Why do you want Health care Reform?

[Marcus Bryant]

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

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

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

[ElNono]

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

Well, these are just some numbers I found on the case of Texas specifically:
LINK
There's obviously disparage opinions about this. But at least this showed a critical point of view backed with actual statistics.

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

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

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

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

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

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

[ElNono]

I don't know how far they went.

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

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

No doubt.

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

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

[ElNono]

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

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

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

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

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

[Wild Cobra]

Well, these are just some numbers I found on the case of Texas specifically:
LINK

That's not very helpful.

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

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

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

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

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

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

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

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

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

No, they just know it's uncons utional.

[Marcus Bryant]

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

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

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

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

[ElNono]

That's not very helpful.

Do you have better statistics?

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

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

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

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

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

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

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

No, they just know it's uncons utional.

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

[ElNono]

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

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

Thanks.

[Trainwreck2100]

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

[Spursmania]

Well, these are just some numbers I found on the case of Texas specifically:
LINK
There's obviously disparage opinions about this. But at least this showed a critical point of view backed with actual statistics.

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

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

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

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

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

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

[LnGrrrR]

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

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

[Trainwreck2100]

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

you should be pissed off, if you have insurance

[ElNono]

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

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

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

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

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

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

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

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

[Wild Cobra]

Do you have better statistics?

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

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

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

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

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

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

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

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

[Spursmania]

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

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

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

[ElNono]

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

Ok.

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

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

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

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

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

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

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

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

[Wild Cobra]

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

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

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

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

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

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

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

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

[SnakeBoy]

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

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

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

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

[ElNono]

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

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

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

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

[Wild Cobra]

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

I agree. The doctor shouldn't have to be concerned with protecting his ass. He should be concerned with practicing the best medicine he can, and only get sued if he makes a monumental -up.

[SnakeBoy]

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

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

[ElNono]

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

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

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

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

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

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

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

Gotcha.

[ElNono]

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

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

[Wild Cobra]

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

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

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

[Wild Cobra]

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

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

Have a 10 year average for each industry by chance?