotes_geek

02-11-2010, 09:33 PM

It doesn't have to be in a piece of legislation for someone to estimate its effect.

Doesn't change the fact that I still haven't seen anyone do it.

I am skeptical that it will result in lower bottom line costs for consumers. You have don't nothing to change my mind.

I'm not trying to change your mind. I'm trying to find out why you are so adamantly opposed to giving consumers more choices. So you're skeptical that it will lower prices. Fair enough. Don't you think consumers would still be better off having more options to choose from?

Um, premiums went up.

Not down.

Way up, in fact.

Tort reform was touted as a solution for rising health costs for consumers.

It didn't work.

Can you show me the numbers that identify tort reform as the reason premiums went up as high as they did? Insurance premiums are a summation of a bunch of different factors, tort reform being just one of them. Isn't it possible that tort reform actually did lower the costs it was intended to do so, but the combination of all the other factors still resulted in premiums going up?

ChumpDumper

02-11-2010, 10:20 PM

Doesn't change the fact that I still haven't seen anyone do it.That in itself is pretty telling to me.

I'm not trying to change your mind. I'm trying to find out why you are so adamantly opposed to giving consumers more choices. So you're skeptical that it will lower prices. Fair enough. Don't you think consumers would still be better off having more options to choose from?Will they? I can't say that is an automatically acceptable assumption either.

Can you show me the numbers that identify tort reform as the reason premiums went up as high as they did? Insurance premiums are a summation of a bunch of different factors, tort reform being just one of them. Isn't it possible that tort reform actually did lower the costs it was intended to do so, but the combination of all the other factors still resulted in premiums going up?If that's the case, it is merely a boondoggle and blanket immunity for doctors, no matter their level of competency. That is the only measure any supporter has pointed to since tort reform.

Hooray, I guess.

TeyshaBlue

02-12-2010, 01:00 PM

Why? If they have to compete against each other, why would they be able to do that? If there's no serious competition, like in the current system, of course that's going to happen. But if there's competition, how would they resist to smart competitors without passing some of the gains to the consumers? I mean, do we need a public option on restaurants to make sure that they don't keep the prices up?

As for the price fixing - people have been trying it for thousands of years. At least since the Romans. Unsurprisingly, it never worked. Like ever.

You know, it just seems self-evident that increased competition would lower prices. I completely understand that.

Unfortunately, my electricity bill dissagrees.

It just doesn't follow that when you try to open up monopolistic combines of companies, that lower prices just fall out as a result.
You cannot realistically compare market forces behind restaurants to those behind insurance companies. Well, I guess you could if hamburgers cost $150.:lol

ElNono

02-12-2010, 01:26 PM

You know, it just seems self-evident that increased competition would lower prices. I completely understand that.

Unfortunately, my electricity bill dissagrees.

It just doesn't follow that when you try to open up monopolistic combines of companies, that lower prices just fall out as a result.
You cannot realistically compare market forces behind restaurants to those behind insurance companies. Well, I guess you could if hamburgers cost $150.:lol

Of course you cannot. But for the free market freedom fighters everything is self-adjusting competition goodness...

elbamba

02-12-2010, 01:40 PM

Can you show me the numbers that identify tort reform as the reason premiums went up as high as they did? Insurance premiums are a summation of a bunch of different factors, tort reform being just one of them. Isn't it possible that tort reform actually did lower the costs it was intended to do so, but the combination of all the other factors still resulted in premiums going up?

no.

mogrovejo

02-15-2010, 05:13 PM

But a purported single-payor or mixed system would remove insurance entirely. It would provide better access to care

How do you know?

At that point, being insured would be irrelevant.

I spend most of my time in 2 countries with single-payer systems and I don't find being insured irrelevant. Quite the opposite.

And you can't calculate the effects of that on mortality until such a system is in place. You simply can't extrapolate the numbers from studies of the uninsured on the current system.

Again, she was answering to those who claim that people are dying because of lack of insurance. The article shows those type of claims aren't sustained by empirical evidence.

mogrovejo

02-15-2010, 05:16 PM

You know, it just seems self-evident that increased competition would lower prices. I completely understand that.

Unfortunately, my electricity bill dissagrees.

Why so?

It just doesn't follow that when you try to open up monopolistic combines of companies, that lower prices just fall out as a result.

Nobody says that breaking a monopoly leads to lower prices. At least I certainly don't.

You cannot realistically compare market forces behind restaurants to those behind insurance companies. Well, I guess you could if hamburgers cost $150.:lol

What do you mean by "market forces"? What about the market for laptops or TV sets, is that one better? A PC is more expensive than a cheeseburger, so I guess it works better.

da_suns_fan

02-15-2010, 05:36 PM

1. Pay doctors differently to remove un-needed treatments. Im 29 and I think my doctor is always trying to get me to come in to rake in more fees from my insurance.

2. Tax high end plans

3. Subsidize poorer citizens.

4. A public option might work if it was a giant non-profit and not just an extention of medicare.

I dont think tort-reform or health saving accounts would do much.

ElNono

02-15-2010, 07:56 PM

How do you know?

I speak from personal experience.

I spend most of my time in 2 countries with single-payer systems and I don't find being insured irrelevant. Quite the opposite.

As far as access to care?
Do the uninsured lack access to care (not just merely emergency care, but overall care)?
I'd like to know what those countries are, and exactly what do you mean.

I actually lived most of my life in a country with a mixed system, but also lived considerable time on a country with single-payer system. My sister also lived in Canada for 5 years, including having children over there.

Again, she was answering to those who claim that people are dying because of lack of insurance. The article shows those type of claims aren't sustained by empirical evidence.

I believe nobody was making that claim here. I guess it was some sort of preemptive claim?

mogrovejo

02-15-2010, 08:48 PM

I speak from personal experience.

That's odd. How have you experienced a single-payer socialized health-care system in America?

As far as access to care?
Do the uninsured lack access to care (not just merely emergency care, but overall care)?
I'd like to know what those countries are, and exactly what do you mean.

Yes, including access. I've recently written here about my experience of needing a consultation to the dentist and being told I'd need to wait 6 months for one. This isn't unusual.

Portugal&Spain. But I've also lived in Italy and France and things are basically equal.

You seem to believe that "universal coverage" systems can provide equal access to everybody. Maybe in theory, but not in practice - there's always rationing. Waiting lists or limitation of drugs subsidized are de fact limitations to access - because most people can't buy private insurance. Even out-of-pocket charges can be a limitation. Plus, unlike private insurers, organizations like Assurance Maladie can (and do) run on gigantic deficits for decades. But as the French are starting to find out, one day the party has to terminate. Even in the US I'd expect to see Medicare users to have increasing difficulties to get consultations in the near future.

I believe nobody was making that claim here.

So? I never made that claim, quit the strawman arguments. I thought the article was interesting enough to worth a mention.

ElNono

02-15-2010, 09:23 PM

That's odd. How have you experienced a single-payer socialized health-care system in America?

No. I was speaking outside of America, obviously.

Yes, including access. I've recently written here about my experience of needing a consultation to the dentist and being told I'd need to wait 6 months for one. This isn't unusual.

That's indeed very unusual. I actually visit the dentist every time I go back home to visit. Just call in two days in advance. Longer waiting times are normally on things like transplants, or high-end care.

Portugal&Spain. But I've also lived in Italy and France and things are basically equal.

Both in Italy and France (I'm an Italian citizen and I lived in Paris also) the system is mixed. You can opt to use the public service or pay for a private insurance and get treatment in private clinics or hospitals.

You seem to believe that "universal coverage" systems can provide equal access to everybody. Maybe in theory, but not in practice - there's always rationing. Waiting lists or limitation of drugs subsidized are de fact limitations to access - because most people can't buy private insurance. Even out-of-pocket charges can be a limitation. Plus, unlike private insurers, organizations like Assurance Maladie can (and do) run on gigantic deficits for decades. But as the French are starting to find out, one day the party has to terminate. Even in the US I'd expect to see Medicare users to have increasing difficulties to get consultations in the near future.

Rationing is exactly the reason I support a mixed system. Rationing exists in the US right now too. Any doctor you call right now will schedule you two months in the future.

All those countries you mention have an emergency system just like the US in case somebody shows up with chest pains and what not.
For non-emergency care, they can all get access to a doctor *FOR FREE* if they're willing to wait for whatever the wait time is. If you want a faster service and can afford it, then you can go with a private insurance which will be no different than what you have here in the US. The private insurance sector in both France and Italy are doing quite well.

But the reality is that people that can't afford private insurance can still go to a hospital with a broken foot, get treated, and don't receive a $5000 bill they can't pay or bankrupts them. People with chronic conditions can go and actually get care without receiving a bill back or without having to wait for an emergency from their unattended chronic condition.

As far as sustainability, well, the Brits started their system right after World War II, when the country was just coming out of that war... tough time to roll out a universal care system. But it's still there 60+ years later. I'd say history is not on your side on that.

Furthermore, I think the US doesn't necessarily needs to copy any of those systems. Just take the best from each, and tailor and improve it for americans. There's no reason the US can't have the best system of them all. We certainly are the most resourceful nation. I think we could do it if there was the political will.

So? I never made that claim, quit the strawman arguments. I thought the article was interesting enough to worth a mention.

Actually, you asked three questions and proceeded to post the article. I have to assume you were talking to yourself, again.

Marcus Bryant

02-15-2010, 09:37 PM

To bring everyone up to speed: http://www.theatlantic.com/doc/200909/health-care

TeyshaBlue

02-16-2010, 09:55 AM

You know, it just seems self-evident that increased competition would lower prices. I completely understand that. Unfortunately, my electricity bill dissagrees.

Why so?

The effects of deregulation of the electricity market in Texas have been, well, not good. Pricing certainly hasn't seemed to improve much with the extra "competition".

It just doesn't follow that when you try to open up monopolistic combines of companies, that lower prices just fall out as a result.

Nobody says that breaking a monopoly leads to lower prices. At least I certainly don't.
Agreed.

You cannot realistically compare market forces behind restaurants to those behind insurance companies. Well, I guess you could if hamburgers cost $150.

What do you mean by "market forces"? What about the market for laptops or TV sets, is that one better? A PC is more expensive than a cheeseburger, so I guess it works better.
Are you suggesting a public option for computers?:lmao

What I meant was, I can go choose a restaurant and purchase a meal at virtually any price point I want. I can do it at any time I wish because, Big Macs are cheaper than health insurance...that's why your comprison is bogus.

Restaurant pricing is lower due to, in part, increased competition and the fact that national chains enjoy an economy of size and structure...something that is largely denied insurance companies due to the state regulation structures. There is certainly no "standard" that is comparable state to state.
You cannot realistically compare the two.

TeyshaBlue

02-16-2010, 10:04 AM

To bring everyone up to speed: http://www.theatlantic.com/doc/200909/health-care

I read that several months ago...I can't remember who originally posted it here. It's a superb article that really drove home the points of pricing opacity and the copay system deficiencies. Certainly worthy of a repost.:toast

mogrovejo

02-16-2010, 11:23 AM

The effects of deregulation of the electricity market in Texas have been, well, not good. Pricing certainly hasn't seemed to improve much with the extra "competition".

How do you know? Because prices raised? That's not enough.

I'm not versed about the case of the Texas electricity market. In some specific markets, like natural monopolies, the maximum efficiency is realized through a single supplier - this is often the case with public utilities. But not only - in other cases, monopolists in markets where barriers to entry are low can behave as if there's competition and maximize efficiency. That's why I'm not in favour of breaking up monopolies merely because one exists (assuming no barriers to entry the market) but only when there's a factual (and not hypothetical) loss to the consumer.

In any case, your electricity bill doesn't disagree with the fact that increased competition leads to lower prices, ceteris paribus. Your electricity bill simply doesn't provide enough information to agree or disagree with that.

Are you suggesting a public option for computers?:lmao

No, I think that would be as ridiculous as a public option for health care.

What I meant was, I can go choose a restaurant and purchase a meal at virtually any price point I want. I can do it at any time I wish because, Big Macs are cheaper than health insurance...that's why your comprison is bogus.

The market forces are still the same, it's just that buying meals is a cheaper and more frequent acquisition. That doesn't make the comparison bogus, the actual price is pretty irrelevant when comparing markets.

Restaurant pricing is lower due to, in part, increased competition and the fact that national chains enjoy an economy of size and structure...something that is largely denied insurance companies due to the state regulation structures. There is certainly no "standard" that is comparable state to state.
You cannot realistically compare the two.

Why not? Every market is different - and the biggest difference I actually see in these cases isn't exactly the price but the information asymmetry (although I suspect that the biggest reason for information asymmetry in the health-care market is that consumers don't have an incentive to look for it). But I have no idea why would the market structure impact be totally different depending on the price of the good. Competition works for very expensive things and very cheap ones alike.

Obviously regulations and the degree of government intervention have an impact, but that's exactly what we're discussing here, isn't it?

But why can't one argue that a national, government sponsored, restaurant chain, with free food for everyone, would be cheaper than the current system, with multiple pro-profit restaurants, while providing universal access to nutritional and tasty food?

Personally, I don't think that the lower prices would result from the increased competition between insurance companies - only in part, but not the most significant one. A quick analysis of the profits that health insurance companies usually make shows that the margin there is smaller than people expect (especially those who want an extremely inefficient organization like the government to drive prices down by competing with those companies - 0% chance of happening). I think the gains for the consumer will come mostly from the regulatory impact and competition between regulators.

TeyshaBlue

02-16-2010, 11:42 AM

How do you know? Because prices raised? That's not enough.

I'm not versed about the case of the Texas electricity market. In some specific markets, like natural monopolies, the maximum efficiency is realized through a single supplier - this is often the case with public utilities. But not only - in other cases, monopolists in markets where barriers to entry are low can behave as if there's competition and maximize efficiency. That's why I'm not in favour of breaking up monopolies merely because one exists (assuming no barriers to entry the market) but only when there's a factual (and not hypothetical) loss to the consumer.

In any case, your electricity bill doesn't disagree with the fact that increased competition leads to lower prices, ceteris paribus. Your electricity bill simply doesn't provide enough information to agree or disagree with that.
If you're not versed in the Texas electricity market, then stop there.

Personally, I don't think that the lower prices would result from the increased competition between insurance companies - only in part, but not the most significant one. A quick analysis of the profits that health insurance companies usually make shows that the margin there is smaller than people expect (especially those who want an extremely inefficient organization like the government to drive prices down by competing with those companies - 0% chance of happening). I think the gains for the consumer will come mostly from the regulatory impact and competition between regulators.
A quick analysis will yield a misleading conclusion. Profit is meaningless unless you look at the Return On Investment involved. Insurance ROI is massive. If their profit margin is 5%, which has been floated, then that 5% margin with a high ROI percentage needs to be weighted a bit differently.

Give me 5% margin anyday with a ROI +50%. That's a slam dunk.

mogrovejo

02-16-2010, 11:50 AM

No. I was speaking outside of America, obviously.

Irrelevant. You said one cant' know what would happen in America until it was actually tried.

That's indeed very unusual.

No, it's not.

I actually visit the dentist every time I go back home to visit. Just call in two days in advance. Longer waiting times are normally on things like transplants, or high-end care.

Where? I never went to the dentist in Milan, but I can get info on that.

Both in Italy and France (I'm an Italian citizen and I lived in Paris also) the system is mixed. You can opt to use the public service or pay for a private insurance and get treatment in private clinics or hospitals.

It's like that pretty much everywhere, including in Spain and Portugal. That's why I pay for private health-insurance.

Rationing is exactly the reason I support a mixed system. Rationing exists in the US right now too. Any doctor you call right now will schedule you two months in the future.

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.

All those countries you mention have an emergency system just like the US in case somebody shows up with chest pains and what not.
For non-emergency care, they can all get access to a doctor *FOR FREE* if they're willing to wait for whatever the wait time is.

Good you put for free in between the asterisks. Free health-care is bloody expensive.

If you want a faster service and can afford it, then you can go with a private insurance which will be no different than what you have here in the US. The private insurance sector in both France and Italy are doing quite well.

Yes. Which shows how well the public sector is doing.

I'd love to have a system where I could actually opt for one of the systems. Unfortunately, that's not what happens. You can't opt out of the public system, you can simply choose not using it in spite of being *free*. The fact that so many people opt to pay for private health-care when they could get it for free in the public system shows the crazyness of the all thing.

The problem is obvious: lots of people simply can't afford to have decent health-care because they spend the money paying for the public system - whether they like it or not.

As far as sustainability, well, the Brits started their system right after World War II, when the country was just coming out of that war... tough time to roll out a universal care system. But it's still there 60+ years later. I'd say history is not on your side on that.

Of course it is, unless you have historical examples (or even a theoretical one) of something running deficits forever. The NHS, in spite of Thatcher best efforts, is running deficits every year - this to provide inhuman degrees of rationing. Sarkozy is already asking for huge co-payments in the public system - the last time I was in France I paid €13 for the "moderation fee" in the urgency room. They're closing hospitals, doctors are leaving the public system and the true reforms are still to come.

Furthermore, I think the US doesn't necessarily needs to copy any of those systems. Just take the best from each, and tailor and improve it for americans. There's no reason the US can't have the best system of them all. We certainly are the most resourceful nation. I think we could do it if there was the political will.

Following that path you'll quickly stop being the most resourceful nation.

A public health-care system in the US is economic suicide. Americans already spend an awful lot of money in health-care, with the crazy insurance-employer system; with a public, gigantic, nation-wide system that would add the government inefficiencies, things would blow up rather quickly.

mogrovejo

02-16-2010, 12:01 PM

If you're not versed in the Texas electricity market, then stop there.

I can stop, but that doesn't make you right. Again, your electricity bill doesn't prove what you think it does.

A quick analysis will yield a misleading conclusion. Profit is meaningless unless you look at the Return On Investment involved. Insurance ROI is massive. If their profit margin is 5%, which has been floated, then that 5% margin with a high ROI percentage needs to be weighted a bit differently.

Give me 5% margin anyday with a ROI +50%. That's a slam dunk.

Do they have a +50% ROI? Profit margins matter because that's what they are supposedly obtaining from lack of competition and monopoly power. Ant the price/earnings ratios of health-insurance companies stocks aren't exactly hight.

ElNono

02-16-2010, 12:27 PM

Irrelevant. You said one cant' know what would happen in America until it was actually tried.

Opinion. And I *do* claim you can't know until you try it in the US. I was using pretty much the rest of the world to make the claim, which is, indeed, true.

No, it's not.

Yes, it is.

Where? I never went to the dentist in Milan, but I can get info on that.

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

It's like that pretty much everywhere, including in Spain and Portugal. That's why I pay for private health-insurance.

No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.

Rationing also happens in the inability to afford care. The more we remove of those, the better.

Good you put for free in between the asterisks. Free health-care is bloody expensive.

Plenty of things are bloody expensive. Our military comes to mind.

Yes. Which shows how well the public sector is doing.

The public sector is rated better than the US system at a fraction of the cost. THAT tells you how well they're doing.

I'd love to have a system where I could actually opt for one of the systems. Unfortunately, that's not what happens. You can't opt out of the public system, you can simply choose not using it in spite of being *free*. The fact that so many people opt to pay for private health-care when they could get it for free in the public system shows the crazyness of the all thing.

It's not crazy at all. The state provides a service, at a certain level, quality and cost for everybody. If you want better/different then go with what you want. It's not different than the state providing Police service, but there's plenty of private security services that are also doing quite well, and that has nothing to do with the level of service of the public Police. They're just providing a separate service to cater a different market segment.

The problem is obvious: lots of people simply can't afford to have decent health-care because they spend the money paying for the public system - whether they like it or not.

I don't see a problem at all. Taxes get levied one way or another. The question is how those taxes are spent, and what are worthwhile services to spend them on. I think providing at least basic healthcare to everybody is a worthwhile service.

Of course it is, unless you have historical examples (or even a theoretical one) of something running deficits forever. The NHS, in spite of Thatcher best efforts, is running deficits every year - this to provide inhuman degrees of rationing. Sarkozy is already asking for huge co-payments in the public system - the last time I was in France I paid €13 for the "moderation fee" in the urgency room.

Yet they still spend less % of the GDP than we do in healthcare. Even when their system has been in the red for the past 20 years.

They're closing hospitals, doctors are leaving the public system and the true reforms are still to come.

Frankly, I find this very unconvincing without further references. I know that the state has been trying to trim expenses, and my uncle in Paris told me about the introduction of the co-pay system, but nothing else noteworthy other than Bachelot saying that the 100% coverage rule was 'set in stone' sometime last year.

And, to be honest, 13 euros is nothing. Without insurance, a basic eye exam here costs $65 in Walmart. Up to $135 on Optical World.

Following that path you'll quickly stop being the most resourceful nation. A public health-care system in the US is economic suicide. Americans already spend an awful lot of money in health-care, with the crazy insurance-employer system; with a public, gigantic, nation-wide system that would add the government inefficiencies, things would blow up rather quickly.

We obviously disagree on this. The current for-profit health-care system in America is already bankrupting americans left and right, already being subsidized by the government, and still not proving a safety net, plus it's one of the most expensive in the world.

TeyshaBlue

02-16-2010, 12:44 PM

I can stop, but that doesn't make you right. Again, your electricity bill doesn't prove what you think it does.

Do they have a +50% ROI? Profit margins matter because that's what they are supposedly obtaining from lack of competition and monopoly power. Ant the price/earnings ratios of health-insurance companies stocks aren't exactly hight.

Not to derail the thread, but to bolster my point of not trusting managed "deregulated" monopolies....My youngest brother is VP of a company that designs outage, job tasking software for electric utilities across the nation. Among his staff are folks who worked for these companies. His understanding of the electric market far surpasses both of ours. His opinion of the Tx market is that it's largely a sham. Municipal providers do much, much better on a $/kwh ratio. Muni providers could conceivably be compared to public option providers, but that's admittedly a bit of a stretch. Muni providers, MOU (Municipal Owned Utilities) operate in a not for profit model.
Texas elect rates are among the highest in the nation...lots of factors to be filtered...our growth rate, our reliance upon natural gas..etc, but when taken into account, it's still my brother's opnion that deregulation driven competition has hurt the Texas market.

P/E ratios do not equal ROI from a standpoint of profit anysis. P/E figures are subject to market worries and concerns. A sizeable component of Insurance ROI figures are lobbying expenses.
But to get a feel for really good ROI figures, Walmart's is roughly 9.2%. Dell's is 12%. Best figures I've found for Insurance companies range from 5.8 - 9.6%...or to put it in another light, roughly $78-$100 per enrollee. But they have the lock on enrollees in our current market.

All this being said, Insurance companies are not the droid we're looking for. They are a part of the issue, and inevitbaly add ineffieciencies to the costs of healthcare...but there is a synergy between Insurance, GPO and Pharma that needs to be examined. These fall outside of traditional P/L analysis.

Wild Cobra

02-16-2010, 12:47 PM

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

How much is transportation and lodging?

ElNono

02-16-2010, 12:51 PM

How much is transportation and lodging?

Round trip flight from the US is probably around $900.
Lodging I have no idea, but should be fairly cheap. I stay at my parent's house (which is 5 blocks from there) when I go visit.

Obviously, I don't make that trip just to go to the dentist.

TeyshaBlue

02-16-2010, 12:52 PM

Round trip flight from the US is probably around $900.
Lodging I have no idea, but should be fairly cheap. I stay at my parent's house (which is 5 blocks from there) when I go visit.

Obviously, I don't make that trip just to go to the dentist.

How good is their cooking? :lol

I'm in!:toast

ElNono

02-16-2010, 12:55 PM

How good is their cooking? :lol

I'm in!:toast

Icecream is great! :lol

http://i48.tinypic.com/154equb.jpg

Wild Cobra

02-16-2010, 12:58 PM

ElNono

02-16-2010, 01:06 PM

I know. I couldn't help joke about it though.

Well, if you have to get two or three crowns done, you might actually be able to justify the cost... kid you not...

ChumpDumper

02-16-2010, 01:59 PM

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.Or accountants and bottom line driven CEOs.

Wild Cobra

02-16-2010, 02:03 PM

Well, if you have to get two or three crowns done, you might actually be able to justify the cost... kid you not...
Probably make a nice vacation out of it too...

At least if you're able to enjoy yourself after seeing the dentist...

mogrovejo

03-01-2010, 01:07 PM

Not to derail the thread, but to bolster my point of not trusting managed "deregulated" monopolies....My youngest brother is VP of a company that designs outage, job tasking software for electric utilities across the nation. Among his staff are folks who worked for these companies. His understanding of the electric market far surpasses both of ours. His opinion of the Tx market is that it's largely a sham. Municipal providers do much, much better on a $/kwh ratio. Muni providers could conceivably be compared to public option providers, but that's admittedly a bit of a stretch. Muni providers, MOU (Municipal Owned Utilities) operate in a not for profit model.
Texas elect rates are among the highest in the nation...lots of factors to be filtered...our growth rate, our reliance upon natural gas..etc, but when taken into account, it's still my brother's opnion that deregulation driven competition has hurt the Texas market.

That's nosense (and I don't care about argumentum ad verecundiam).

"Deregulation" can lead to higher prices, ceteris paribus, if:

- you're calling deregulation to the regulation of a previous existent monopoly. If a natural monopoly is broken up by state intervention, than it's possible prices may go up due to the entrance of less competitive providers who aren't able to offer the incumbent's price. But this isn't called deregulation but regulation.

- you're calling deregulation to a package of laws that politicians label deregulation but in fact impose further regulations on the industry, driving up the prices.

If you know any other scenario, please explain it, even theoretically, instead of resorting to platitudes like "it's the way it is", "my bill says so" and "it's my brother's opinion".

If the Muni providers are able to provide electricity at a lower cost than their competition, then they are still able to do it. If the competition tries to sell at a higher price, nobody will buy from them. Unless the reason why Muni providers were able to provide electricity at a lower cost was the same that a public option provider in health care would - by getting subsidies from the government. Which would mean that the electricity bill would lie because part of the price was erased from the bill and traded to the tax return form . Which would be a shame because taxpayers, even those who spend very little electricity, would be paying for the electricity of consumers.

P/E ratios do not equal ROI from a standpoint of profit anysis. P/E figures are subject to market worries and concerns. A sizeable component of Insurance ROI figures are lobbying expenses.
But to get a feel for really good ROI figures, Walmart's is roughly 9.2%. Dell's is 12%. Best figures I've found for Insurance companies range from 5.8 - 9.6%...or to put it in another light, roughly $78-$100 per enrollee. But they have the lock on enrollees in our current market.

All this being said, Insurance companies are not the droid we're looking for. They are a part of the issue, and inevitbaly add ineffieciencies to the costs of healthcare...but there is a synergy between Insurance, GPO and Pharma that needs to be examined. These fall outside of traditional P/L analysis.

I know the differences between p/e and ROR. What is getting a feel for "really good ROI figures"?

I've checked the numbers for a few well-known companies:

http://www.google.com/finance?q=NYSE:CI

http://finance.google.com/finance?q=NYSE:WCG

http://finance.google.com/finance?q=NYSE:UNH

http://finance.google.com/finance?q=NYSE:AET

http://finance.google.com/finance?q=NYSE:HUM

Uh, the idea that insurance companies drive up the costs of acquiring health care due to their for-profit nature is flat out crazy. There's no other way to put it. Take away all the profits from all the health-care insurance companies and health-care costs would hardly change a millimetre.

mogrovejo

03-01-2010, 01:48 PM

Opinion. And I *do* claim you can't know until you try it in the US. I was using pretty much the rest of the world to make the claim, which is, indeed, true.

It's funny how one can't use peer-reviewed scientific studies to get some insight and suggestions about the effect of socialized health-care but you can use your absolutely subjective and potentially misinformed view of how the rest of the world to argue in favour of your position.

Yes, it is.

You have no idea about what you're talking about. Accessing a public health-care dentist is a nightmare - in Portugal, England, France, Australia, whatever.

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

That's in Argentina, not in France. I can find an even cheaper dentist in Luanda, for example.

No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.

First, I'd always pay. It's amazing you simply can't grasp that everybody pays an insane amount of money to health-care by default, without even having the choice to pay/not pay for it.

Secondly, saying that I'd be able to get service is wishful thinking. I wasn't. I couldn't live with a tooth ache for months and months. Lot's of people don't get surgery they need on time, they die before. And many medical services aren't available on the public service. I mean, try to get a dental implant in a public service dentist.

Thirdly, you seem completely oblivious to the fact that people would only go bankrupt due to the fact that they're paying an obscene amount of money to the national health care/insurances. I suspect you simply have never done the math. I'd be very comfortable in paying my medical expenses out of the pocket if I could save all the money that I was forced to give away to pay for health-care I don't use.

Rationing also happens in the inability to afford care. The more we remove of those, the better.

What? Remove of those what?

The public sector is rated better than the US system at a fraction of the cost. THAT tells you how well they're doing.

Rated by who? By governmental institutions? What are the criteria?

The "fraction of the cost" is completely useless. Do you think health-care costs will diminish in the US if government takes over the system? You're into a big disappointment.

It's not crazy at all. The state provides a service, at a certain level, quality and cost for everybody. If you want better/different then go with what you want. It's not different than the state providing Police service, but there's plenty of private security services that are also doing quite well, and that has nothing to do with the level of service of the public Police. They're just providing a separate service to cater a different market segment.

Police and private security services don't do the same thing - at best, they can be complementary. But there's a reason why the state needs to offer the police service (or the military, or the judicial). Locke explains.

I don't see a problem at all. Taxes get levied one way or another.

Why? I disagree. As long as they are at their current level, I don't see taxes as an inevitability.

The question is how those taxes are spent, and what are worthwhile services to spend them on.

No. The question is if the services that politicians are offering and paying for by using others people money are needed or, on the other hand, could be offered without evolving politicians and without forcing everybody to pay for it.

Your ideas about taxes and spending are frankly amusing. You'd probably be happy in Cuba.

Yet they still spend less % of the GDP than we do in healthcare. Even when their system has been in the red for the past 20 years.

Lots of things are cheaper in Europe than in the US. I'm always surprised why people think this is a big deal and indicative of anything de per si.

This kind of analysis is so crappy... for example, a big reason why health care is more expensive in the US is because doctors are better paid. How are you going to solve that? By paying an American doctor the same a French doctor makes? You'd run out of doctors in a couple of months.

Most of those cost comparative analysis nothing but lazy, cheap propaganda. Europeans spend a lot of money in health-care indirectly that isn't factored - like in training doctors, for example.

The fact that their system isn't economic sustainable is a problem that you seem to be undervaluing. I mean, it's all nice and fine, but in the end non sustainable systems go bankrupt and terminate.

Frankly, I find this very unconvincing without further references. I know that the state has been trying to trim expenses, and my uncle in Paris told me about the introduction of the co-pay system, but nothing else noteworthy other than Bachelot saying that the 100% coverage rule was 'set in stone' sometime last year.

What's exactly unconvincing?

The co-pays are just a temporary palliative. The current system is economic suicide. They simply don't have the money to pay for it and they can't raise taxes - otherwise they'll keep losing companies and jobs. What's so difficult to understand about this?

And, to be honest, 13 euros is nothing. Without insurance, a basic eye exam here costs $65 in Walmart. Up to $135 on Optical World.

Once again, your making a comparison forgetting part of the equation. It's amazing how you keep making the same mistake endlessly.

We obviously disagree on this. The current for-profit health-care system in America is already bankrupting americans left and right, already being subsidized by the government, and still not proving a safety net, plus it's one of the most expensive in the world.

I agree, the current health-care system in America is a disgrace. It's just a bit better than the alternative you propose.

TeyshaBlue

03-01-2010, 02:03 PM

I know the differences between p/e and ROR. What is getting a feel for "really good ROI figures"?

I've checked the numbers for a few well-known companies:

http://www.google.com/finance?q=NYSE:CI

http://finance.google.com/finance?q=NYSE:WCG

http://finance.google.com/finance?q=NYSE:UNH

http://finance.google.com/finance?q=NYSE:AET

http://finance.google.com/finance?q=NYSE:HUM

Uh, the idea that insurance companies drive up the costs of acquiring health care due to their for-profit nature is flat out crazy. There's no other way to put it. Take away all the profits from all the health-care insurance companies and health-care costs would hardly change a millimetre.

I'm leaving the electricity market debate lay where it is...you clearly don't have an understanding of the Tx market and how municipal suppliers operate..and I aint the one to educate you.

As far as insurance companies driving heathcare costs, you completely ignore the willful collusion between GPO's and Insurance and Pharma companies with an assist by the large pharma distributors. Deleting the profits does not negate the upward pressure of the third party, insurane company model.
Bob's Drug Company works with Larry's Group Purchasing Organization and offers Larry's GPO Aspirin @ $5/bottle. Larry's says "No...too high." Insurance says, ok we'll honor that price. Now Bob has to work a rebate deal with Larry...sell my Aspirin for $5/bottle and we'll rebate you x% of the contract. That gets the deal done. Had insurance said, "No we wont honor those prices!", then the rebate scenario goes away. Insurance rarely says no because they can build the drug costs into their billing population, until the costs of medications skyrocket. That's why they battle the current crop of biologicals ie..Remicade, Humira, Enbrel..etc... At 20k a pop, they can't realistically increase a person's premium to pay for that...so they just say "No."

mogrovejo

03-01-2010, 02:10 PM

I'm leaving the electricity market debate lay where it is...you clearly don't have an understanding of the Tx market and how municipal suppliers operate..and I aint the one to educate you.

So you ran out of arguments and resorted to ad hominem arguments and personal insults?

As far as insurance companies driving heathcare costs, you completely ignore the willful collusion between GPO's and Insurance and Pharma companies with an assist by the large pharma distributors. Deleting the profits does not negate the upward pressure of the third party, insurane company model.

What do insurance companies gain from this alleged collusion?

Bob's Drug Company works with Larry's Group Purchasing Organization and offers Larry's GPO Aspirin @ $5/bottle. Larry's says "No...too high." Insurance says, ok we'll honor that price. Now Bob has to work a rebate deal with Larry...sell my Aspirin for $5/bottle and we'll rebate you x% of the contract. That gets the deal done. Had insurance said, "No we wont honor those prices!", then the rebate scenario goes away. Insurance rarely says no because they can build the drug costs into their billing population, until the costs of medications skyrocket. That's why they battle the current crop of biologicals ie..Remicade, Humira, Enbrel..etc... At 20k a pop, they can't realistically increase a person's premium to pay for that...so they just say "No."

This isn't collusion, it's the consequence of a system where the consumer isn't paying for the expenses.

The conclusion that the for-profit nature of insurance companies isn't a problem remains.

mogrovejo

03-01-2010, 02:12 PM

Millions have difficulties accessing an NHS Dentist
(http://www.citizensadvice.org.uk/index/pressoffice/press_index/press_20080106.htm)
Millions of adults in England and Wales haven’t been to an NHS dentist since April 2006 mainly because they couldn’t find one to treat them, says new research carried out for national charity Citizens Advice as it urges Primary Care Trusts to spend newly allocated resources to improve access.

he Ipsos MORI survey found that lack of access is the most common reason cited by people in England and Wales for not seeing an NHS dentist since April 2006, along with not needing treatment. It was mentioned by 31% of respondents in England and Wales who have not been to an NHS dentist since April 2006. This is the equivalent of approximately 7.4 million people who have not been to an NHS dentist since April 2006 because of difficulties in finding one. Of these, the equivalent of approximately 4.7 million have sought private treatment instead and the equivalent of approximately 2.7 million have gone without treatment altogether.

The research also reveals that the problem is more evident in the South West (53%) and the North West (39%).

Citizens Advice Chief Executive David Harker said:

"These figures show the scale of the lack of access to NHS dentistry, reflecting the evidence which bureaux across England and Wales have been reporting ever since the early 90’s. People on low incomes are particularly affected as private treatment is just not an option."

Universal access to health-care.

ChumpDumper

03-01-2010, 02:16 PM

You're trying to tell us people in Britain actively seek dental care?

:lol

TeyshaBlue

03-01-2010, 02:17 PM

So you ran out of arguments and resorted to ad hominem arguments and personal insults?

What do insurance companies gain from this alleged collusion?

This isn't collusion, it's the consequence of a system where the consumer isn't paying for the expenses.

The conclusion that the for-profit nature of insurance companies isn't a problem remains.

Saying you don't have an understanding of our electrical market is not an ad hominem. Nor is it a personal insult. :rolleyes:bang

You appear to have the inablity to recognize that you don't know what you don't know. I worked inside the pharmaceutical industry for 12 years. At one point, I administered the Vetran's Administration's and the DOD's pharmaceutical contracts, in addition to most of the Indian Health contracts. I worked daily with Pharma companies, Insurance companies, GPO's and all the while was employed by the largest drug distributor in the world. I call it collusion because I watched it happen from the inside...I watched the contract pricing move around based on an arbitrary WAC pricing and massive rebates between all 3 players.. I wathced major insurers say, "We don't care about the cost as long as we can recover it."
If you're unwilling to understand that others might, just maybe, have a deeper understanding of an angle of a particular issue, then you lose any crediblity. Not that it matters.
Removing insurance profit from healthcare costs does not remove the costs that insurance companies drive.

TeyshaBlue

03-01-2010, 02:18 PM

You're trying to tell us people in Britain actively seek dental care?

:lol

:lol:lol:lol

mogrovejo

03-01-2010, 02:22 PM

You appear to have the inablity to recognize that you don't know what you don't know. I worked inside the pharmaceutical industry for 12 years. At one point, I administered the Vetran's Administration's and the DOD's pharmaceutical contracts, in addition to most of the Indian Health contracts. I worked daily with Pharma companies, Insurance companies, GPO's and all the while was employed by the largest drug distributor in the world. I call it collusion because I watched it happen from the inside...I watched the contract pricing move around based on an arbitrary WAC pricing and massive rebates between all 3 players.. I wathced major insurers say, "We don't care about the cost as long as we can recover it."
If you're unwilling to understand that others might, just maybe, have a deeper understanding of an angle of a particular issue, then you lose any crediblity. Not that it matters.
Removing insurance profit from healthcare costs does not remove the costs that insurance companies drive.

Your endless appeals to authority are tiring.

Either you want to present arguments or you don't. Repeating "I know because I worked there" and "I know because my brother works there" may function with high-schoolers but not with me.

http://en.wikipedia.org/wiki/Argument_from_authority

It's even more bizarre that you're not even making an argument. You're just saying "you're wrong because I know more than you and you don't have credibility because you don't recognize I know more than you do". Which is, to say the least, pathetic.

TeyshaBlue

03-01-2010, 02:32 PM

Your endless appeals to authority are tiring.

Either you want to present arguments or you don't. Repeating "I know because I worked there" and "I know because my brother works there" may function with high-schoolers but not with me.

http://en.wikipedia.org/wiki/Argument_from_authority

It's even more bizarre that you're not even making an argument. You're just saying "you're wrong because I know more than you and you don't have credibility because you don't recognize I know more than you do". Which is, to say the least, pathetic.

You are beginning to blur the lines between "tiring" and "butthurt".:lol If you're so tired, then run along little fella. Don't pay any attention to me.:downspin:

No, I'm attempting to negate your demonstrably bogus assertion that insurance companies don't contribute to increased healthcosts because their profits are so miniscule by pointing out that profits are not the metric to define healthcare cost reductions.
It's these little tidbits of inane inaccuracies that fuel the continued obfuscation of improving health care in this country. You can't get this. Ok, I understand. Find a wiki for that.:rolleyes

I'm still waiting for you to present an arguement.

Winehole23

03-01-2010, 02:35 PM

You sure act like an arrogant jerk for someone who claims to care about manners, mogro.

TeyshaBlue

03-01-2010, 02:36 PM

You sure act like an arrogant jerk for someone who claims to care about manners.

Manners schmanners.

(funny edit!)

mogrovejo

03-01-2010, 02:39 PM

No, I'm attempting to negate your demonstrably bogus assertion that insurance companies don't contribute to increased healthcosts because their profits are so miniscule by pointing out that profits are not the metric to define healthcare cost reductions.t.

This is a plain lie, I've never asserted that. As I've said, the insurance companies contribute to increased health care costs due to the nature of the system - insurance is always economically inefficient, due to the detachment between consumers and providers. But that doesn't change with a government system that runs on the same basis or with non-profit companies, etc.

My point is that their for-profit nature is immaterial to the debate and it's not the factor leading to a raise in health-care costs.

Once again, I'd be grateful if you could leave the personal arguments out of this.

TeyshaBlue

03-01-2010, 02:46 PM

This is a plain lie, I've never asserted that. As I've said, the insurance companies contribute to increased health care costs due to the nature of the system - insurance is always economically inefficient, due to the detachment between consumers and providers. But that doesn't change with a government system that runs on the same basis or with non-profit companies, etc.

My point is that their for-profit nature is immaterial to the debate and it's not the factor leading to a raise in health-care costs.

Once again, I'd be grateful if you could live the personal arguments out of this.

But, it's my contention that the for-profit nature is central to the debate. Were they non-profit, then they would likely say "Hey, $5 for a bottle of Aspirin seems a little steep. You want to re-work that a little?" Or, "Hey 20k for 9mg of Remicade seems to be quite a stretch. We can't recover that from our customers. Can something be done to mitigate this?" The loss of the for profit nature could actually create more of an bargaining atmosphere. It's the same way the VA or DOD approaches their contract pricing. Their stance is, "We want the best contract pricing on the planet, bar none. Then we want you to pull 10% from that. If you screw us with the pricing on Tylenol, then we'll put Enbrel on contract for .10 until you figure it out." The VA cannot recover their costs from their customers...they are non-profit....same as the DOD same as IHS. Their pricing is far superior to any contract from contemporary GPO, hence, that aspect of costs is significantly reduced.

btw...I haven't insulted you yet. You'll know when I do.:rollin

Winehole23

03-01-2010, 02:51 PM

Once again, I'd be grateful if you could leave the personal arguments out of this.You call others liars, unreliable and ignorant for merely disagreeing with you, then plead for civility.

http://www.phrases.org.uk/images/fauvel.jpg

Winehole23

03-01-2010, 02:51 PM

HYPOCRITE, n. One who, professing virtues that he does not respect, secures the advantage of seeming to be what he despises.

mogrovejo

03-01-2010, 02:52 PM

But, it's my contention that the for-profit nature is central to the debate. Were they non-profit, then they would likely say "Hey, $5 for a bottle of Aspirin seems a little steep. You want to re-work that a little?" Or, "Hey 20k for 9mg of Remicade seems to be quite a stretch. We can't recover that from our customers. Can something be done to mitigate this?" The loss of the for profit nature could actually create more of an bargaining atmosphere. It's the same way the VA or DOD approaches their contract pricing. Their stance is, "We want the best contract pricing on the planet, bar none. Then we want you to pull 10% from that. If you screw us with the pricing on Tylenol, then we'll put Enbrel on contract for .10 until you figure it out." The VA cannot recover their costs from their customers...they are non-profit....same as the DOD same as IHS. Their pricing is far superior to any contract from contemporary GPO, hence, that aspect of costs is significantly reduced.

Yeah, but why?

Why would insurance companies employees be more likely to bargain for better deals if they didn't need to worry about the bottom line? Generally it happens the opposite, profit is the most powerful incentive to achieve efficiency gains.

Why couldn't a non-profit company recover costs from their consumers?

btw...I haven't insulted you yet. You'll know when I do.:rollin

I don't care, my problem is with personal arguments and they don't even need to be insults.

TeyshaBlue

03-01-2010, 03:04 PM

Yeah, but why?

Why would insurance companies employees be more likely to bargain for better deals if they didn't need to worry about the bottom line? Generally it happens the opposite, profit is the most powerful incentive to achieve efficiency gains.
There's truth in this. They can drive overall cost reductions if there were incentive to do so. Where's their incentive? They have a captive population who cannot realistically drop their coverage because it's part of their compensation..and if they do, the same population will have to wait, often 90 days before they're eligible for benefits if the leave their company. Even then, if it's a pre-existing condition, they're hosed. Efficiency does not always = effectiveness. If a 5% cost reduction is realized via efficiency, then it's meaningless unless it's passed to the consumer. That's where the for profit model fails. It can drive efficiencies but without guarantee that they'll pass those along. As insurance companies operate today, there's just not much pressure to develop efficiency...the byzantine construct of documentation should serve as proof enough of that. Each company has it's own discreete coding system...it's own triplicate forms, it's own methodology. There's literally millions if not billions, to be harvested just in standardization alone. But they steadfastly refuse to do so..even under the pressure brought to bear by HIPAA.

Why couldn't a non-profit company recover costs from their consumers?
Perhaps due to the particular economic standing of their consumers? In the case of the VA, their consumers don't bring in alot of scratch. How are they going to force a rate increase?

I'm not saying either stance is absolute...it isn't. The truth, as usual, is somewhere in the middle. But there is demonstrable evidence that a non-profit insurance organization cuts costs, significantly in the case of the VA and their drug pricing contracts, compared to some for profit companies.

ElNono

03-01-2010, 03:18 PM

It's funny how one can't use peer-reviewed scientific studies to get some insight and suggestions about the effect of socialized health-care but you can use your absolutely subjective and potentially misinformed view of how the rest of the world to argue in favour of your position.

Strawman. The peer-reviewed scientific studies your brought up study insured vs non-insured under the current insurance model. The studies obviously do not attempt to quantify socialized health-care simply because socialized health-care is not the current model.

You have no idea about what you're talking about. Accessing a public health-care dentist is a nightmare - in Portugal, England, France, Australia, whatever.

I know exactly what I'm talking about. Accessing a public health-care dentist in Argentina is just a phone call away.

That's in Argentina, not in France. I can find an even cheaper dentist in Luanda, for example.

Still socialized health-care. That's bad, right?

First, I'd always pay.

That's your choice, and one of many people that can afford to pay.
It's not an option if you can't.

It's amazing you simply can't grasp that everybody pays an insane amount of money to health-care by default, without even having the choice to pay/not pay for it.

I do grasp that. And we do that for an enormous amount of different services that the state provides, not just health-care. Some I agree spending in, some don't. A public option I agree spending in.

Secondly, saying that I'd be able to get service is wishful thinking. I wasn't. I couldn't live with a tooth ache for months and months. Lot's of people don't get surgery they need on time, they die before. And many medical services aren't available on the public service. I mean, try to get a dental implant in a public service dentist.

So, your complaint is that you're unhappy with the public service, but you already said you can afford a private service. What exactly are you complaining about?

Thirdly, you seem completely oblivious to the fact that people would only go bankrupt due to the fact that they're paying an obscene amount of money to the national health care/insurances. I suspect you simply have never done the math. I'd be very comfortable in paying my medical expenses out of the pocket if I could save all the money that I was forced to give away to pay for health-care I don't use.

No, you're entirely unaware how the healthcare system works here in America. If you happen to get a condition that prevents you from working, you will get laid off and lose your insurance. No other insurance will take you because of your pre-existing condition. Furthermore, this is exactly the time when you need to coverage the most. What ends up happening is that if you have access to credit, you're going to end up cleaning credit cards paying out of pocket for all the stuff you need done. At some point, you're going to be able to go back to work, but it's going to take you 15-20 years to repay all that. This happened to my wife 20 years ago, BTW. This is very real stuff. And I'm not even mentioning those that end up crippled and cannot get a job anymore. Or people that simply do not happen to have access to credit. About half of all bankruptcy cases in the US today are related to medical expenses. I'm not making this up, these are real numbers.

What? Remove of those what?

Remove the barriers that separate people from accessible, affordable care.

Rated by who? By governmental institutions? What are the criteria?

The WHO.

The "fraction of the cost" is completely useless. Do you think health-care costs will diminish in the US if government takes over the system? You're into a big disappointment.

I don't want the US government to take over the system. For the 10000th time, I want a mixed system, like those in many other countries.

Police and private security services don't do the same thing - at best, they can be complementary. But there's a reason why the state needs to offer the police service (or the military, or the judicial). Locke explains.

Sure they do the same thing. They overlap in certain areas, and they complement each other in others. No different than private vs public health-care services you know so well.

Why? I disagree. As long as they are at their current level, I don't see taxes as an inevitability.

Strawman, again. Considering nobody in power is advocating doing away with taxes entirely, they're indeed a inevitability right now, for all practical purposes.

No. The question is if the services that politicians are offering and paying for by using others people money are needed or, on the other hand, could be offered without evolving politicians and without forcing everybody to pay for it.

If the services are being offered and available to everybody without government intervention, then there would be no clamoring for the government to intervene. Obviously, services are not being offered or available to everybody on certain circumstances, and that's exactly why this is a political talking point at all.

Your ideas about taxes and spending are frankly amusing. You'd probably be happy in Cuba.

You don't know me at all. But I can see you're quick to jump into conclusions.
I think certain spending is justified. I think certain spending is not.
For example, I think the humongous military spending can and should be trimmed off.
I simply don't agree with you on what needs to be cut and what needs to be spent.

Lots of things are cheaper in Europe than in the US. I'm always surprised why people think this is a big deal and indicative of anything de per si.

This kind of analysis is so crappy... for example, a big reason why health care is more expensive in the US is because doctors are better paid. How are you going to solve that? By paying an American doctor the same a French doctor makes? You'd run out of doctors in a couple of months.

Same was said when the HMO/Insurance system we have was introduced. Doctors took it up their asses and still do today. They still make a good amount of money, just not as much as before. And yeah, they're going to get used to driving a domestic car instead of a german car. It's part of reducing costs.

Most of those cost comparative analysis nothing but lazy, cheap propaganda. Europeans spend a lot of money in health-care indirectly that isn't factored - like in training doctors, for example.

So the cost comparative analysis that don't agree with you are bullshit, but I should take your word for it... :jack

The fact that their system isn't economic sustainable is a problem that you seem to be undervaluing. I mean, it's all nice and fine, but in the end non sustainable systems go bankrupt and terminate.

Or find a way to be sustainable.

What's exactly unconvincing?

That the systems are unsustainable and are going to disappear.

The co-pays are just a temporary palliative. The current system is economic suicide. They simply don't have the money to pay for it and they can't raise taxes - otherwise they'll keep losing companies and jobs. What's so difficult to understand about this?

That there have been there for 60+ years and are still there with no plan of doing away with them?

Once again, your making a comparison forgetting part of the equation. It's amazing how you keep making the same mistake endlessly.

What part of the equation I missed? I guess I'll keep on missing parts of the equation that disagree with your view. Fine by me.

I agree, the current health-care system in America is a disgrace. It's just a bit better than the alternative you propose.

No way. I've been in both. Neither is perfect, but one of them provides a safety net, the other does not.

spursncowboys

03-01-2010, 03:22 PM

elnono: who's safety net? Why does someone need a safety net? Who is funding this safety net? How does this work with the idea that taxes should go to services that benefit everyone?

ElNono

03-01-2010, 03:25 PM

elnono: who's safety net? Why does someone need a safety net? Who is funding this safety net? How does this work with the idea that taxes should go to services that benefit everyone?

Everyone.
And people need a safety net when it comes to health because sometimes they don't have access to credit, or a family around that can help them out.
Because you get a temporary condition doesn't mean you need to be set back for 15-20 years, or declare bankruptcy.

mogrovejo

03-01-2010, 03:35 PM

Strawman. The peer-reviewed scientific studies your brought up study insured vs non-insured under the current insurance model. The studies obviously do not attempt to quantify socialized health-care simply because socialized health-care is not the current model.

I know exactly what I'm talking about. Accessing a public health-care dentist in Argentina is just a phone call away.

Still socialized health-care. That's bad, right?

Are you familiar with the concept of purchasing power parity?

That's your choice, and one of many people that can afford to pay.
It's not an option if you can't.

It's not my choice. How hard is this to understand? I'm forced to pay, if I don't I go to jail.

So, your complaint is that you're unhappy with the public service, but you already said you can afford a private service. What exactly are you complaining about?

Again, you seem completely oblivious to the fact that I pay for something that doesn't work for those who need it and I don't use.

No, you're entirely unaware how the healthcare system works here in America. If you happen to get a condition that prevents you from working, you will get laid off and lose your insurance. No other insurance will take you because of your pre-existing condition. Furthermore, this is exactly the time when you need to coverage the most. What ends up happening is that if you have access to credit, you're going to end up cleaning credit cards paying out of pocket for all the stuff you need done. At some point, you're going to be able to go back to work, but it's going to take you 15-20 years to repay all that. This happened to my wife 20 years ago, BTW. This is very real stuff. And I'm not even mentioning those that end up crippled and cannot get a job anymore. Or people that simply do not happen to have access to credit. About half of all bankruptcy cases in the US today are related to medical expenses. I'm not making this up, these are real numbers.

Huh? Why am I unaware? How is this related to anything I wrote? I'm tired of cheap personal dramatizations and anecdotes.

I don't want the US government to take over the system. For the 10000th time, I want a mixed system, like those in many other countries.

You have a mixed system in the US. THe US government spends more per capita in health-care than any other government in the entire world. And your argument is "the government should spend more".

Sure they do the same thing. They overlap in certain areas, and they complement each other in others. No different than private vs public health-care services you know so well.

Of course they don't do the same thing. Ask any private security officer if they can do what a policeman does.

Strawman, again. Considering nobody in power is advocating doing away with taxes entirely, they're indeed a inevitability right now, for all practical purposes.

You failed to read "at their current level".

If the services are being offered and available to everybody without government intervention, then there would be no clamoring for the government to intervene. Obviously, services are not being offered or available to everybody on certain circumstances, and that's exactly why this is a political talking point at all.

Of course the services are being offered. It's just a matter of price.

Same was said when the HMO/Insurance system we have was introduced. Doctors took it up their asses and still do today. They still make a good amount of money, just not as much as before. And yeah, they're going to get used to driving a domestic car instead of a german car. It's part of reducing costs.

Doctors in France or Spain or England also drive German cars. You seem completely oblivious to the fact that one reason why American doctors are so well paid relatively to their counterparts is because their training is so expensive and they have to pay for it.

If you think that you can have doctors with the standard living of janitors or primary school teachers you're out of your mind. I'm sorry to break this news for you, but price controls don't work: never did, never will.

So the cost comparative analysis that don't agree with you are bullshit, but I should take your word for it...

I made my argument on why the comparative analysis are bogus. Your inability to refute my argument is very telling.

What part of the equation I missed? I guess I'll keep on missing parts of the equation that disagree with your view. Fine by me.

This part: the affordable, free, safety-net, health-care is extremely expensive and people spend a lot of money paying for it - some even go bankrupt because of the money they spend on it.

mogrovejo

03-01-2010, 03:44 PM

There's truth in this. They can drive overall cost reductions if there were incentive to do so. Where's their incentive? They have a captive population who cannot realistically drop their coverage because it's part of their compensation..and if they do, the same population will have to wait, often 90 days before they're eligible for benefits if the leave their company. Even then, if it's a pre-existing condition, they're hosed. Efficiency does not always = effectiveness. If a 5% cost reduction is realized via efficiency, then it's meaningless unless it's passed to the consumer. That's where the for profit model fails. It can drive efficiencies but without guarantee that they'll pass those along..

I thought we'd already gone through this. If they're getting that efficiency and not passing it to the consumer, than they should be getting much higher profit margins. So, the gains in efficiency either goes to the bottom line or is passed to the consumer (generally both).

Why are you going backwards? I thought we had already settled that the profit margin of insurance companies isn't that big.

As insurance companies operate today, there's just not much pressure to develop efficiency

Why? To me it seems that:

- need to be solvent and not being run out of business

- need to deliver profits

are good enough incentives.

But it seems that you believe that removing the incentive of the profit and just keeping the solvency one would result in a better overall incentive. That's extremely odd and that's why I want to know why do you think that way.

Perhaps due to the particular economic standing of their consumers? In the case of the VA, their consumers don't bring in alot of scratch. How are they going to force a rate increase?

I'm not saying either stance is absolute...it isn't. The truth, as usual, is somewhere in the middle. But there is demonstrable evidence that a non-profit insurance organization cuts costs, significantly in the case of the VA and their drug pricing contracts, compared to some for profit companies.

Uh, wouldn't the consumers be the same? I'm puzzled. What are you talking about? The consumers that you have now are the same consumers you'd have tomorrow.

Sorry, but you need to explain why would insurance companies employees be more likely to bargain for better deals if they didn't need to worry about the bottom line? This is a truly extraordinary claim - I've never seen it made before anywhere, probably because it's so far-fetched - so I'd like to see some sort of rationale supporting it.

ElNono

03-01-2010, 04:14 PM

Are you familiar with the concept of purchasing power parity?

Sure. What's next? A dissertation on the Geary-Khamis dollar?

It's not my choice. How hard is this to understand? I'm forced to pay, if I don't I go to jail.

Really? You go to jail if you don't purchase private insurance?
You need to keep up with the thread and what you post.

Again, you seem completely oblivious to the fact that I pay for something that doesn't work for those who need it and I don't use.

It works fine. It's not faultless, but the burden is on you to prove that in the vast majority of the cases it doesn't work. Furthermore, that you don't like or agree with what you personally deem functional service doesn't amount to failure.

Huh? Why am I unaware? How is this related to anything I wrote? I'm tired of cheap personal dramatizations and anecdotes.

When you write:

Thirdly, you seem completely oblivious to the fact that people would only go bankrupt due to the fact that they're paying an obscene amount of money to the national health care/insurances.

in response to:

No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.

Then you're completely unaware why people go bankrupt in this country with regards to healthcare spending.

You have a mixed system in the US. THe US government spends more per capita in health-care than any other government in the entire world. And your argument is "the government should spend more".

No, we have a scam by insurance companies in the US. When people are old enough to require increased healthcare spending, they toss them to the public system. In the meantime, they collude to concentrate markets and keep premium prices up.

Of course they don't do the same thing. Ask any private security officer if they can do what a policeman does.

They can certainly do certain things a policeman does.
What part of 'both complement and overlap' is so hard to understand?

You failed to read "at their current level".

Again, are we doing away with taxes?

Of course the services are being offered. It's just a matter of price.

I didn't omit 'available' right next to 'offered'. You did.

Doctors in France or Spain or England also drive German cars.

As long as you're part of the union, that's a 'domestic' car for all intents and purposes.

You seem completely oblivious to the fact that one reason why American doctors are so well paid relatively to their counterparts is because their training is so expensive and they have to pay for it.

My wife is a registered nurse. That's how oblivious I am to that fact. :rolleyes
But that's another scam for another thread: The government backed student loans.

If you think that you can have doctors with the standard living of janitors or primary school teachers you're out of your mind. I'm sorry to break this news for you, but price controls don't work: never did, never will.

Do doctors in Europe have the standard of living of janitors or primary school teachers? It's rhetorical questions, BTW. I know the answer and you do too.

I made my argument on why the comparative analysis are bogus. Your inability to refute my argument is very telling.

This is what you posted:

Most of those cost comparative analysis nothing but lazy, cheap propaganda. Europeans spend a lot of money in health-care indirectly that isn't factored - like in training doctors, for example.

That's your argument? It reads a lot more like an unsubstantiated rant to me.

This part: the affordable, free, safety-net, health-care is extremely expensive and people spend a lot of money paying for it - some even go bankrupt because of the money they spend on it.

Something to substantiate this please? I mean, I know people go to jail for evading taxes, but I also know people get tax exemptions/rebates under certain pressure conditions.

TeyshaBlue

03-01-2010, 04:45 PM

I thought we'd already gone through this. If they're getting that efficiency and not passing it to the consumer, than they should be getting much higher profit margins. So, the gains in efficiency either goes to the bottom line or is passed to the consumer (generally both).

Why are you going backwards? I thought we had already settled that the profit margin of insurance companies isn't that big.

Generally both? Really? I'm not sure any meaningful efficiency gains have been made in the last decade anyway. As I tried to illustrate, the savings in standardization of forms and methodology alone could reap millions, yet there is no movement towards gains in this area. Why would they not do this? I wonder about this alot. Standardization lends itself to some forms of transparency.....if every company adhered to the same standard of methodology, it sure would be easier to devise metrics for performance which would invite some unkind comparisons perhaps. I dunno...I cant figure it out. There's a whole industry out there of HIS coders who would love to see some kind of standardization so the multiples upon multiples of platforms could be unified.
Why the fixation on margins? That's borderline irrelevant and is certainly not the only component of healthcare costs inflated by insurance. I keep trying to steer you towards other methods they can cause costs to increase, but you keep bringing the discussion back to this. I don't get it

Why? To me it seems that:

- need to be solvent and not being run out of business

- need to deliver profits

are good enough incentives.

But it seems that you believe that removing the incentive of the profit and just keeping the solvency one would result in a better overall incentive. That's extremely odd and that's why I want to know why do you think that way.

No, that's not what I'm saying at all. I swear, we are just talking right past each other.:lol Those are good enough incentives to insure quarterly bonuses. But you're going to have to show me where those incentives + better profits = lower premiums because I just don't think the correlation exists.

Uh, wouldn't the consumers be the same? I'm puzzled. What are you talking about? The consumers that you have now are the same consumers you'd have tomorrow.

No. The customers the VA have are not the same customers that United Healthcare has. Two completely different populations with completely different economic pictures.

Sorry, but you need to explain why would insurance companies employees be more likely to bargain for better deals if they didn't need to worry about the bottom line? This is a truly extraordinary claim - I've never seen it made before anywhere, probably because it's so far-fetched - so I'd like to see some sort of rationale supporting it.

Sorry, but you are either intentionally mis-stating my point or I'm simply failing to make it understandable. I never said they would be more likely to bargain for better deals if they weren't worried about the bottom line. That's absurd. My point is, if the bottom line wasn't mobile, then they would have an incentive to bargain. As it stands now, the bottom line can simply be moved higher and higher...ie the costs passed on to the consumer.
Non profits tend to operate with a static bottom line....

mogrovejo

03-01-2010, 05:06 PM

Generally both? Really? I'm not sure any meaningful efficiency gains have been made in the last decade anyway. As I tried to illustrate, the savings in standardization of forms and methodology alone could reap millions, yet there is no movement towards gains in this area. Why would they not do this? I wonder about this alot. Standardization lends itself to some forms of transparency.....if every company adhered to the same standard of methodology, it sure would be easier to devise metrics for performance which would invite some unkind comparisons perhaps. I dunno...I cant figure it out. There's a whole industry out there of HIS coders who would love to see some kind of standardization so the multiples upon multiples of platforms could be unified.
Why the fixation on margins? That's borderline irrelevant and is certainly not the only component of healthcare costs inflated by insurance. I keep trying to steer you towards other methods they can cause costs to increase, but you keep bringing the discussion back to this. I don't get it

You're confusing issues.

If no gains of efficiency have been made in the last few years, then there have been no gains to be passed on to the consumer.

If there were, they were passed on to the consumer and/or to the profit margin.

I'm not saying that efficiency gains were made; the issue was your statement that the for profit model fails because "It can drive efficiencies but without guarantee that they'll pass those along".

No, that's not what I'm saying at all. I swear, we are just talking right past each other.:lol Those are good enough incentives to insure quarterly bonuses. But you're going to have to show me where those incentives + better profits = lower premiums because I just don't think the correlation exists.

Uh? Do you care to explain how the incentives that work for every other market known to the mankind don't work in the health-care insurance markets?

No. The customers the VA have are not the same customers that United Healthcare has. Two completely different populations with completely different economic pictures.

I beg your pardon? What was your point bringing up VA then?

The consumers of the current for-profit insurers would be the same consumers if those companies weren't for-profit.

So, when you say something like "Perhaps due to the particular economic standing of their consumers?" is just nonsensical.

Sorry, but you are either intentionally mis-stating my point or I'm simply failing to make it understandable. I never said they would be more likely to bargain for better deals if they weren't worried about the bottom line. That's absurd.

Great. I never said you said that though (not worried about the bottom line?). I said you stated that they would be more prone to exercise their bargain power if they were non-profit companies. Unfortunately you seem completely unable to explain why.

My point is, if the bottom line wasn't mobile, then they would have an incentive to bargain. As it stands now, the bottom line can simply be moved higher and higher...ie the costs passed on to the consumer.
Non profits tend to operate with a static bottom line....

What exactly is a static bottom line and why would they have an incentive to bargain more in that case? I've never hard such an extraordinary line of reasoning.

mogrovejo

03-01-2010, 05:08 PM

If non-profits were more effective making efficiency gains then all you have to do is to allow non-profits to compete with for-profits: if your theory is true, that the formers will drive the laters out of the market rather quickly.

Winehole23

03-01-2010, 05:08 PM

That you've never heard of something is no proof against it, profe.

TeyshaBlue

03-01-2010, 05:15 PM

You're confusing issues.

If no gains of efficiency have been made in the last few years, then there have been no gains to be passed on to the consumer.

If there were, they were passed on to the consumer and/or to the profit margin.

I'm not saying that efficiency gains were made; the issue was your statement that the for profit model fails because "It can drive efficiencies but without guarantee that they'll pass those along".

Uh? Do you care to explain how the incentives that work for every other market known to the mankind don't work in the health-care insurance markets?

Insurance companies operate in a quasi-monopolistic mode. Not too many markets in which to make a comparison, are there?

I beg your pardon? What was your point bringing up VA then?

The consumers of the current for-profit insurers would be the same consumers if those companies weren't for-profit.

Don't be thick. In any contemporary discussion of a public option, there has also been a provision for private insurance. Where do you suppose the line of deliniation would form? Most likely income with those with lower or restricted incomes moving towards public option and those with cash sticking with a private plan.

So, when you say something like "Perhaps due to the particular economic standing of their consumers?" is just nonsensical.
No, it's not as explained above.

Great. I never said you said that though (not worried about the bottom line?). I said you stated that they would be more prone to exercise their bargain power if they were non-profit companies. Unfortunately you seem completely unable to explain why.

I've explained the concept multiple times. Inexplicably, you fail to recognize that.

What exactly is a static bottom line and why would they have an incentive to bargain more in that case? I've never hard such an extraordinary line of reasoning.

Ditto the above.

Look, you're not interested in a discussion. This is turning into some weird validation exercise. You've done nothing but refute without a single counter arguement. Fine....if you want to sit and pick apart a post, knock yourself out kid. When you're ready to propose a solution of your own, I'll be ready to listen.

ElNono

03-01-2010, 05:15 PM

Or the laters will adapt to offer a complementary service to the formers... which is not a theory really. You can see that in a lot of different parts of the economy. For example, the postal service.

mogrovejo

03-01-2010, 05:37 PM

Sure. What's next? A dissertation on the Geary-Khamis dollar?

I don't think you are - otherwise, why the reference to an Argentinian dentist?

Really? You go to jail if you don't purchase private insurance?
You need to keep up with the thread and what you post.No, if I don't pay for the public system they send me to jail. If I dont' pay for my private insurance, I just run a higher risk of dying sooner.

It works fine. It's not faultless, but the burden is on you to prove that in the vast majority of the cases it doesn't work. Furthermore, that you don't like or agree with what you personally deem functional service doesn't amount to failure.I've just posted an article that proves you're full of BS about the access to dental care.

Plus, I think you completely miss the point: I'm paying for it. If it's working and it doesn't work for me, than there's an easy solution: exempt me from paying for it. What's the problem? If it works so well, it shouldn't be a problem, there will be tons of people willing to be part of it and pay for it.

It's very easy to say "hey, my product is great, it works!" when you can force people to buy your stuff, isn't it?

Then you're completely unaware why people go bankrupt in this country with regards to healthcare spending.Quick question: how much money a middle-class American spends on health-care in health-care premiums+taxes during his life span?

In any case, you're confused. Even you admit I was responding to this:

Originally Posted by ElNono
No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.
What does this have to do with America? You probably just wanted to insert the dramatic anecdote, even though you can't prove that less people would be bankrupted or lifes would be saved with the system you propose.

No, we have a scam by insurance companies in the US. When people are old enough to require increased healthcare spending, they toss them to the public system. In the meantime, they collude to concentrate markets and keep premium prices up.No? No? Of course yes.

I repeat what I said: you have a mixed system in the US and the American government spends more in health care per capita than any other government, including the French or the Italian or whatever.

Your theory is odd considering that insurance companies don't really make extraordinary profits. I understand you have been listening to nothing but that narrative for years and you've grown accostumed to it, but sometimes facts are a real pain in the ass.

They can certainly do certain things a policeman does.So can I. Your point is? That we can have the government managing restaurants as well? Maybe low-cost restaurants that would complement the existent offer that prices out so many people? What about cars? Housing industry? Clothes? Supermarkets? Farms?

Defence and justice are services that only the state can provide due to the requirement of neutrality.

Again, are we doing away with taxes?
I hope that most of them are gone as soon as possible. The idea that "taxes already exist so let's spend some more" is too ridiculous to merit a discussion.

I didn't omit 'available' right next to 'offered'. You did.Available? I refer you to the britains looking for a dentist. Your idea that socialized health-care would prevent rationing is hilarious.

As long as you're part of the union, that's a 'domestic' car for all intents and purposes.

My wife is a registered nurse. That's how oblivious I am to that fact. :rolleyes
But that's another scam for another thread: The government backed student loans.

Do doctors in Europe have the standard of living of janitors or primary school teachers? It's rhetorical questions, BTW. I know the answer and you do too.

This is what you posted:

That's your argument? It reads a lot more like an unsubstantiated rant to me.Funny.

American doctor -> huge costs to be trained -> bigger salary to pay for aforementioned costs -> more costly health-care to the consumer
+
European doctor -> huge costs to be trained -> doesn't need a higher salary to pay for those costs -> less costly health-care to the consumer
=
OMG!! AMericans spend a lot more money than Europeans in health-care!!!111!

Yet, there are no free lunches. Somebody pays for those training costs for European doctors. The idea that if you hide costs they dissipate isn't a very good one. It only makes things less transparent and therefore less efficient.

This is my argument about the studies, btw. They only account for expenses directly related to health-care: the money that Europeans spend on education through taxation doesn't enter the calculation.

Of course doctors in Europe don't have the standard of living of primary school teachers - that's exactly my point. But do you want American doctors to have a lower standard of living then they currently have? If not, how exactly to you want to make them earn less? What do you mean by "domestic cars"? What's exactly your proposal? How exactly are you going to convince doctors to reduce their salaries and standard of living? Or is this just wishfull thinking?

Something to substantiate this please? I mean, I know people go to jail for evading taxes, but I also know people get tax exemptions/rebates under certain pressure conditions.It's very easy: calculate how much an average person spends on health-care, including mandatory tax payments, in Europe (hint: in some cases 1/5 of your earnings to go pay the health-care systems). Then try to figure out how many could have used that money to avoid bankruptcy.

mogrovejo

03-01-2010, 05:40 PM

Or the laters will adapt to offer a complementary service to the formers...

Why?

I mean, if the non-profit companies are more efficient and therefore able to offer better prices, why would we need the laters? They would simply disappear, the market would kill them because nobody would buy their services. I think this is absolutely obvious.

mogrovejo

03-01-2010, 05:43 PM

Insurance companies operate in a quasi-monopolistic mode. Not too many markets in which to make a comparison, are there?
Unfortunately there are plenty of monopolistic or quasi-monopolistic markets. But that's completely irrelevant for the discussion.

Don't be thick. In any contemporary discussion of a public option, there has also been a provision for private insurance. Where do you suppose the line of deliniation would form? Most likely income with those with lower or restricted incomes moving towards public option and those with cash sticking with a private plan.

No, it's not as explained above.

I've explained the concept multiple times. Inexplicably, you fail to recognize that.

Ditto the above.

Look, you're not interested in a discussion. This is turning into some weird validation exercise. You've done nothing but refute without a single counter arguement. Fine....if you want to sit and pick apart a post, knock yourself out kid. When you're ready to propose a solution of your own, I'll be ready to listen.

Okay, you are unable to explain why would non-profit health-insurance companies be more careful exercising their bargaining power than for-profit ones.

I'm not surprised; I strongly suspect you could win a Nobel prize if you were able to explain it, btw.

Winehole23

03-01-2010, 05:46 PM

I refer you to the britains looking for a dentist. The British, or Englishmen, we say in English. I'm tempted to say your bad English impairs your comprehension of others, but it's probably just your high-handed self-regard that keeps getting in the way.

You blame other posters when you don't understand something instead of acknowledging that there might be limits to your own knowledge. Telling.

mogrovejo

03-01-2010, 05:54 PM

One easy thing that people who sustain that a non-profit health-insured would be more efficient and drive prices down could do to prove they're right: get together and form one. If they are right, that non-profit insurer would offer the smallest prices on the market, causing for-profit companies to lower their premiums or to close doors.

I'm always appalled by the fact that people who know so much and are so sure about what works and what doesn't work aren't more willing to put their money when their mouth is.

ElNono

03-01-2010, 06:16 PM

I don't think you are - otherwise, why the reference to an Argentinian dentist?

Because Argentina has a mixed socialized-private system? Just as good an example as anywhere else. Don't forget we were talking about availability, not price.

No, if I don't pay for the public system they send me to jail.

Do you go to jail for not paying the private system?
You can keep moving the goalposts all you want, but the thread is there for everyone to see.

I've just posted an article that proves you're full of BS about the access to dental care.

Where?

Plus, I think you completely miss the point: I'm paying for it. If it's working and it doesn't work for me, than there's an easy solution: exempt me from paying for it. What's the problem? If it works so well, it shouldn't be a problem, there will be tons of people willing to be part of it and pay for it.

No, what you want is a cop-out. People don't get to micromanage what taxes are spent on. You get to vote for people that say how they're going to spend the money, period. The money is spent wether you like it or not, and wether you think it's useful or not.

It's very easy to say "hey, my product is great, it works!" when you can force people to buy your stuff, isn't it?

So now you claim it works because people are forced to but it?
Didn't you just say it doesn't work?
You need to make up your mind.

Quick question: how much money a middle-class American spends on health-care in health-care premiums+taxes during his life span?

Depends on the insurance the individual has.

In any case, you're confused. Even you admit I was responding to this:
What does this have to do with America? You probably just wanted to insert the dramatic anecdote, even though you can't prove that less people would be bankrupted or lifes would be saved with the system you propose.

If you understood what's not working on the American model, you would know what this have to do with America and why I specifically brought it up.
But you don't have to take my 'dramatic anecdote' at face value if you don't want to. Feel free to read all about it here (http://www.reuters.com/article/idUSTRE5530Y020090604?feedType=nl&feedName=ushealth1100).

No? No? Of course yes.

I repeat what I said: you have a mixed system in the US and the American government spends more in health care per capita than any other government, including the French or the Italian or whatever.

Please, we have nothing of the sort. You're way past being disingenuous here. Don't omit the fact that the public system does not compete with the private system. Furthermore, the public system shoulders the burden of taking care of those that have a higher requirement for service.

Your theory is odd considering that insurance companies don't really make extraordinary profits. I understand you have been listening to nothing but that narrative for years and you've grown accostumed to it, but sometimes facts are a real pain in the ass.

First of all, my 'theory' is no such thing. Plenty of countries implement different variations of it, and you know that quite well. And as long as there's a public option to compete with the private insurance companies, I really couldn't care less what their profits are.

So can I. Your point is? That we can have the government managing restaurants as well? Maybe low-cost restaurants that would complement the existent offer that prices out so many people? What about cars? Housing industry? Clothes? Supermarkets? Farms?

There's simply a lot of those you can do without. So, in my personal opinion, no, the government doesn't need to get in those markets.
That said, the government already DOES provide a safety net for those that cannot earn enough to purchase enough food for the entire family by means of food stamps.

Defence and justice are services that only the state can provide due to the requirement of neutrality.

Sure. That doesn't mean they cannot provide it for a lot less money.

I hope that most of them are gone as soon as possible. The idea that "taxes already exist so let's spend some more" is too ridiculous to merit a discussion.

I would recommend you sit while you wait. It will be a long wait indeed.

Available? I refer you to the britains looking for a dentist. Your idea that socialized health-care would prevent rationing is hilarious.

So you bring up ONE case, in ONE country with socialized medicine, and that has to be the standard?
I gave you an example of a country with socialized medicine that refutes your case, but you refuse to accept it.

Funny.

American doctor -> huge costs to be trained -> bigger salary to pay for aforementioned costs -> more costly health-care to the consumer
+
European doctor -> huge costs to be trained -> doesn't need a higher salary to pay for those costs -> less costly health-care to the consumer
=
OMG!! AMericans spend a lot more money than Europeans in health-care!!!111!

Yet, there are no free lunches. Somebody pays for those training costs for European doctors. The idea that if you hide costs they dissipate isn't a very good one. It only makes things less transparent and therefore less efficient.

This is my argument about the studies, btw. They only account for expenses directly related to health-care: the money that Europeans spend on education through taxation doesn't enter the calculation.

Perhaps the US should move more towards an European model for doctor's education then.

Of course doctors in Europe don't have the standard of living of primary school teachers - that's exactly my point. But do you want American doctors to have a lower standard of living then they currently have? If not, how exactly to you want to make them earn less? What do you mean by "domestic cars"? What's exactly your proposal? How exactly are you going to convince doctors to reduce their salaries and standard of living? Or is this just wishfull thinking?

I absolutely do. I rather see a doctor more interested in medicine than in it for the money. I don't want them to starve, or have the standard of living of janitors or primary school teachers, but sure. They would need to take a cut here too. And I'm also including myself having to pay more taxes also.

It's very easy: calculate how much an average person spends on health-care, including mandatory tax payments, in Europe (hint: in some cases 1/5 of your earnings to go pay the health-care systems). Then try to figure out how many could have used that money to avoid bankruptcy.

Strawman, again. That's an imaginary post-facto bankruptcy. Not a bankruptcy as a result of paying for healthcare.