Health Care Reform: Here We Go Again!

[Winehole23]

I'd rather laugh away at your ignorance. You know what they say ignorance is bliss. Afterall, I won't be the one on a waiting list.

Laughing at your ignorance of my point of view. I'm not in favor of healthcare reform as proposed, and you failed to notice I partially agreed with you upstream.

You're not much of a reader, are you?

[ElNono]

I am not fearmongering, but rather laying out a simple truth. Do you ever have to wait for an appointment and/or make one ahead of time? The AMA has already articulated the shortge of physicians we will have, and the need for more physicians due to the demand we will be seeing.

Depends. If it's specialized medicine I do. If it's your run of the mill cold, I go to a walk-in clinic and I'm normally seen within 15 minutes.

I do agree that Healthcare reform is needed. However, the way Congress is burdening only the wealthiest Americans with a surtax to pay for health care reform is socialistic. If all Americans want this reform, then all should have to pay a tax to cover their load. Would you like to pay 45% of your taxes for the rest of us?

I don't necessarily disagree with you in that there could be possibly better ways to pay for this. At least different ways that would be considered more 'fair'. But I also don't see you complaining about how much of your taxes go to bailout Wall Street executives. Or being wasted on inordinate military spending. The reality is that we're going to be taxed no matter what, so I would rather see some of that tax money go to provide a modi of health care and help drive some of the costs of healthcare down.

At least in Germany, everybody is required to pay into a medical insurance system. But, I would hardly call it the highest quality of healthcare available that's for sure. My friend's brother died because they misdiagnosed his cancer read. Moreover, I didn't get an epidural when delivering my fist child. I hardly call that state of the art health care.

The reason doctors are required to have malpractice insurance here in the US is because malpractice happens here too. But without serious tort reform that's also one of the biggest drivers of care cost.

I am talking about the wait lines you will see in the US.
When's the last time you went to see a DR? I went to my pediatrician a month ago, 3 hours! And that was after waiting a few days for an appointment. If you believe healthcare will only get better you are in for a disappointment.

One of the reasons for the lack of availability has to do with the current insurance system. At least two of my doctor clients simply do not see walk-in patients anymore and moved to only see patients under a personalized care program. They simply got fed up of fighting with insurance companies to get paid. I'm not really concerned about doctor's availability under a mixed program. If third world countries figured this stuff out a long time ago, I don't think it's going to be a problem for the US.

Your cost may go down a bit, but your quality of care will go down much more drastically. A vast and sweeping reform like this needs to take into account all participants. Obama's proposal hardly does that. He's trying to get it passed quickly without any open dialogue or transparent debates. As a result, it will be a partisan bill, and as written will destroy the greatest free choice health care system in the world.

I'm not against debate, but if it's only to stall and prevent any kind of reform happening, much like what happened under Clinton, then I would say pass it, and we'll tweak it as we go along. We need something to shake up the current system.

[ElNono]

Health care is never going to be cheap, so drop that fantasy world. Students don't go to school until their almost 30 and take out massive loans to get paid 40k a year. It is a very specialized field and it isn't surprising at all that medicine costs what it does. The problem is people want bleeding edge technology without the costs. Well, high tech plastics, electronics, $4 million dollar MRI machines and so forth have to get paid somehow. X-rays are so routine now, but they cost a fortune to maintain, use, and buy in the first place.

Healthcare costs worldwide are a lot cheaper than in the US. There's simply no denying that. And short of the niche of very high tech specialized medicine (which probably accounts for under 1% of total care, and it's here to stay since most insurance companies don't cover them anyways), the vast majority of doctor's visits don't involve any of that equipment.

The whole thing is a very tricky situation. Is health care even a vital need, or a luxury? We've doubled/tripled our life expectancy through expensive technology. Most animals get through the majority of their adulthood without needing health care. Can people? Protecting people from crime and fire is different than from disease. Crime can be stopped by underpaid and unskilled workers. Same with fire. Health? Not so much.

I think CERTAIN basic care is vital. I don't think the entire spectrum of healthcare necessarily is. I think there's some basic care everyone should have access to, and then the luxury items reserved for those that can afford them. And I don't even think the line that separates the two is necessarily a static line. I would also like to think that we've evolved enough to do better than your run of the mill animal. And I completely disagree that crime and fire can be stopped by unskilled workers. Otherwise, anybody could prevent a crime or stop a fire, and we would not need to call the cops or the firemen.
That said, medicine is probably the one that requires the most skill and training.

There is a wealth of issues at stake.

If the government has a stake in health care, do they have an implied right to restrict things like transfats, smoking, alcohol?

What are solutions to an industry with massive demand and little supply?

How do you draw the line between luxury and necessary health care? Dental cleanings? Cavities? What is considered cosmetic and what is necessary?

What is the cost?

Who bears the burden?

Is this even ethical?

Sure there are massive issues at stake. And everybody is going to have a different opinion about those issues. The question is wether we do something to shake up the elitist and expensive system we have, we just sit on our asses and do nothing about it.

[101A]

But I didn't pay more than the benefit available. I don't think you understood my example at all. Which would explain a lot.

I guarantee you I know what I am talking about.

You wrote:

This is how the last time I went to the dentist, he did x-rays and fixed 2 cavities and he charged the insurance $1250, of which he only got paid back $300.

Had you had the dentist submit a predetermination, you would have found out beforehand EXACTLY how much the insurance company was going to pay him (btw, HE is way out of line with his fees), and could have chosen to either pay his excessive price, or find another provider.

Or maybe, because you're such a prick, ANY dentist is going to nail it to you, having to spend 2 hours listening to your annoying ass in their chair and all.

[101A]

Here's what I don't get.

If you feel that way, do you also feel the same about police and fire departments? That it would be fair to pay for certain levels of coverage? I'm guessing now, but I'd like to hear your thoughts.

I'm not talking about "level" of coverage; I'm talking about price.

Do you have any doubt that Police and Firemen make more in the U.S. than they do in Mexico...they cost "more". El Nono is on record as wanting doctors to be regulated to accepting modest salaries on moral grounds; should police and firemen as well? (his comparison was with Mexico, or some S. American country, I think).

I'm already on record as saying that health care ought to be a right in a country as wealthy as ours - and by that I don't limit it to basic, or rudimentary procedures. People ought to have access to the best we have to offer; and those that provide it ought to be both rewarded and have financial incentive to develop and provide the best.

[101A]

Healthcare costs worldwide are a lot cheaper than in the US. There's simply no denying that. And short of the niche of very high tech specialized medicine (which probably accounts for under 1% of total care, and it's here to stay since most insurance companies don't cover them anyways), the vast majority of doctor's visits don't involve any of that equipment.

Bull . You have no idea what you are talking about. Damn near every insurance contract out there pays for EVERY procedure, drug or device, regardless of price, if it is approved by the FDA, and administered/prescribed by a licensed MD/DO.

[ElNono]

Had you had the dentist submit a predetermination, you would have found out beforehand EXACTLY how much the insurance company was going to pay him (btw, HE is way out of line with his fees), and could have chosen to either pay his excessive price, or find another provider.

As I already explained in this thread, I did shop around, and there was nothing under $800. This is the system we have right now.

Or maybe, because you're such a prick, ANY dentist is going to nail it to you, having to spend 2 hours listening to your annoying ass in their chair and all.

If not wanting to be ripped off makes me a prick, then so be it.
In the meantime, you can keep on getting anally raped in a chair while you smile thinking how well the current free market system works. I'm sure your dentist appreciates your business.

[ElNono]

Bull . You have no idea what you are talking about. Damn near every insurance contract out there pays for EVERY procedure, drug or device, regardless of price, if it is approved by the FDA, and administered/prescribed by a licensed MD/DO.

Sure as I do. My doctor prescribed Prevacid for me 4 months ago. The insurance company filled it for the first month and now refuses to keep on filling up the very same prescription. My doctor has been fighting with them for 3 months now, and I still don't have my medicine. My wife needs to take MetanX for her arthritis, which is prescription strength folic acid. Insurance won't pay for it because it's classified as 'vitamins'. But you can't buy it without a prescription. Out of pocket, here we go.

I'm really glad that you have a nice insurance plan. Not all of us are that lucky. For us, it's either this plan or being uninsured.

[101A]

As I already explained in this thread, I did shop around, and there was nothing under $800. This is the system we have right now.

Then you're lying about what you had done, or you have some really crappy insurance. The vast majority of plans limit charges to a "percentile" of an area's dentists going rates. Cheap plans limit to the 50th or 60th - meaning they will provide benefit for up to what 50 or 60% of dentists in an area charge. MOST plans pay at the 80th, and good ones pay at the 90th; meaning they are only cutting back charges on the most expensive 10% of dentists. There are several private companies in this country that payors (insurance companies) buy the billing data from.

If not wanting to be ripped off makes me a prick, then so be it.
In the meantime, you can keep on getting anally raped in a chair while you smile thinking how well the current free market system works. I'm sure your dentist appreciates your business.

My job is to make sure that not only I, but 20,000 other people specifically DO NOT get rip off their self-insured employers.

[ElNono]

Then you're lying about what you had done, or you have some really crappy insurance. The vast majority of plans limit charges to a "percentile" of an area's dentists going rates. Cheap plans limit to the 50th or 60th - meaning they will provide benefit for up to what 50 or 60% of dentists in an area charge. MOST plans pay at the 80th, and good ones pay at the 90th; meaning they are only cutting back charges on the most expensive 10% of dentists. There are several private companies in this country that payors (insurance companies) buy the billing data from.

Again, I think you're missing my point. Out of those $800 I would have had to pay $160, since my insurance covers 80%. The same exact procedure paid out of pocket where I grew up costs $30. Obviously, standards of living differ between here and there, but the difference is definitely not 266%. I would actually say that the actual cost of the procedure here is most likely the amount the insurance paid. But those prices are simply not available to those without insurance.

My job is to make sure that not only I, but 20,000 other people specifically DO NOT get rip off their self-insured employers.

[101A]

Sure as I do. My doctor prescribed Prevacid for me 4 months ago. The insurance company filled it for the first month and now refuses to keep on filling up the very same prescription. My doctor has been fighting with them for 3 months now, and I still don't have my medicine.

They might be asking the doc why you need the Rx drug, when there are OTC brands that do very similar, or the exact same thing. Believe me, this is one place where the govt. will be LESS flexible than even the insurance companies; wouldn't surprise me if drugs like Prevacid didn't disappear altogether.....try Pepsid, Zantac, etc, for your heartburn.....

My wife needs to take MetanX for her arthritis, which is prescription strength folic acid. Insurance won't pay for it because it's classified as 'vitamins'. But you can't buy it without a prescription. Out of pocket, here we go.

Metanx is NOT FDA approved for that - vitamins or not. And again, you blame the insurance, but remember what Obama is saying he wants to fight....out of control costs. Both things that are happening to you are because someone is trying to control costs. You think these things will improve when the govt. takes over? They'll get much, much worse.

I'm really glad that you have a nice insurance plan. Not all of us are that lucky. For us, it's either this plan or being uninsured.

I do understand that my understanding of the system makes all of this much easier for me - it is a confusing system, and people such as yourself are NOT treated with any care, usually, from any side of the equation (provider OR payor) - they are also both real good at blaming the other. I would recommend YOU call your insurance company on the Prevacid issue; chances are they are asking for some information that your doc. isn't providing - believe me, it costs them more to have an ongoing issue than to just pay the claim for a cheap Rx like that.

[Aggie Hoopsfan]

Sure as I do. My doctor prescribed Prevacid for me 4 months ago. The insurance company filled it for the first month and now refuses to keep on filling up the very same prescription. My doctor has been fighting with them for 3 months now, and I still don't have my medicine. My wife needs to take MetanX for her arthritis, which is prescription strength folic acid. Insurance won't pay for it because it's classified as 'vitamins'. But you can't buy it without a prescription. Out of pocket, here we go.

I'm really glad that you have a nice insurance plan. Not all of us are that lucky. For us, it's either this plan or being uninsured.

If you think your wait is long now, wait until ObamaCare...

[ElNono]

They might be asking the doc why you need the Rx drug, when there are OTC brands that do very similar, or the exact same thing. Believe me, this is one place where the govt. will be LESS flexible than even the insurance companies; wouldn't surprise me if drugs like Prevacid didn't disappear altogether.....try Pepsid, Zantac, etc, for your heartburn.....

I've tried them all. Even prescription ones. I'm actually fortunate enough that I make a living writing practice management software, including insurance claim processing, and I have direct access to the doctors. I've been using sample packs for the past 3 months. The status of my prescription is "In Review". It's been like that for the past 3 months. They have my entire clinical history on this matter, including the drugs I've tried. Prevacid actually does not have a generic, but it's rumored there will be one soon. I've called. My doctor called. They're still reviewing, and I still don't have my medicine. I guess if I keep busting their balls eventually they're going to give in. It just simply shouldn't be this hard.

Metanx is NOT FDA approved for that - vitamins or not. And again, you blame the insurance, but remember what Obama is saying he wants to fight....out of control costs. Both things that are happening to you are because someone is trying to control costs. You think these things will improve when the govt. takes over? They'll get much, much worse.

Don't get me wrong. I'm not 100% on the boat with the proposed plan. But I'm also way, way tired of the current system. I want SOMETHING done.

I do understand that my understanding of the system makes all of this much easier for me - it is a confusing system, and people such as yourself are NOT treated with any care, usually, from any side of the equation (provider OR payor) - they are also both real good at blaming the other. I would recommend YOU call your insurance company on the Prevacid issue; chances are they are asking for some information that your doc. isn't providing - believe me, it costs them more to have an ongoing issue than to just pay the claim for a cheap Rx like that.

I believe I understand the system pretty well. I understand that insurance companies fight to control costs, and increase their bottom line. That simply did not bring down the costs of health, or provide better access to it. That plan FAILED. Now it's time to try something else. I'm not saying it's necessarily what's being proposed, but we can definitely do better than what we have been doing, IMHO.

[Wild Cobra]

Actually, my point of contention is that free market is what got us in this hole.
Now, I don't necessarily think that a competing free insurance is the only answer, but I do see how it would drive costs down. It's either that or capping profits, IMHO.

I disagree. Maybe your area has a shortage of dentists. If that's the case, it's because government red tape has chased them out one way or another. More government will make things worse. Not better.

By the way, I am of the probably minority that thinks health care by and large, is a luxury good. People are spoiled

I think government should only bear the cost of emergency medicine. All routine check-ups, dentistry work, vision/hearing problems, fractures, disease should be paid by those who can afford it.

You know, where do you draw the line? Poverty is sad, the class gap is sad, but that's life. You can't artificially prop them up, it just doesn't work. Time and time again, government has tried to close this gap and failed every time. Like it or not, humans operate on capitalistc greed.

I agree with you. For how many millennium have people not had health care anywhere close to today's medicine? Our race has done rather well. Al;l nicities of life should be earned. Not given or taken for granted. They should be something that motivates people want to strive for, to better themselves, rather than be a burden on society.

[DarkReign]

So you know, ElNono, youre arguing with a guy who runs a medical claim company (correct me where thats wrong, 101). 101A does nothing alllllll day but deal with insurance companies in just about every facet of the medical field in America.

Instead of arguing, take the advice. What you say happened to you, I believe you. But 101 is giving you some pointers for future reference in order to avoid being...well, ed like you were before.

[ElNono]

So you know, ElNono, youre arguing with a guy who runs a medical claim company. 101A does nothing alllllll day but deal with insurance companies in just about every facet of the medical field in America.

I'm fully aware who I'm having a conversation with.

Instead of arguing, take the advice. What you say happened to you, I believe you. But 101 is giving you some pointers for future reference in order to avoid being...well, ed like you were before.

I do take his advice, which is appreciated. I also want to present him with a different perspective from somebody that lived 20+ years under a mixed system, and that it's been living for over 10 years under the US system.
My experience is that they both have their pro and cons. That's all.

[LnGrrrR]

I'm not talking about "level" of coverage; I'm talking about price.

Do you have any doubt that Police and Firemen make more in the U.S. than they do in Mexico...they cost "more". El Nono is on record as wanting doctors to be regulated to accepting modest salaries on moral grounds; should police and firemen as well? (his comparison was with Mexico, or some S. American country, I think).

I'm already on record as saying that health care ought to be a right in a country as wealthy as ours - and by that I don't limit it to basic, or rudimentary procedures. People ought to have access to the best we have to offer; and those that provide it ought to be both rewarded and have financial incentive to develop and provide the best.

101A, I'm sorry if I wasn't clear, but I wasn't asking rhetorically.

What I meant is... police and firefighters are often state government, right? As such, they probably have salaries.

Now, when they respond to an issue, they don't require that the people they protect pay a certain amount monthly on fire or police insurance, right?

It has always seemed to me that medics are as an essential part of a functioning society as police. After all, even tribes have medicine men, right? (Though they usually function as the religious person as well.

Anyways, I have no expertise in this, and am just asking for information/opinions.

[DarkReign]

I'm fully aware who I'm having a conversation with.

, my bad then.

[Spursmania]

Laughing at your ignorance of my point of view. I'm not in favor of healthcare reform as proposed, and you failed to notice I partially agreed with you upstream.

You're not much of a reader, are you?

Winehole, the reform, as proposed will have a devastating effect on many segments of the health care field but not all in effective or positive ways. I certainly believe insurance companies and pharmaceutical companies need to be reigned in more, so their policies are affordable and drugs are affordable.

However, this bill will kill Doctors. And, since MD"s make up a very small segment of society Obama doesn't care how drastically this bill affects doctors. First, the proposal will cut Doctor fees by 40%. This is called the "CMS fee changes". Secondly, only the so called wealthiest Americans will be paying a surtax 5.4% so the rest of America can have this health care reform. Is this fair? Where are people's own responsibilities for the reform? Everybody wants reform but no one wants to pay for it.

MD's already get killed with the medical malpractice fees the insurance companies charge. I don't see any reform that will control medical lawsuits? Tort reform is not enough.

These MD"s have gone through years and years of schooling, with college, medical school, internship, residency and then their specialty, if they choose to specialize, like my spouse. Hundreds of thousands spent on education, so they can provide the best healthcare Americans would want, and now they are getting screwed by this socialist bill.That is why I am calling Obama's reform a redistribution of wealth. A small amount of businesses and individuals, the so called "rich Americans" will be footing the bill for the rest of America's healthcare.

This bill should focus more on insurance industries and pharmaceuticals rather than biting the hand that feeds them-the Doctors. Most people are happy with their Doctors. Doctors are not the problem. This reform is a mess and only creates class warfare. This bill is astronomically expensive.
Those people and small businesses that have made it with their blood and sweat will now be paying for the rest of America health care, literally carrying them on their backs. This is not Capitalism, this is socialism at it's finest.

The economic stimulus package is hardly making a dent. Yet we passed the bill quickly because Obama thought the sky would fall if we didn't do it right away. It is not working. And, now the sky is falling again on healthcare. This plan doesn't even consult with the very people who will be providing the real healthcare-the Doctors. This is just a bunch of congressman guessing as to how they think a system should be run.

This bill will revolutionize health care and change the way you receive healthcare. Any bill that will cost 1.5 trillion dollars over ten years will definitely cost more than that. Since when has the government underspend?

Government run health care is the last thing people would want if they want quality. There are other options for reform, but without transparencies and real debates, this will be a partisan bill. And our children, and grandchildren will carry the load of our debt for generations to come. This is not what I want for them. I think we can do better.

[Spursmania]

This is the proposed health care chart. It is difficult to get directly to your Doctor without going through many bureaucratic loopholes. I'm trying to find a bigger chart.

[Spursmania]

Fear the chart. A day after House Democrats rolled out their plan for universal health care coverage, the GOP struck back hard on Wednesday with one of the toughest weapons in a politician's arsenal: a flowchart.

Via TPM's Brian Beutler comes this flowchart from the GOP. The message of this great big collection of lines, shapes, colors and boldface fonts? Health care reform legislation involves just too much government.













"If anybody thinks that all of this bureaucracy will fix our health-care system, I politely disagree," House Minority Leader John Boehner said of the chart to MSNBC. Trouble is, though, that very few of the agencies on the charts are ones that most Americans will ever have to interact with.

The president is on the chart. Every time I want a flu shot, I'm going to have to call Barack Obama first. And he's probably just going to want to keep me on the phone all day suggesting more exercise and asking if I'm getting a full eight hours of sleep.

The plan from House Democrats would cover 97 percent of Americans, cost $1 trillion over 10 years, according to the Congressional Budget Office; and offer individuals the option to participate in government-funded insurance. Rep. Kevin Brady (R-Texas), whose office generated the chart, may be remembering back to 1994 -- the last time health care reform legislation looked ready to roll through Congress -- when another scary-looking flowchart from then-Republican Sen. Arlen Specter did raise concerns that health care legislation was too complicated.

Acting under the maxim that the only way to fight charts is with charts, though, House Democrats have been passing around their own (also via TPM):














An even better counterpoint in this game of chart vs. chart, though, may be this one from the The New Republic explaining how our health care system currently works:

[Aggie Hoopsfan]

Stupid chart by the Dems.

The Republicans did offer a plan, but the Dems told them they didn't care because the Waxman plan is the one they are going with.

They also pretend that doing their kneecap job on the American health care industry is better than no reform at all, which is comical at best, criminal in reality.

The economic stimulus package is hardly making a dent. Yet we passed the bill quickly because Obama thought the sky would fall if we didn't do it right away. It is not working. And, now the sky is falling again on healthcare.

Obama didn't think that, that's just how he justified his political payback bill.

[Spursmania]

Stupid chart by the Dems.

The Republicans did offer a plan, but the Dems told them they didn't care because the Waxman plan is the one they are going with.

They also pretend that doing their kneecap job on the American health care industry is better than no reform at all, which is comical at best, criminal in reality.



Obama didn't think that, that's just how he justified his political payback bill.

And, what's up with Czar's he's created? Just more government and control I guess.

[Wild Cobra]

I didn't see Cap and Trade on the chart.

Aren't we going to cap how much care someone gets, and trade our unused benefits with others?

What about roll-over care?

[Winehole23]